An Initial Evaluation of Web-Based Opioid Overdose Education

Virtual opioid poisoning education and naloxone distribution programs: A scoping review

The global opioid poisoning crisis is a complex issue with far-reaching public health implications. Opioid Poisoning Education and Naloxone Distribution (OPEND) programs aim to reduce stigma and promote harm reduction strategies, enhancing participants' ability to apply life-saving interventions, including naloxone administration and cardiopulmonary resuscitation (CPR) to opioid poisoning. While virtual OPEND programs have shown promise in improving knowledge about opioid poisoning response, their implementation and evaluation have been limited. The COVID-19 pandemic has sparked renewed interest in virtual health services, including OPEND programs. Our study reviews the literature on fully virtual OPEND programs worldwide. We analyzed 7,722 articles, 30 of which met our inclusion criteria. We extracted and synthesized information about the interventions' type, content, duration, the scales used, and key findings. Our search shows a diversity of interventions being implemented, with different study designs, duration, outcomes, scales, and different time points for measurement, all of which hinder a meaningful analysis of interventions' effectiveness. Despite this, virtual OPEND programs appear effective in increasing knowledge, confidence, and preparedness to respond to opioid poisoning while improving stigma regarding people who use opioids. This effect appears to be true in a wide variety of populations but is significantly relevant when focused on laypersons. Despite increasing efforts, access remains an issue, with most interventions addressing White people in urban areas. Our findings offer valuable insights for the design, implementation, and evaluation of future virtual OPEND programs.

Internet-Based Learning for Professionals in Addiction Psychiatry: A Scoping Review

BACKGROUND AND AIM

Distance learning techniques are gaining popularity as the internet today is a faster and more convenient source of spreading exhaustive information. We aim at conducting a scoping review on the utility of internet-based learning in addiction psychiatry.

METHODS

We performed a systematic search of databases such as Google Scholar, PubMed, and Cochrane using the following keywords: Distance education, substance related disorder, teaching, internet, along with the MeSH terms ("Internet" AND "Teaching" AND "Substance Related Disorders") OR ("Distance Education" AND "Substance Related Disorders"). The reference lists of articles were searched for other relevant literature.

RESULTS

A total of 34 studies were included. Most of the courses offered online were on specific therapies, for example, training on motivational interviewing, twelve-step facilitation, cognitive behavioral therapy, alcohol screening, and brief intervention. They were based on various aspects of distance learning such as the acquisition of knowledge or skills, feasibility, level of satisfaction of the trainees/students, the cost-effectiveness of the techniques, and the type of trainees who have access to the course. The majority of the studies showed positive findings in terms of the parameter being studied. However, the level of satisfaction among the students is questionable.

CONCLUSION

Internet-based teaching programs provide a good alternative to traditional educational methods in terms of effectiveness, feasibility, and acquisition of knowledge and skills. We emphasize the use of internet-based training in addiction psychiatry reinforced by actual practical experiences.

Randomized comparison of two web-based interventions on immediate and 30-day opioid overdose knowledge in three unique risk groups

BACKGROUND

In response to the opioid overdose epidemic, scalable interventions that instruct at-risk populations how to prevent and respond to overdose scenarios are needed.

METHOD

The following groups of at-risk individuals were recruited online: (1) Acute Pain patients with an opioid prescription, (2) Chronic Pain patients with an opioid prescription, and (3) persons without pain who use Illicit Opioids. Participants were tested on their opioid overdose knowledge using the Brief Opioid Overdose Knowledge (BOOK) questionnaire and randomized to one of two web-based interventions that contained 25 educational content slides. One intervention consisted of embedded questions with corrective feedback (Presentation + Mastery, n = 58), the other did not (Presentation, n = 61). Participants completed the BOOK again at the end of the intervention and 30 days later. Overdose risk behaviors were assessed at baseline and 30-days.

RESULTS

Relative to baseline, both Presentation and Presentation + Mastery interventions increased total BOOK scores immediately and 30 days later. There was a significant effect of Group on BOOK Knowledge, whereby those with Acute Pain had lower scores across time, regardless of intervention, relative to those with Chronic Pain and Illicit Opioid Use. Compared to baseline, all three groups reported fewer instances of using opioids alone or concurrently with alcohol at the 30-day follow-up.

CONCLUSIONS

A web-based intervention increased opioid overdose knowledge and decreased overdose risk behavior immediately and at a one-month follow-up, suggesting that this brief, practical, and scalable program could have utility in several populations who are at-risk of opioid overdose.

Implementation of Online Opioid Prevention, Recognition and Response Trainings for Laypeople: Year 1 Survey Results

BACKGROUND

This article reports on the first implementation of an online opioid-overdose prevention, recognition and response training for laypeople. The training was disseminated nationally in November 2014. Between 2000 and 2014, U.S. opioid deaths increased by 200%. The importance of complementary approaches to reduce opioid overdose deaths, such as online training, cannot be overstated.

OBJECTIVES

A retrospective evaluation was conducted to assess perceived knowledge, skills to intervene in an overdose, confidence to intervene, and satisfaction with the training.

MEASUREMENTS

Descriptive statistics were used to report sample characteristics, compare experiences with overdose and/or naloxone between subgroups, and describe participants' satisfaction with the trainings. Z-ratios were used to compare independent proportions, and paired t-tests were used to compare participant responses to items pre- and posttraining, including perceived confidence to intervene and perceived knowledge and skills to intervene successfully.

RESULTS

Between January and October 2015, 2,450 laypeople took the online training; 1,464 (59.8%) agreed to be contacted. Of these, 311 (21.2% of those contacted) completed the survey. Over 80% reported high satisfaction with content, format and mode of delivery and high satisfaction with items related to confidence and overdose reversal preparedness. Notably, 89.0% of participants felt they had the knowledge and skills to intervene successfully posttraining compared to 20.3% pretraining (z = -17.2, p <.001). Similarly, posttraining, 87.8% of participants felt confident they could successfully intervene compared to 24.4% pretraining (z = -15.9, p <.001).

CONCLUSIONS

This study demonstrates the effectiveness of the GetNaloxoneNow.org online training for laypeople.

Randomized controlled trial of a computerized opioid overdose education intervention

BACKGROUND

Opioid overdose (OD) has become a significant public health problem in need of effective interventions. The majority of existing educational interventions target provision of naloxone and are conducted in-person; these elements present logistical barriers that may limit wide-spread implementation. This study developed and evaluated an easily disseminated opioid OD educational intervention and compared computerized versus pamphlet delivery METHODS: Participants (N=76) undergoing opioid detoxification were randomly assigned to receive OD education via a Pamphlet (N=25), Computer (N=24), or Computer+Mastery (N=27) with identical content for all delivery modalities. Primary outcomes were changes from pre- to post-intervention in knowledge of opioid effects, opioid OD symptoms, and recommended opioid OD responses, as well as intervention acceptability. Also assessed at 1 and 3-month follow-ups were retention of knowledge and change in reported OD risk behaviors.

RESULTS

Knowledge increased following all three intervention-delivery modalities with few between-group differences observed in knowledge gain or acceptability ratings. Largest gains were in the domain of opioid OD response (from 41.8% to 73.8% mean correct responses; p<0.001). Knowledge was well sustained at the 1 and 3-month follow-ups among completers, where a significant reduction was seen in the critical behavioral risk factor of using opioids while alone.

CONCLUSION

Opioid overdose education delivered by computer or written pamphlet produced sustained increases in knowledge and reduction in a key behavioral risk factor.

RESULTS

Results support further evaluation of this educational intervention that can be used alone or to complement naloxone-training programs.