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Agley J, Henderson C, Seo DC, Parker M, Golzarri-Arroyo L, Dickinson S, Tidd D. The Feasibility of Using the National PulsePoint Cardiopulmonary Resuscitation Responder Network to Facilitate Overdose Education and Naloxone Distribution: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e57280. [PMID: 38551636 PMCID: PMC11015366 DOI: 10.2196/57280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 02/27/2024] [Accepted: 03/04/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND The use of naloxone, an opioid antagonist, is a critical component of the US response to fatal opioid-involved overdoses. The importance and utility of naloxone in preventing fatal overdoses have been widely declaimed by medical associations and government officials and are supported by strong research evidence. Still, there are gaps in the current US national strategy because many opioid-involved overdose fatalities have no evidence of naloxone administration. Improving the likelihood that naloxone will be used to prevent fatal overdoses is predicated on facilitating an environment wherein naloxone is available near each overdose and can be accessed by someone who is willing and able to use it. How to accomplish this on a national scale has been unclear. However, there exists a national network of >1 million cardiopulmonary resuscitation (CPR) layperson responders and 4800 emergency responder agencies linked through a mobile phone app called PulsePoint Respond. PulsePoint responders certify that they are trained to administer CPR and are willing to respond to possible cardiac events in public. When such an event occurs near their mobile phone's location, they receive an alert to respond. These motivated citizens are ideally positioned to carry naloxone and reverse overdoses that occur in public. OBJECTIVE This randomized controlled trial will examine the feasibility of recruiting first responder agencies and layperson CPR responders who already use PulsePoint to obtain overdose education and carry naloxone. METHODS This will be a 3-arm parallel-group randomized controlled trial. We will randomly select 180 first responder agencies from the population of agencies contracting with the PulsePoint Foundation. The 3 study arms will include a standard recruitment arm, a misperception-correction recruitment arm, and a control arm (1:1:1 allocation, with random allocation stratified by zip code designation [rural or nonrural]). We will study agency recruitment and, among the agencies we successfully recruit, responder certification of receiving overdose and naloxone education, carrying naloxone, or both. Hypothesis 1 contrasts agency recruitment success between arms 1 and 2, and hypothesis 2 contrasts the ratios of layperson certification across all 3 arms. The primary analyses will be a logistic regression comparing the recruitment rates among the arms, adjusting for rural or nonrural zip code designation. RESULTS This study was reviewed by the Indiana University Institutional Review Board (20218 and 20219). This project was funded beginning September 14, 2023, by the National Institute on Drug Abuse. CONCLUSIONS The hypotheses in this study will test whether a specific type of messaging is particularly effective in recruiting agencies and layperson responders. Although we hypothesize that arm 2 will outperform the other arms, our intention is to use the best-performing approach in the next phase of this study if any of our approaches demonstrates feasibility. TRIAL REGISTRATION OSF Registries osf.io/egn3z; https://osf.io/egn3z. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/57280.
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Affiliation(s)
- Jon Agley
- Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, Bloomington, IN, United States
| | - Cris Henderson
- Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, Bloomington, IN, United States
| | - Dong-Chul Seo
- Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, Bloomington, IN, United States
| | - Maria Parker
- Department of Epidemiology and Biostatistics, School of Public Health Bloomington, Indiana University Bloomington, Bloomington, IN, United States
| | - Lilian Golzarri-Arroyo
- Biostatistics Consulting Center, School of Public Health Bloomington, Indiana University Bloomington, Bloomington, IN, United States
| | - Stephanie Dickinson
- Biostatistics Consulting Center, School of Public Health Bloomington, Indiana University Bloomington, Bloomington, IN, United States
| | - David Tidd
- Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, Bloomington, IN, United States
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Holmes LM, Rishworth A, King BH. Disparities in opioid overdose survival and naloxone administration in Pennsylvania. Drug Alcohol Depend 2022; 238:109555. [PMID: 35810621 DOI: 10.1016/j.drugalcdep.2022.109555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Pennsylvania has one of the highest opioid overdose rates in the US; however, since 2018 approximately 80% of people who experienced an opioid overdose in the state survived. More attention has been paid to opioid overdose mortality despite notable individual and geographic differences in overdose survival. Naloxone is an essential tool in increasing chances of survival after opioid overdose, but its availability and the rate at which it is administered differs by county in Pennsylvania and nationally. METHODS We use 2018-2020 Pennsylvania Overdose Information Network data on opioid incidents and where they occurred, combined with 2015-2019 American Community Survey data, to evaluate opioid overdose survival and naloxone administration by county over a three-year period. RESULTS Individuals who received at least one dose of naloxone following overdose had 11 times greater odds of survival. White, middle-aged men were least likely to survive opioid overdose. Both survival and naloxone administration rates differed by county with lower rates in less populated counties. CONCLUSION Expanding naloxone distribution and administration and ensuring proper education about standing orders for naloxone administration are important tools for addressing opioid overdose mortality.
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Affiliation(s)
- Louisa M Holmes
- The Pennsylvania State University, Department of Geography, University Park, PA 16802, USA.
| | - Andrea Rishworth
- University of Toronto Mississauga, Department of Geography, Geomatics and Environment, Mississauga, ON L5L 1C6, Canada
| | - Brian H King
- The Pennsylvania State University, Department of Geography, University Park, PA 16802, USA
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Fentanyl epidemic hits the U.S. West Coast: Opioid-related deaths in San Francisco from 2009-2019. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 95:103402. [PMID: 34364179 DOI: 10.1016/j.drugpo.2021.103402] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 07/01/2021] [Accepted: 07/20/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Opioid-use disorders have led to a nationwide epidemic of accidental overdoses in the United States. In recent years this opioid epidemic has worsened due to the increased availability of fentanyl in the illicit drug market. The increase in fentanyl-related deaths is well known on the U.S. East Coast, however, limited comprehensive information of mortality data exists from major West Coast cities. METHODS Following comprehensive medico-legal death and toxicological investigations, a retrospective cohort study was performed on all accidental opioid overdose deaths (AOOD) from 2009 - 2019 in San Francisco. The sex, age and race of decedents, location, and date and time of death were described and statistically compared by the type of opioid(s) causing death. RESULTS Since 2016, fentanyl deaths started to replace heroin deaths leading to a sharp increase in fatal overdoses involving fentanyl, surpassing heroin and/or medicinal opioids by 2018. Fentanyl contributed to between 3% and 12% of deaths per year from 2009 to 2015, and between 20% and 73% per year from 2016 to 2019. White and Black males represented 91.5% of all AOOD. Age groups younger than 45 died using fentanyl and heroin significantly more often than older populations (60.7% of ≤45 vs. 40.7% of >45 year-olds, χ2p<0.001). CONCLUSIONS This study shows an upward trend in fentanyl fatal accidental overdoses in recent years in a major West Coast U.S. city. These patterns appear to follow patterns seen in eastern states, albeit with an approximate 3-year delay, and may be indicative of other western populations. The described observations provide detailed demographic, chronological and toxicological information to public health and policy-making agencies for drug harm reduction measures.
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Riazi F, Toribio W, Irani E, Hughes TM, Huxley-Reicher Z, McBratney E, Vu T, Sigel K, Weiss JJ. Community Case Study of Naloxone Distribution by Hospital-Based Harm Reduction Program for People Who Use Drugs in New York City. FRONTIERS IN SOCIOLOGY 2021; 6:619683. [PMID: 34307540 PMCID: PMC8292929 DOI: 10.3389/fsoc.2021.619683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 06/03/2021] [Indexed: 05/04/2023]
Abstract
Background: In 2017, The Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program at Mount Sinai Hospital became a registered Opioid Overdose Prevention Program (OOPP) and received funding from the New York City Department of Health and Mental Hygiene to develop a program to provide overdose education and naloxone distribution (OEND) training to at risk population and bystanders. We report on the programmatic quality improvement initiatives conducted. Methods: From April 2017 to December 2020, the REACH OOPP conducted 290 opioid overdose reversal trainings, throughout the Mount Sinai Health System and in multiple other community settings. OEND training was at times offered alone and in other settings alongside Hepatitis C Virus point of care testing. Additionally, a "train the trainer" model was implemented whereby medical students and nurses at outpatient clinics were trained to train others. Results: There were 4235 naloxone kits distributed to 3,906 participants. The training venues included hospital settings (patients and medical staff), public events, substance use programs, educational facilities, homeless prevention programs, faith-based organizations, alternative to incarceration programs, and community-based organizations. We implemented two types of training. During outreach sessions, we utilized one-on-one personalized sessions to train bystanders. When training clinic staff in the "train the trainer" model we utilized a standardized didactic presentation with slides. The two top reasons participants reported for being trained were "Just in case I see someone overdose" (59.3%) and "I'm worried that someone I know will overdose OR that I will overdose" (20.2%). Conclusion: The REACH program at Mount Sinai Hospital developed an effective model to train community bystanders and health care staff by leveraging administrative support and building on broader programmatic initiatives to promote drug user health and stigma-free care for people who use drugs. Hospitals do not currently mandate staff training or keeping naloxone stocked at inpatient units or outpatients clinics posing a challenge when implementing an OEND program in this setting. A recommended policy change needed to decrease overdose deaths is for hospitals to be required to implement systematic naloxone education and access for all health care personal and at risk patients.
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Affiliation(s)
- Farah Riazi
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Wilma Toribio
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Emaun Irani
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Terence M. Hughes
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Elisa McBratney
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Trang Vu
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Keith Sigel
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jeffrey J. Weiss
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Moore PQ, Cheema N, Celmins LE, Patel A, Follman S, Soni H, Szwak JA, Pho MT, Carter K, Arora VM. Point-of-care naloxone distribution in the emergency department: A pilot study. Am J Health Syst Pharm 2021; 78:360-366. [PMID: 33555343 PMCID: PMC10893849 DOI: 10.1093/ajhp/zxaa409] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Opioid overdose education and naloxone distribution (OEND) for use by laypersons has been shown to be safe and effective, but implementation in the emergency department (ED) setting is challenging. Recent literature has shown a discouragingly low rate of obtainment of naloxone that is prescribed in the ED setting. We conducted a study to evaluate the feasibility of point-of-care (POC) distribution of naloxone in an ED, hypothesizing a rate of obtainment higher than prescription fill rates reported in previous studies. SUMMARY A multidisciplinary team of experts, including pharmacists, physicians, nurses, and case management professionals used an iterative process to develop a protocol for POC OEND in the ED. The protocol includes 5 steps: (1) patient screening, (2) order placement in the electronic health record (EHR), (3) a patient training video, (4) dispensing of naloxone kit, and (5) written discharge instructions. The naloxone kits were assembled, labeled to meet requirements for a prescription, and stored in an automated dispensing cabinet. Two pharmacists, 30 attending physicians, 65 resident physicians, and 108 nurses were trained. In 8 months, 134 orders for take-home naloxone were entered and 117 naloxone kits were dispensed, resulting in an obtainment rate of 87.3%. The indication for take-home naloxone kit was heroin use for 61 patients (92.4%). CONCLUSION POC naloxone distribution is feasible and yielded a rate of obtainment significantly higher than previous studies in which naloxone was prescribed. POC distribution can be replicated at other hospitals with low rates of obtainment.
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Affiliation(s)
- P Quincy Moore
- Section of Emergency Medicine, Pritzker School of Medicine, University of Chicago Medicine, Chicago, IL
| | - Navneet Cheema
- Section of Emergency Medicine, Pritzker School of Medicine, University of Chicago Medicine, Chicago, IL
| | - Laura E Celmins
- Department of Pharmacy, University of Chicago Medicine, Chicago, IL
| | - Alisha Patel
- Department of Pharmacy, University of Chicago Medicine, Chicago, IL
| | - Sarah Follman
- Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Hailey Soni
- Department of Pharmacy, University of Chicago Medicine, Chicago, IL
| | | | - Mai T Pho
- Section of Infectious Diseases and Global Health, Pritzker School of Medicine, University of Chicago Medicine, Chicago, IL
| | - Keme Carter
- Section of Emergency Medicine, Pritzker School of Medicine, University of Chicago Medicine, Chicago, IL
| | - Vineet M Arora
- Pritzker School of Medicine, University of Chicago Medicine, Chicago, IL
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Nath JM, Scharf B, Stolbach A, Tang N, Jenkins JL, Margolis A, Levy MJ. A Longitudinal Analysis of a Law Enforcement Intranasal Naloxone Training Program. Cureus 2020; 12:e11312. [PMID: 33282588 PMCID: PMC7714746 DOI: 10.7759/cureus.11312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION The opioid crisis continues to claim lives at historically unprecedented levels and shows few signs of abating. One means of mitigating the harm from opioid abuse and unintentional overdose is training and equipping police officers to administer intranasal (IN) naloxone as part of a broader public health response. While an increasing number of state and local agencies have implemented law enforcement officer (LEO) naloxone training programs, due to the novelty of these programs, the evidence of program efficacy is limited. This study describes the implementation and evaluation of a LEO training program in opioid overdose recognition, management, and administration of IN naloxone. METHODS This evaluation consisted of a secondary analysis of de-identified administrative quality assurance data. Police officers in Howard County, Maryland (n=281) underwent an IN naloxone training program between June and July 2015. The training program entailed a 30-minute online component, a 45-minute in-service session, and a 15-question post-test (n=228). The success of the training program was evaluated via an opioid overdose knowledge survey administered at 30 days (n=207) and 6 months (n=182) after training. RESULTS The 30-day and 6-month scores for all knowledge outcomes indicated that officers retained the contents of the training program well over time. After six months, 100% of respondents correctly identified the physiological effects of naloxone administration, and 95.6% correctly identified the opioid-containing drugs that may result in overdose. At the six-month mark, 74.59% correctly identified the initial signs of opioid overdose, and 60.99% correctly identified the time required for IN to begin working. CONCLUSION LEOs exhibit the ability to retain the contents of IN training over 30-day and 6-month periods and express confidence in their ability to assist suspected opioid overdose victims. Further research is necessary to determine the degree to which further knowledge decay might occur, the sustained ability to implement this knowledge under real-world conditions, and the subsequent effects on overdose victim survival.
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Affiliation(s)
- Jennifer M Nath
- Emergency Medicine, Upstate University Hospital, Syracuse, USA
| | - Becca Scharf
- Office of the Medical Director, Howard County Department of Fire and Rescue Services, Marriottsville, USA.,Emergency Health Services, University of Maryland, Baltimore County, Baltimore, USA
| | - Andrew Stolbach
- Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Nelson Tang
- Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - J Lee Jenkins
- Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.,Emergency Health Services, University of Maryland, Baltimore County, Baltimore, USA
| | - Asa Margolis
- Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, USA
| | - Matthew J Levy
- Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.,Office of the Medical Director, Howard County Department of Fire and Rescue Services, Mariottsville, USA
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Glober NK, Hern G, McBride O, Mercer MP. Variations in the California Emergency Medical Services Response to Opioid Use Disorder. West J Emerg Med 2020; 21:671-676. [PMID: 32421518 PMCID: PMC7234694 DOI: 10.5811/westjem.2019.12.45189] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/08/2019] [Indexed: 01/24/2023] Open
Abstract
Introduction Opioids contributed to over 300,000 deaths in the United States in the past 10 years. Most research on drug use occurs in clinics or hospitals; few studies have evaluated the impact of opioid use on emergency medical services (EMS) or the EMS response to opioid use disorder (OUD). This study describes the perceived burden of disease, data collection, and interventions in California local EMS agencies (LEMSA). Methods We surveyed medical directors of all 33 California LEMSAs with 25 multiple-choice and free-answer questions. Results were collected in RedCap and downloaded into Excel (Microsoft Corporation, Redmond WA). This study was exempt from review by the Alameda Health System - Highland Hospital Institutional Review Board. Results Of the 33 California LEMSAs, 100% responded, all indicating that OUD significantly affects their patients. Most (91%) had specific protocols directing care of those patients and repeat naloxone dosing. After naloxone administration, none permitted release to law enforcement custody, 6% permitted patient refusal of care, and 45% directed base hospital contact for refusal of care. Few protocols directed screening or treatment of OUD or withdrawal symptoms. Regular data collection occurred in 76% of LEMSAs, with only 48% linking EMS data with hospital or coroner outcomes. In only 30% did the medical director oversee regular quality improvement meetings. Of respondents, 64% were aware of public health agency-based outreach programs and 42% were aware of emergency department BRIDGE programs (Medication Assisted Treatment and immediate referral). Only 9% oversaw naloxone kit distribution (all under the medical director), and 6% had EMS-based outreach programs. In almost all (94%), law enforcement officers carried naloxone and administered it anywhere from a few times a year to greater than 200 in one LEMSA. Conclusion This study represents an important description of EMS medical directors’ approaches to the impact of OUD as well as trends in protocols and interventions to treat and prevent overdoses. Through this study, we can better understand the variable response to patients with OUD across California.
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Affiliation(s)
- Nancy K Glober
- Indiana University, Department of Emergency Medicine, Indianapolis, Indiana
| | - Gene Hern
- Alameda Health System-Highland Hospital, Department of Emergency Medicine, Oakland, California
| | - Owen McBride
- Alameda Health System-Highland Hospital, Department of Emergency Medicine, Oakland, California
| | - Mary P Mercer
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
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Jozaghi E. The Opioid Epidemic: Task-Shifting in Health Care and the Case for Access to Harm Reduction for People Who Use Drugs. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2020; 52:261-268. [PMID: 32268811 DOI: 10.1177/0020731420914820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We are sadly experiencing unprecedented levels of overdose mortalities attributed to the increased availability of synthetic opioids in illegal markets. While the majority of attention in North America has focused on preventing drug overdose cases through the distribution and administration of naloxone, in addition to stricter regulations of opioid prescriptions and greater law enforcement in illegal markets, little attention has been given to other alternative models and treatments for people who use drugs that are tailored specifically to the health care needs of this marginalized population. Through this analysis, the implications of task-shifting in health care via the distribution of naloxone for an already marginalized population are discussed. Alternatively, the role of pioneering harm-reduction programs - such as supervised injection/consumption sites, a variety of opioids maintenance therapies, and social-structural interventions - are highlighted as crucial interventions in the current ongoing opioid crisis. Moreover, people with lived experiences of illegal drug use are discussed as having a pivotal role but being ultimately overshadowed by public health partners.
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Affiliation(s)
- Ehsan Jozaghi
- The School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Hargraves D, White CC, Mauger MR, Puthota A, Pallerla H, Wigle P, Brubaker SL, Schlaudecker JD. Evaluation of an interprofessional naloxone didactic and skills session with medical residents and physician assistant learners. Pharm Pract (Granada) 2019; 17:1591. [PMID: 31592036 PMCID: PMC6763304 DOI: 10.18549/pharmpract.2019.3.1591] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 09/01/2019] [Indexed: 11/14/2022] Open
Abstract
Background The CDC has reported 399,230 opioid-related deaths from 1999-2017. In 2018, the US surgeon general issued a public health advisory, advising all Americans to carry naloxone. Studies show that enhanced naloxone access directly reduces death from opioid overdose. Despite this, health care professional learners report low knowledge and confidence surrounding naloxone. Therefore, it becomes critical that medical education programs incorporate didactic and experiential sessions improving knowledge, skills and attitudes regarding harm reduction through naloxone. Objectives 1. Describe the components and evaluation of a replicable and adaptable naloxone didactic and skills session model for medical providers; 2. Report the results of the evaluation from a pilot session with family medicine residents and physician assistant students; and 3. Share the session toolkit, including evaluation surveys and list of materials used. Methods In July 2017, a literature search was completed for naloxone skill training examining best practices on instruction and evaluation. A training session for family medicine residents and physician assistant learners was designed and led by University of Cincinnati College of Medicine and College of Pharmacy faculty. The same faculty designed a pre and post session evaluation form through internal review on elements targeting naloxone knowledge, attitude, and self-efficacy. Results The training session included one hour for a didactic and one hour for small group live skills demonstration in four methods of naloxone administration (syringe and ampule, nasal atomizer, branded nasal spray and auto injector). Forty-eight participants showed statistically significant (p<0.05) improvement in knowledge (67.5% to 95.9%), attitudes (71.2% to 91.2%), and self-efficacy (62.1% to 97.8%) from pre to post assessment. Forty-four of 48 participants agreed that the pace of the training was appropriate and that the information will be of use in their respective primary care practices. Supply costs for the session were USD 1,200, with the majority being reusable on subsequent trainings. Conclusions Our study of a naloxone didactic and skills session for primary care trainees demonstrated significant improvements in knowledge, self-efficacy, and attitudes. It provides an adaptable and efficient model for delivery of knowledge and skills in naloxone administration training. The pilot data suggest that the training was efficacious.
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Affiliation(s)
- Daniel Hargraves
- Department of Family & Community Medicine, College of Medicine, University of Cincinnati. Cincinnati, OH (United States).
| | - Christopher C White
- Associate Professor of Family & Community Medicine. College of Medicine, University of Cincinnati. Cincinnati, OH (United States).
| | - Marcia R Mauger
- College of Medicine, University of Cincinnati. Cincinnati, OH (United States).
| | - Aruna Puthota
- The Christ Hospital; & Family Medicine Residency Program, University of Cincinnati. Cincinnati, OH (United States).
| | - Harini Pallerla
- Department of Family & Community Medicine, College of Medicine, University of Cincinnati. Cincinnati, OH (United States).
| | - Patricia Wigle
- James L. Winkle College of Pharmacy, University of Cincinnati. Cincinnati, OH (United States).
| | - Sarah L Brubaker
- Program Coordinator, Department of Family & Community Medicine, College of Medicine, University of Cincinnati. Cincinnati, OH (United States).
| | - Jeffrey D Schlaudecker
- Associate Professor of Family & Community Medicine, College of Medicine, University of Cincinnati. Cincinnati, OH (United States).
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Darracq MA, Lee J, Wilson T, Lasoff D, Armenian P. Pharmacist dispensed naloxone: Knowledge, availability, participation and cost in selected California counties. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 71:113-117. [PMID: 31301549 DOI: 10.1016/j.drugpo.2019.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 03/21/2019] [Accepted: 06/05/2019] [Indexed: 11/24/2022]
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Verdier M, Routsolias JC, Aks SE. Naloxone prescriptions from the emergency department: An initiative in evolution. Am J Emerg Med 2019; 37:164-165. [DOI: 10.1016/j.ajem.2018.05.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/15/2018] [Accepted: 05/21/2018] [Indexed: 11/29/2022] Open
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Naloxone access among an urban population of opioid users. Am J Emerg Med 2018; 36:2126-2127. [DOI: 10.1016/j.ajem.2018.03.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/23/2018] [Accepted: 03/23/2018] [Indexed: 12/28/2022] Open
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Simmons J, Rajan S, Goldsamt LA, Elliott L. Implementation of Online Opioid Prevention, Recognition and Response Trainings for Laypeople: Year 1 Survey Results. Subst Use Misuse 2018; 53:1997-2002. [PMID: 29641944 PMCID: PMC6240473 DOI: 10.1080/10826084.2018.1451891] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
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.
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Affiliation(s)
- Janie Simmons
- a National Development and Research Institutes , New York , New York , USA
| | - Sonali Rajan
- b Department of Health and Behavior Studies , Teacher's College, Columbia University , New York , New York , USA
| | - Lloyd A Goldsamt
- c Meyers College of Nursing, New York University , New York , New York , USA
| | - Luther Elliott
- a National Development and Research Institutes , New York , New York , USA
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Latkin CA, Edwards C, Davey-Rothwell MA, Yang C, Tobin KE. The relationship between drug use settings, roles in the drug economy, and witnessing a drug overdose in Baltimore, Maryland. Subst Abus 2018; 39:384-389. [PMID: 29432084 DOI: 10.1080/08897077.2018.1439801] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND There has been a dramatic increase in drug overdose deaths in the United States. In the current study, the authors examined factors associated with witnessing a drug overdose. METHODS A sample of 450 substance users in Baltimore, Maryland, were recruited for a behavioral intervention and were administered a survey. Multinomial logistic regression models were used to compare participants who never witnessed a drug overdose with those who witnessed one in the prior 6 months and those who witnessed an overdose over 6 months ago. RESULTS Most (58%) participants were male, 40% experienced homelessness in the prior 6 months, 63% reported a history of heroin injecting, 84% had snorted heroin, 75% reported witnessing a drug overdose, and 38% experienced an overdose. In multinomial logistic regression models, witnessing an overdose in the past 6 months was associated with number of different types of places where drugs were used (adjusted odds ratio [aOR] = 1.34), history of experiencing an overdose (aOR = 1.80), injecting heroin and/or speedball (aOR = 1.78), and snorting heroin (aOR = 1.54). Witnessing an overdose more than 6 months ago was associated with number of different places where drugs were used (aOR = 1.25), history of experiencing an overdose (aOR = 1.61), snorting heroin (aOR = 1.42), and injecting heroin or speedball (aOR = 1.47). CONCLUSIONS These data suggest that people who engage in more public and frequent drug use, and hence are more likely to witness an overdose, should be targeted for interventions to prevent and treat drug overdose.
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Affiliation(s)
- Carl A Latkin
- a Department of Health , Behavior, and Society, Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Catie Edwards
- a Department of Health , Behavior, and Society, Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Melissa A Davey-Rothwell
- a Department of Health , Behavior, and Society, Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Cui Yang
- a Department of Health , Behavior, and Society, Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Karin E Tobin
- a Department of Health , Behavior, and Society, Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
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Emergency department naloxone rescue kit dispensing and patient follow-up. Am J Emerg Med 2017; 36:1503-1504. [PMID: 29237542 DOI: 10.1016/j.ajem.2017.12.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 12/07/2017] [Indexed: 11/24/2022] Open
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Factors associated with naloxone administration in an opioid dependent sample. J Subst Abuse Treat 2017; 84:17-20. [PMID: 29195589 DOI: 10.1016/j.jsat.2017.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 10/10/2017] [Accepted: 10/16/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Naloxone is a safe and effective antidote for reversing opioid overdose. Layperson administration of naloxone is increasingly common, yet little is known about demographic and clinical factors associated with opioid users' likelihood of having administered naloxone to another opioid user who had overdosed. We examined predictors of reported naloxone administration in the past year. METHODS Four hundred and sixty-eight patients were interviewed upon admission to brief, inpatient opioid detoxification between May and December of 2015. Between group differences were tested using t-tests for differences in means and χ2-tests for differences in counts. RESULTS Participants averaged 32years of age, 28.9% were female, and 86.8% were White. Most (86.8%) reported detoxifying from heroin, 69.0% had injected drugs in the last 30days. One sixth (n=68) of those detoxifying from heroin, but none of those detoxifying from other opioids (n=62) had administered naloxone in the past year. Among the small number of Black/African American participants (n=20), none had administered naloxone, although 90% were heroin users. Respondents were more likely to have administered naloxone if they reported recent injection drug use (IDU), had a history of overdose, or witnessed an overdose in the past year (ps<0.05), even though less than one-third of bystanders of overdose reported administering naloxone. CONCLUSIONS Higher opioid-related mortality risk (heroin use, IDU, past overdose) was associated with greater likelihood of reported naloxone administration in the past year. The non-use of naloxone among certain groups-prescription pill users and Blacks-was unexpected.
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Chhabra N, Aks SE. Current Opiate and Opioid Hazards in Children and Adolescents. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2017. [DOI: 10.1016/j.cpem.2017.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Devries J, Rafie S, Polston G. Implementing an overdose education and naloxone distribution program in a health system. J Am Pharm Assoc (2003) 2017; 57:S154-S160. [DOI: 10.1016/j.japh.2017.01.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 01/05/2017] [Accepted: 01/08/2017] [Indexed: 02/08/2023]
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Das S, Shah N, Ghadiali M. Intravenous use of intranasal naloxone: A case of overdose reversal. Subst Abus 2016; 38:18-21. [DOI: 10.1080/08897077.2016.1267686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Smita Das
- Department of Addiction Psychiatry, University of California San Francisco, San Francisco, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
- San Francisco VA Medical Center, San Francisco, California, USA
| | - Nina Shah
- Chemical Dependency Recovery Program, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | - Murtuza Ghadiali
- Department of Addiction Psychiatry, University of California San Francisco, San Francisco, California, USA
- Department of Addiction Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
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Stolbach AI, Nelson LS. Choosing Opioid Policies Our Patients Can Live With. Acad Emerg Med 2016; 23:1290-1292. [PMID: 27343859 DOI: 10.1111/acem.13040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Andrew I. Stolbach
- Department of Emergency Medicine; Johns Hopkins University; Baltimore MD
| | - Lewis S. Nelson
- Ronald O. Perelman Department of Emergency Medicine; New York University School of Medicine; New York City Poison Control Center; New York NY
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Lewis DA, Park JN, Vail L, Sine M, Welsh C, Sherman SG. Evaluation of the Overdose Education and Naloxone Distribution Program of the Baltimore Student Harm Reduction Coalition. Am J Public Health 2016; 106:1243-6. [PMID: 27077351 PMCID: PMC4984772 DOI: 10.2105/ajph.2016.303141] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2016] [Indexed: 11/04/2022]
Abstract
Although historically the majority of overdose education and naloxone distribution (OEND) programs have targeted opioid users, states are increasingly passing laws that enable third-party prescriptions of naloxone to individuals who may be able to respond to an overdose, including friends and family members of individuals who use opioids. In this report, we discuss the Baltimore Student Harm Reduction Coalition (BSHRC) OEND program, Maryland's first community-based, state-authorized training program under a new law allowing third-party naloxone prescription. In an 8-month pilot period, 250 free naloxone kits were distributed, and 3 overdose reversals were reported to BSHRC. Trainings were effective in increasing self-efficacy surrounding overdose prevention and response, which appears to persist at up to 12 months following the training.
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Affiliation(s)
- Dinah A Lewis
- Dinah A. Lewis and Laura Vail are with the Johns Hopkins School of Medicine, Baltimore, MD. Ju Nyeong Park and Susan G. Sherman are with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore. Mark Sine is with the Baltimore Student Harm Reduction Coalition, Baltimore. Christopher Welsh is with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore
| | - Ju Nyeong Park
- Dinah A. Lewis and Laura Vail are with the Johns Hopkins School of Medicine, Baltimore, MD. Ju Nyeong Park and Susan G. Sherman are with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore. Mark Sine is with the Baltimore Student Harm Reduction Coalition, Baltimore. Christopher Welsh is with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore
| | - Laura Vail
- Dinah A. Lewis and Laura Vail are with the Johns Hopkins School of Medicine, Baltimore, MD. Ju Nyeong Park and Susan G. Sherman are with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore. Mark Sine is with the Baltimore Student Harm Reduction Coalition, Baltimore. Christopher Welsh is with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore
| | - Mark Sine
- Dinah A. Lewis and Laura Vail are with the Johns Hopkins School of Medicine, Baltimore, MD. Ju Nyeong Park and Susan G. Sherman are with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore. Mark Sine is with the Baltimore Student Harm Reduction Coalition, Baltimore. Christopher Welsh is with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore
| | - Christopher Welsh
- Dinah A. Lewis and Laura Vail are with the Johns Hopkins School of Medicine, Baltimore, MD. Ju Nyeong Park and Susan G. Sherman are with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore. Mark Sine is with the Baltimore Student Harm Reduction Coalition, Baltimore. Christopher Welsh is with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore
| | - Susan G Sherman
- Dinah A. Lewis and Laura Vail are with the Johns Hopkins School of Medicine, Baltimore, MD. Ju Nyeong Park and Susan G. Sherman are with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore. Mark Sine is with the Baltimore Student Harm Reduction Coalition, Baltimore. Christopher Welsh is with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore
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An Initial evaluation of law enforcement overdose training in Rhode Island. Drug Alcohol Depend 2016; 162:211-8. [PMID: 27020323 DOI: 10.1016/j.drugalcdep.2016.03.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 03/10/2016] [Accepted: 03/14/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To assess initial change in knowledge, self-efficacy, and anticipated behaviors among Rhode Island law enforcement officers on drug overdose response and prevention. METHODS Law enforcement officers (N=316) voluntarily completed a pre-post evaluation immediately before and after taking part in overdose prevention and response trainings. Assessment items included measures of knowledge (Brief Overdose Recognition and Response Assessment (BORRA)), self-efficacy, attitudes toward drugs and overdose prevention, awareness of the Good Samaritan Law, and open-ended items pertaining to overdose knowledge and response behaviors. Non-parametric tests measured within-group and between-group differences. Wilcoxon Signed Rank tests and Kruskal-Wallis tests evaluated changes in BORRA scores and self-efficacy items. McNemar's tests assessed changes regarding the Good Samaritan law and open-ended items. Wilcoxon Signed Rank tests measured post-training change in attitudes. RESULTS Law enforcement officers demonstrated statistically significant improvements in self-efficacy (identifying signs of opioid overdose, naloxone indication, counseling witnesses in overdose prevention, and referring witnesses for more information), overdose identification knowledge (BORRA mean increased from 7.00 to 10.39), naloxone administration knowledge (BORRA mean increased from 10.15 to 12.59), Good Samaritan Law awareness (17.9% increase after training), and anticipated behaviors in response to future observed overdose (65.7% changed from passive to active response post training). CONCLUSIONS Harm reduction programs can provide law enforcement officers with the knowledge and skills necessary to intervene and reduce overdose mortality. Given the statistically significant improvements in self-efficacy, attitudinal changes, and Good Samaritan law awareness, law enforcement officers are more prepared to actively interact with drug users during a drug-involved emergency.
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Alqurshi A, Kumar Z, McDonald R, Strang J, Buanz A, Ahmed S, Allen E, Cameron P, Rickard JA, Sandhu V, Holt C, Stansfield R, Taylor D, Forbes B, Royall PG. Amorphous Formulation and in Vitro Performance Testing of Instantly Disintegrating Buccal Tablets for the Emergency Delivery of Naloxone. Mol Pharm 2016; 13:1688-98. [DOI: 10.1021/acs.molpharmaceut.6b00096] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Abdulmalik Alqurshi
- Institute of Pharmaceutical Science, King’s College London, Franklin-Wilkins Building, 150 Stamford Street, London, U.K., SE1
9NH
| | - Zahrae Kumar
- Institute of Pharmaceutical Science, King’s College London, Franklin-Wilkins Building, 150 Stamford Street, London, U.K., SE1
9NH
| | - Rebecca McDonald
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London (National Addiction Centre), Addictions Sciences Building, 4 Windsor Walk, Denmark Hill, London, U.K., SE5 8BB
| | - John Strang
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London (National Addiction Centre), Addictions Sciences Building, 4 Windsor Walk, Denmark Hill, London, U.K., SE5 8BB
| | - Asma Buanz
- UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London, U.K., WC1N 1AX
| | - Shagufta Ahmed
- Quintiles Ltd, Quintiles Drug Research Unit at Guy’s Hospital, 6 Newcomen Street London, U.K., SE1 1YR
| | - Elizabeth Allen
- Quintiles Ltd, Quintiles Drug Research Unit at Guy’s Hospital, 6 Newcomen Street London, U.K., SE1 1YR
| | - Peter Cameron
- Guy’s and St Thomas’ NHS Foundation Trust Pharmacy
Manufacturing Unit, Guy’s Hospital, Great Maze Pond, London, U.K., SE1 9RT
| | - James A. Rickard
- Guy’s and St Thomas’ NHS Foundation Trust Pharmacy
Manufacturing Unit, Guy’s Hospital, Great Maze Pond, London, U.K., SE1 9RT
| | - Verity Sandhu
- Guy’s and St Thomas’ NHS Foundation Trust Pharmacy
Manufacturing Unit, Guy’s Hospital, Great Maze Pond, London, U.K., SE1 9RT
| | - Chris Holt
- Guy’s and St Thomas’ NHS Foundation Trust Pharmacy
Manufacturing Unit, Guy’s Hospital, Great Maze Pond, London, U.K., SE1 9RT
| | - Rebecca Stansfield
- Guy’s and St Thomas’ NHS Foundation Trust Pharmacy
Manufacturing Unit, Guy’s Hospital, Great Maze Pond, London, U.K., SE1 9RT
| | - David Taylor
- Institute of Pharmaceutical Science, King’s College London, Franklin-Wilkins Building, 150 Stamford Street, London, U.K., SE1
9NH
| | - Ben Forbes
- Institute of Pharmaceutical Science, King’s College London, Franklin-Wilkins Building, 150 Stamford Street, London, U.K., SE1
9NH
| | - Paul G. Royall
- Institute of Pharmaceutical Science, King’s College London, Franklin-Wilkins Building, 150 Stamford Street, London, U.K., SE1
9NH
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Young MM, Dubeau C, Corazza O. Detecting a signal in the noise: monitoring the global spread of novel psychoactive substances using media and other open-source information. Hum Psychopharmacol 2015. [PMID: 26216568 PMCID: PMC4584493 DOI: 10.1002/hup.2477] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine the feasibility and utility of using media reports and other open-source information collected by the Global Public Health Intelligence Network (GPHIN), an event-based surveillance system operated by the Public Health Agency of Canada, to rapidly detect clusters of adverse drug events associated with 'novel psychoactive substances' (NPS) at the international level. METHODS AND RESULTS Researchers searched English media reports collected by the GPHIN between 1997 and 2013 for references to synthetic cannabinoids. They screened the resulting reports for relevance and content (i.e., reports of morbidity and arrest), plotted and compared with other available indicators (e.g., US poison control center exposures). The pattern of results from the analysis of GPHIN reports resembled the pattern seen from the other indicators. CONCLUSIONS The results of this study indicate that using media and other open-source information can help monitor the presence, usage, local policy, law enforcement responses, and spread of NPS in a rapid effective way. Further, modifying GPHIN to actively track NPS would be relatively inexpensive to implement and would be highly complementary to current national and international monitoring efforts.
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Affiliation(s)
- Matthew M Young
- Senior Research and Policy Analyst, Canadian Centre on Substance AbuseOttawa, Ontario, Canada,Adjunct Research Professor, Department of Psychology, Carleton UniversityOttawa, Ontario, Canada,*Correspondence to: M. M. Young, Senior Research and Policy Analyst, 500–75 rue Albert Street, Ottawa, Ontario, K1P 5E7, Canada. Tel: 613-235-4048 x 222; Fax 613-235-8101 E-mail:
| | - Chad Dubeau
- Information Specialist, Canadian Centre on Substance AbuseOttawa, Ontario, Canada
| | - Ornella Corazza
- School of Life and Medical Sciences, University of HertfordshireHatfield, UK
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Smith SW, Farmer BM. Toxicology in the Service of Patient and Medication Safety: a Selected Glance at Past and Present Innovations. J Med Toxicol 2015; 11:245-52. [PMID: 25804670 PMCID: PMC4469728 DOI: 10.1007/s13181-015-0470-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Medical and medication errors remain definite threats to patients in US health care. Medical toxicologists frequently encounter patients either harmed by or at risk for harm from adverse drug events, including medication errors and inadvertent exposures. An historical perspective, as viewed through the lens of specific disciplines, can be useful to trace systemic responses to safety threats. Early efforts to address anesthesia perioperative risks and recent actions in medicine, surgery, and obstetrics to introduce checklists, communication tools, and systems approaches are reviewed. Patient safety concepts can be utilized and disseminated by toxicologists to improve medication safety and drive innovative approaches to confront patient harm. Various approaches include simulation of high-risk scenarios which might predispose to medication error, assembling multidisciplinary groups of health care providers to review events and implement mitigation strategies, and proactive patient safety rounds in clinical areas to allow frontline staff to voice concerns and introduce solutions for administration, evaluation, and implementation. We review selected lessons from the past and current innovations to achieve safe medication practice.
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Affiliation(s)
- Silas W Smith
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, 462 First Avenue, Room A345-A, New York, NY, 10016, USA,
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