Feasibility of paying people who use drugs cash to distribute naloxone within their networks

INTRODUCTION

Immediate access to naloxone is needed to prevent fatal opioid-related overdoses in the presence of fentanyl analogs saturating the opioid supply. Peer models engage impacted populations who are not accessing naloxone through standard venues, yet compensating peers who utilize syringe service programs with cash stipends to distribute naloxone within networks of people who use drugs is not well described.

METHODS

As part of the HEALing Communities Study, syringe service program-based interventions were developed in Holyoke and Gloucester, MA, which paid people who use drugs ("peers") cash to distribute naloxone. Early program outcomes were evaluated for the time each program was funded within the HCS study period.

RESULTS

During 22 study-months of observation, peers in two communities distributed 1104 naloxone kits. The total cost of peer compensation for program delivery was $10,510. The rate of peer-distributed naloxone per 100 K population reached 109 kits/mo and 222 kits/mo in the two communities. Participating peers addressed gaps in harm reduction outreach and distributed naloxone and other harm reduction equipment to individuals who were not syringe service program participants, expanding organizational reach. Being compensated with unrestricted cash stipends supported dignity and acknowledged peers' work in overdose prevention.

CONCLUSION

The underutilization of compensated peer models is often attributed to funding and organizational barriers. These programs demonstrate that providing cash stipends to peers is feasible and expanded naloxone distribution at two existing syringe service programs. Providing cash stipends for peers who engage in secondary naloxone distribution offers promise in delivering naloxone to people not accessing syringe services.

Cardiac arrhythmia and betel nut chewing--is there a causal effect?

Betel nuts are widely ingested in many countries, including Taiwan. They stimulate various autonomic and CNS reactions, but there have been no reports of cardiac toxicity. We treated 2 patients with cardiac dysrhythmias thought due to betel nut chewing. In case 1, a 44-y-old previously healthy male presented with chest tightness, dyspnea, diaphoresis and palpitation immediately after chewing 1 betel quid. He soon became breathless and died despite immediate cardiopulmonary resuscitation. In Case 2, a 28-y-old man suffered palpitations, epigastralgia, and chest distress following consumption of 4 betel quid. Paroxysmal supraventricular tachycardia was noted and terminated by repeated verapamil administration. The pharmacological properties of betel nuts and the time sequence of these cases raise the possibility of betel nut-induced cardiac dysrhythmias. The number of betel nut chewers in Taiwan continues to increase, suggesting there may be other cases of betel nut-related cardiac toxicities in the future.

Results of femoral lengthening using the Ilizarov technique

We report the results of 36 femoral lengthenings in 30 consecutive patients using the Ilizarov technique. Patient age at surgery in 19 boys and 11 girls averaged 13.4 years (range, 5-18). Minimum follow-up was 2 years. The etiology of femoral shortening was congenital in 21 femora and acquired in 15. Twelve femora underwent concomitant correction of associated angular deformities during treatment. The average lengthening was 8.3 cm (range, 3.5-12 cm) with a treatment time of 6.4 months (range, 2.5-12). The mean number of surgeries per patient was 2.3, including apparatus application and removal. Lengthening index (months of treatment/centimeter lengthening) was 0.74. Complications included premature consolidation in four patients, malunion of > 10 degrees in two patients, and residual limb length inequality (< 2 cm) in two. There were two instances of knee subluxation [corrected]. No osteomyelitis, ring sequestra, neurologic or vascular compromise, compartment syndrome, hypertension, or hip or knee dislocations occurred. Psychological problems necessitated cessation of lengthening in two patients. These results show a significant improvement over previous reports of earlier techniques of femoral lengthening in terms of greater lengthening, simultaneous deformity correction, and fewer major complications.

A needs assessment strategy for educational planning

Increasing public concern regarding the quality and cost of health care, present economic conditions, employee expectations for participative management, and increasing awareness of career opportunities have mandated that the occupational therapy manager base education and training needs on objective and validated data. The needs assessment strategy is a technique that can be used to identify training needs, match these needs to organizational goals and resources, and allow for employee participation. Several assessment methods are discussed and a report format is suggested. A report of assessed needs, subsequent training, and positive outcomes resulting from training could be included in the departmental quality assurance report, as well as in the yearly managerial plan. Since using this strategy, the author's department has been granted a substantial increase in monies for education and training.