title: Overdose training and take-home naloxone for opiate users: prospective cohort study of impact on knowledge and attitudes and subsequent management of overdoses.
abstract: OBJECTIVE
  To examine the impact of training in overdose management and naloxone provision on the knowledge and confidence of current opiate users; and to record subsequent management of overdoses that occur during a 3-month follow-up period.
  
  
  METHODS
  Repeated-measures design to examine changes in knowledge and confidence immediately after overdose management training; retention of knowledge and confidence at 3 months; and prospective cohort study design to document actual interventions applied at post-training overdose situations.
  
  
  METHODS
  A total of 239 opiate users in treatment completed a pre-training questionnaire on overdose management and naloxone administration and were re-assessed immediately post-training, at which point they were provided with the take-home emergency supply of naloxone. Three months later they were re-interviewed.
  
  
  RESULTS
  Significant improvements were seen in knowledge of risks of overdose, characteristics of overdose and appropriate actions to be taken; and in confidence in the administration of naloxone. A 78% follow-up rate was achieved (186 of 239) among whom knowledge of both the risks and physical/behavioural characteristics of overdose and also of recommended management actions was well retained. Eighteen overdoses (either experienced or witnessed) had occurred during the 3 months between the training and the follow-up. Naloxone was used on 12 occasions (a trained client's own supply on 10 occasions). One death occurred in one of the six overdoses where naloxone was not used. Where naloxone was used, all 12 resulted in successful reversal.
  
  
  CONCLUSIONS
  With overdose management training, opiate users can be trained to execute appropriate actions to assist the successful reversal of potentially fatal overdose. Wider provision may reduce drug-related deaths further. Future studies should examine whether public policy of wider overdose management training and naloxone provision could reduce the extent of opiate overdose fatalities, particularly at times of recognized increased risk.
authors.affiliation: National Addiction Centre (Institute of Psychiatry/The Maudsley), Addiction Sciences Building, Denmark Hill, London, UK. j.strang@iop.kcl.ac.uk
authors.forename: John
authors.initials: J
authors.lastname: Strang
authors.forename: Victoria
authors.initials: V
authors.lastname: Manning
authors.forename: Soraya
authors.initials: S
authors.lastname: Mayet
authors.forename: David
authors.initials: D
authors.lastname: Best
authors.forename: Emily
authors.initials: E
authors.lastname: Titherington
authors.forename: Laura
authors.initials: L
authors.lastname: Santana
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Offor
authors.forename: Claudia
authors.initials: C
authors.lastname: Semmler
mesh_terms: D000328:Adult; D062787:Drug Overdose / Q000188:drug therapy / Q000401:mortality; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009294:Narcotics / Q000506:poisoning*; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D011314:Preventive Health Services / Q000592:standards; D015397:Program Evaluation; D011446:Prospective Studies
chemical_list: D009292:Narcotic Antagonists; D009294:Narcotics; D009270:Naloxone