title: Evaluation of an overdose prevention and response training programme for injection drug users in the Skid Row area of Los Angeles, CA.
abstract: BACKGROUND
  Fatal opioid overdose is a significant cause of mortality among injection drug users (IDUs).
  
  
  METHODS
  We evaluated an overdose prevention and response training programme for IDUs run by a community-based organisation in Los Angeles, CA. During a 1-h training session participants learned skills to prevent, recognise, and respond to opioid overdoses, including: calling for emergency services, performing rescue breathing, and administering an intramuscular injection of naloxone (an opioid antagonist). Between September 2006 and January 2008, 93 IDUs were trained. Of those, 66 (71%) enrolled in the evaluation study and 47 participants (71%) completed an interview at baseline and 3-month follow-up.
  
  
  RESULTS
  Twenty-one percent of participants were female, 42% were white, 29% African American, and 18% Latino. Most were homeless or lived in temporary accommodation (73%). We found significant increases in knowledge about overdose, in particular about the use of naloxone. Twenty-two participants responded to 35 overdoses during the follow-up period. Twenty-six overdose victims recovered, four died, and the outcome of five cases was unknown. Response techniques included: staying with the victim (85%), administering naloxone (80%), providing rescue breathing (66%), and calling emergency services (60%). The average number of appropriate response techniques used by participants increased significantly from baseline to follow-up (p<0.05). Half (53%) of programme participants reported decreased drug use at follow-up.
  
  
  CONCLUSIONS
  Overdose prevention and response training programmes may be associated with improved overdose response behaviour, with few adverse consequences and some unforeseen benefits, such as reductions in personal drug use.
authors.affiliation: Institute for Health Promotion and Disease Prevention Research, Keck School of Medicine, University of Southern California, Alhambra, CA 91803, USA. kdwagner@usc.edu
authors.forename: Karla D
authors.initials: KD
authors.lastname: Wagner
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Valente
authors.forename: Mark
authors.initials: M
authors.lastname: Casanova
authors.forename: Susan M
authors.initials: SM
authors.lastname: Partovi
authors.forename: Brett M
authors.initials: BM
authors.lastname: Mendenhall
authors.forename: James H
authors.initials: JH
authors.lastname: Hundley
authors.forename: Mario
authors.initials: M
authors.lastname: Gonzalez
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Unger
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000506:poisoning*; D002140:California; D062787:Drug Overdose / Q000188:drug therapy / Q000517:prevention & control*; D004493:Education / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006703:Ill-Housed Persons / Q000193:education*; D006801:Humans; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000627:therapeutic use; D010353:Patient Education as Topic / Q000379:methods*; D015397:Program Evaluation; D015819:Substance Abuse, Intravenous / Q000401:mortality
chemical_list: D000701:Analgesics, Opioid; D009270:Naloxone