title: Overdose rescues by trained and untrained participants and change in opioid use among substance-using participants in overdose education and naloxone distribution programs: a retrospective cohort study.
abstract: BACKGROUND
  One approach to preventing opioid overdose, a leading cause of premature, preventable mortality, is to provide overdose education and naloxone distribution (OEND). Two outstanding issues for OEND implementation include 1) the dissemination of OEND training from trained to untrained community members; and 2) the concern that OEND provides active substance users with a false sense of security resulting in increased opioid use.
  
  
  METHODS
  To compare overdose rescue behaviors between trained and untrained rescuers among people reporting naloxone rescue kit use; and determine whether heroin use changed after OEND, we conducted a retrospective cohort study among substance users in the Massachusetts OEND program from 2006 to 2010. We used chi square and t-test statistics to compare the differences in overdose management characteristics among overdoses managed by trained versus untrained participants. We employed Wilcoxon signed rank test to compare median difference among two repeated measures of substance use among participants with drug use information collected more than once.
  
  
  RESULTS
  Among 4,926 substance-using participants, 295 trained and 78 untrained participants reported one or more rescues, resulting in 599 rescue reports. We found no statistically significant differences in help-seeking (p = 0.41), rescue breathing (p = 0.54), staying with the victim (p = 0.84) or in the success of naloxone administration (p = 0.69) by trained versus untrained rescuers. We identified 325 OEND participants who had drug use information collected more than once. We found no significant overall change in the number of days using heroin in past 30 days (decreased 38%, increased 35%, did not change 27%, p = 0.52).
  
  
  CONCLUSIONS
  Among 4926 substance users who participated in OEND, 373(7.6%) reported administering naloxone during an overdose rescue. We found few differences in behavior between trained and untrained overdose rescuers. Prospective studies will be needed to determine the optimal level of training and whether naloxone rescue kits can meet an over-the-counter standard. With no clear evidence of increased heroin use, this concern should not impede expansion of OEND programs or policies that support them.
authors.forename: Maya
authors.initials: M
authors.lastname: Doe-Simkins
authors.forename: Emily
authors.initials: E
authors.lastname: Quinn
authors.forename: Ziming
authors.initials: Z
authors.lastname: Xuan
authors.forename: Amy
authors.initials: A
authors.lastname: Sorensen-Alawad
authors.forename: Holly
authors.initials: H
authors.lastname: Hackman
authors.forename: Al
authors.initials: A
authors.lastname: Ozonoff
authors.affiliation: Clinical Addiction Research Education Unit, Section of General Internal Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, Second Floor, Boston, MA 02118, USA. awalley@bu.edu.
authors.forename: Alexander Y
authors.initials: AY
authors.lastname: Walley
mesh_terms: D000328:Adult; D062787:Drug Overdose / Q000188:drug therapy* / Q000209:etiology; D055030:Drug Users; D005260:Female; D006266:Health Education; D006282:Health Personnel; D003932:Heroin / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000150:complications*; D012119:Respiration; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D009292:Narcotic Antagonists; D009270:Naloxone; D003932:Heroin