title: Brief overdose education is sufficient for naloxone distribution to opioid users.
abstract: BACKGROUND
  While drug users are frequently equipped with naloxone for lay opioid overdose reversal, the amount of education needed to ensure knowledge of indications and administration is unknown.
  
  
  METHODS
  We administered four instruments, assessing comfort and knowledge around opioid overdose and naloxone administration, to opioid users receiving naloxone for the first time (N=60) and upon returning for a refill (N=54) at community distribution programs. Participants completed the instruments prior to receiving naloxone; first-time recipients repeated the instruments immediately after the standardized 5-10min education.
  
  
  RESULTS
  Comfort with recognition of, response to, and administration of naloxone for an overdose event significantly increased after brief education among first-time recipients (p<0.05). Knowledge of appropriate responses to opioid overdose was high across all assessments; 96% of participants could identify at least one acceptable action to assess and one acceptable action to care for an opioid overdose. Facility with naloxone administration was high across all assessments and significantly increased for intranasal administration after education for first-time recipients (p<0.001). First-time recipients (before and after education) and refillers demonstrated a high level of knowledge on the Brief Overdose Recognition and Response Assessment, correctly identifying a mean of 13.7 out of 16 overdose scenarios.
  
  
  CONCLUSIONS
  Opioid users seeking naloxone in San Francisco have a high level of baseline knowledge around recognizing and responding to opioid overdose and those returning for refills retain that knowledge. Brief education is sufficient to improve comfort and facility in recognizing and managing overdose.
authors.affiliation: San Francisco Department of Public Health, Substance Use Research Unit, San Francisco, CA, USA. Electronic address: Emily.behar@sfdph.org.
authors.forename: Emily
authors.initials: E
authors.lastname: Behar
authors.affiliation: San Francisco Department of Public Health, Substance Use Research Unit, San Francisco, CA, USA; University of California San Francisco, San Francisco, CA, USA.
authors.forename: Glenn-Milo
authors.initials: GM
authors.lastname: Santos
authors.affiliation: Harm Reduction Coalition, Oakland, CA, USA.
authors.forename: Eliza
authors.initials: E
authors.lastname: Wheeler
authors.affiliation: San Francisco Department of Public Health, Substance Use Research Unit, San Francisco, CA, USA; University of California Berkeley, Berkeley, CA, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Rowe
authors.affiliation: San Francisco Department of Public Health, Substance Use Research Unit, San Francisco, CA, USA; University of California San Francisco, San Francisco, CA, USA.
authors.forename: Phillip O
authors.initials: PO
authors.lastname: Coffin
mesh_terms: D000328:Adult; D062787:Drug Overdose / Q000188:drug therapy / Q000517:prevention & control*; D055030:Drug Users / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D010353:Patient Education as Topic / Q000379:methods*; D012495:San Francisco / Q000453:epidemiology
chemical_list: D009292:Narcotic Antagonists; D009270:Naloxone
keywords: Naloxone; Opioid overdose; Opioid safety; Overdose prevention; Syringe access program