title: Patient perspectives on an opioid overdose education and naloxone distribution program in the U.S. Department of Veterans Affairs.
abstract: BACKGROUND
  In an effort to prevent opioid overdose mortality among Veterans, Department of Veterans Affairs (VA) facilities began implementing opioid overdose education and naloxone distribution (OEND) in 2013 and a national program began in 2014. VA is the first national health care system to implement OEND. The goal of this study is to examine patient perceptions of OEND training and naloxone kits.
  
  
  METHODS
  Four focus groups were conducted between December 2014 and February 2015 with 21 patients trained in OEND. Participants were recruited from a VA residential facility in California with a substance use disorder treatment program (mandatory OEND training) and a homeless program (optional OEND training). Data were analyzed using matrices and open and closed coding approaches to identify participants' perspectives on OEND training including benefits, concerns, differing opinions, and suggestions for improvement.
  
  
  RESULTS
  Veterans thought OEND training was interesting, novel, and empowering, and that naloxone kits will save lives. Some veterans expressed concern about using syringes in the kits. A few patients who never used opioids were not interested in receiving kits. Veterans had differing opinions about legal and liability issues, whether naloxone kits might contribute to relapse, and whether and how to involve family in training. Some veterans expressed uncertainty about the effects of naloxone. Suggested improvements included active learning approaches, enhanced training materials, and increased advertisement.
  
  
  CONCLUSIONS
  OEND training was generally well received among study participants, including those with no indication for a naloxone kit. Patients described a need for OEND and believed it could save lives. Patient feedback on OEND training benefits, concerns, opinions, and suggestions provides important insights to inform future OEND training programs both within VA and in other health care settings. Training is critical to maximizing the potential for OEND to save lives, and this study includes specific suggestions for improving the effectiveness and acceptability of training.
authors.affiliation: a Center for Innovation to Implementation , VA Palo Alto Health Care System , Menlo Park , California , USA.|b Program Evaluation and Resource Center , VA Office of Mental Health Operations , Menlo Park , California , USA.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Oliva
authors.affiliation: a Center for Innovation to Implementation , VA Palo Alto Health Care System , Menlo Park , California , USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Nevedal
authors.affiliation: a Center for Innovation to Implementation , VA Palo Alto Health Care System , Menlo Park , California , USA.|b Program Evaluation and Resource Center , VA Office of Mental Health Operations , Menlo Park , California , USA.
authors.forename: Eleanor T
authors.initials: ET
authors.lastname: Lewis
authors.affiliation: a Center for Innovation to Implementation , VA Palo Alto Health Care System , Menlo Park , California , USA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: McCaa
authors.affiliation: c Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Stanford , California , USA.|d VA Palo Alto Health Care System , Menlo Park , California , USA.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Cochran
authors.affiliation: e Louis Stokes Cleveland VA Medical Center , Cleveland , Ohio , USA.|f Department of Psychiatry , Case Western Reserve University School of Medicine , Cleveland , Ohio , USA.
authors.forename: P Eric
authors.initials: PE
authors.lastname: Konicki
authors.affiliation: g Network for Public Health Law , Los Angeles , California , USA.
authors.forename: Corey S
authors.initials: CS
authors.lastname: Davis
authors.affiliation: h Cincinnati VA Medical Center , Cincinnati , Ohio , USA.|i Department of Psychiatry and Behavioral Neuroscience , University of Cincinnati College of Medicine , Cincinnati , Ohio , USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Wilder
mesh_terms: D000328:Adult; D000368:Aged; D062787:Drug Overdose / Q000517:prevention & control*; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; 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; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000193:education* / Q000523:psychology*; D055815:Young Adult
chemical_list: D009292:Narcotic Antagonists; D009270:Naloxone
keywords: Heroin; homeless; legal; naloxone; narcan; opioids; overdose; residential treatment; substance use disorder