Abstract
SETTING: A harm reduction program at a public health unit in Toronto, Ontario, between August 31, 2011 and August 31, 2013.
INTERVENTION: We conducted a process evaluation of the first two years of an opioid overdose prevention and response program, Prevent Overdose in Toronto (POINT), including analysis of data from program documentation forms, as well as qualitative interviews with program staff, representatives from partner agencies, and program clients.
OUTCOMES: In the first two years of the program, 662 individuals (52.4% male; mean age 38.3 years) were trained in opioid overdose prevention and given a naloxone kit. Among clients currently using opioids, the most frequently reported opioids were oxycodone (40.4%) and heroin (34.4%). Clients reported 98 administrations of naloxone, primarily to friends and acquaintances. Nearly all naloxone recipients reportedly survived; one did not survive, and one had an unknown outcome.
Staff and partner agencies feel the program reaches the target population and that POINT training meets clients’ needs. Clients would like to see the training offered more widely. Overall, staff, partner agencies and clients were pleased with the POINT program, and they offered suggestions on program recruitment and delivery.
IMPLICATIONS: Individuals at risk of opioid overdose have participated in overdose prevention and response training, and reported using naloxone in overdose events. Results of this initial program evaluation are being used to improve the delivery of the POINT program and can inform broader public health practice in opioid overdose prevention.
Key Words: Drug overdose, naloxone, program evaluation
Résumé
LIEU : Un programme de réduction des méfaits mené dans un bureau de santé publique de Toronto (Ontario) entre le 31 août 2011 et le 31 août 2013.
INTERVENTION : Nous avons mené une évaluation des processus après les deux premières années d’un programme de prévention et d’intervention en cas de surdoses d’opioïdes, Prevent Overdose in Toronto (POINT); l’évaluation a compris l’analyse des données des formulaires du programme, ainsi que des entretiens qualitatifs avec le personnel de POINT, les représentants des organismes partenaires et les clients.
RÉSULTATS : Au cours des deux premières années du programme, 662 personnes (52,4 % hommes; âge moyen de 38,3 ans) ont été formées à la prévention des surdoses d’opioïdes et ont reçu une trousse de naloxone. Chez les clients qui consommaient actuellement des opioïdes, les opioïdes les plus souvent déclarés étaient l’oxycodone (40,4 %) et l’héroïne (34,4 %). Les clients ont fait état de 98 administrations de naloxone, principalement à des amis et à des connaissances. Presque toutes les personnes auxquelles on a administré la naloxone ont survécu; une n’a pas survécu, et on ignore ce qui est arrivé dans un autre cas.
Selon le personnel et les organismes partenaires, le programme joint sa population cible, et la formation donnée par POINT répond aux besoins des clients. Ces derniers aimeraient que la formation soit offerte à plus grande échelle. Dans l’ensemble, le personnel, les organismes partenaires et les clients étaient satisfaits et ont suggéré des améliorations au recrutement et à l’exécution du programme.
CONSÉQUENCES : Des personnes à risque de surdose d’opioïde ont suivi une formation sur la prévention et l’intervention en cas de surdose et déclaré avoir administré de la naloxone lors de surdoses. Les résultats de cette évaluation initiale servent à améliorer l’exécution du programme POINT; ils peuvent aussi éclairer les pratiques de prévention des surdoses d’opioïdes ailleurs dans le domaine de la santé publique.
Mots Clés: surdose, naloxone, programme
Footnotes
Conflict of Interest: None to declare.
References
- 1.Dart RC, Surratt HL, Cicero TJ, Parrino MW, Severtson SG, Bucher-Bartelson B, et al. Trends in opioid analgesic abuse and mortality in the United States. N Engl J Med. 2015;372(3):241–48. doi: 10.1056/NEJMsa1406143. [DOI] [PubMed] [Google Scholar]
- 2.Hasegawa K, Espinola JA, Brown DF, Camargo CA., Jr. Trends in U. S. emergency department visits for opioid overdose, 1993–2010. Pain Med. 2014;15(10):1765–70. doi: 10.1111/pme.12461. [DOI] [PubMed] [Google Scholar]
- 3.National Advisory Committee on Prescription Drug Misuse. First Do No Harm: Responding to Canada’s Prescription Drug Crisis. 2013. [Google Scholar]
- 4.Office of National Drug Control Policy, US Executive Office of the President. Epidemic: Responding to America’s Prescription Drug Abuse Crisis. 2011. [Google Scholar]
- 5.Johnson NB, Hayes LD, Brown K, Hoo EC, Ethier KA. CDC national health report: Leading causes of morbidity and mortality and associated behavioral risk and protective factors–United States, 2005–2013. MMWR Surveill Summ. 2014;63(Suppl4):3–27. [PubMed] [Google Scholar]
- 6.Wheeler E, Jones TS, Gilbert MK, Davidson PJ. Opioid overdose prevention programs providing naloxone to laypersons–United States, 2014. MMWR Morb Mortal Wkly Rep. 2015;64(23):631–35. [PMC free article] [PubMed] [Google Scholar]
- 7.Banjo O, Tzemis D, Al-Qutub D, Amlani A, Kesselring S, Buxton JA. A quantitative and qualitative evaluation of the BritishColumbia TakeHomeNaloxone program. CMAJ Open. 2014;2(3):E153–61. doi: 10.9778/cmajo.20140008. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Leece PN, Hopkins S, Marshall C, Orkin A, Gassanov MA, Shahin RM. Development and implementation of an opioid overdose prevention and response program in Toronto, Ontario. Can J Public Health. 2013;104(3):e200–4. doi: 10.17269/cjph.104.3788. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.World Health Organization. Community Management of Opioid Overdose. 2014. [PubMed] [Google Scholar]
- 10.Clark AK, Wilder CM, Winstanley EL. A systematic review of community opioid overdose prevention and naloxone distribution programs. J Addict Med. 2014;8(3):153–63. doi: 10.1097/ADM.0000000000000034. [DOI] [PubMed] [Google Scholar]
- 11.McAuley A, Aucott L, Matheson C. Exploring the life-saving potential of naloxone: A systematic review and descriptive meta-analysis of take home naloxone (THN) programmes for opioid users. Int J Drug Policy. 2015;26(12):1183–88. doi: 10.1016/j.drugpo.2015.09.011. [DOI] [PubMed] [Google Scholar]
- 12.Mueller SR, Walley AY, Calcaterra SL, Glanz JM, Binswanger IA. A review of opioid overdose prevention and naloxone prescribing: Implications for translating community programming into clinical practice. Subst Abus. 2015;36(2):240–53. doi: 10.1080/08897077.2015.1010032. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Administration of Naloxone in a Home or Community Setting: A Review of the Clinical Effectiveness, Cost-effectiveness,Guidelines. Rapid Response Report: Summary with Critical Appraisal. Ottawa, ON: Canadian Agency for Drugs and Technologies in Health; 2014. [PubMed] [Google Scholar]
- 14.Giglio RE, Li G, DiMaggio CJ. Effectiveness of bystander naloxone administration and overdose education programs: A meta-analysis. Inj Epidemiol. 2015;2(10):1. doi: 10.1186/s40621-015-0041-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Walley AY, Xuan Z, Hackman HH, Quinn E, Doe-Simkins M, Sorensen-Alawad A, et al. Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: Interrupted time series analysis. BMJ. 2013;346:f174. doi: 10.1136/bmj.f174. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Coffin PO, Sullivan SD. Cost-effectiveness of distributing naloxone to heroin users for lay overdose reversal. Ann Intern Med. 2013;158(1):1–9. doi: 10.7326/0003-4819-158-1-201301010-00003. [DOI] [PubMed] [Google Scholar]
- 17.Dong KA, Taylor M, Wild CT, Villa-Roel C, Rose M, Salvalaggio G, et al. Community-based naloxone: A Canadian pilot program. Can J Addict Med. 2012;3(2):4–9. [Google Scholar]
- 18.Medical Officer of Health, City of Toronto. Overdose in Toronto: Trends, Prevention, and Response. 2015. [Google Scholar]
- 19.Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. doi: 10.1191/1478088706qp063oa. [DOI] [Google Scholar]
- 20.Walley AY, Doe-Simkins M, Quinn E, Pierce C, Xuan Z, Ozonoff A. Opioid overdose prevention with intranasal naloxone among people who take methadone. J Subst Abuse Treat. 2013;44(2):241–47. doi: 10.1016/j.jsat.2012.07.004. [DOI] [PubMed] [Google Scholar]
- 21.Maxwell S, Bigg D, Stanczykiewicz K, Carlberg-Racich S. Prescribing naloxone to actively injecting heroin users: A program to reduce heroin overdose deaths. J Addict Dis. 2006;25(3):89–96. doi: 10.1300/J069v25n03_11. [DOI] [PubMed] [Google Scholar]
- 22.Enteen L, Bauer J, McLean R, Wheeler E, Huriaux E, Kral AH, et al. Overdose prevention and naloxone prescription for opioid users in San Francisco. J Urban Health. 2010;87(6):931–41. doi: 10.1007/s11524-010-9495-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Stoove MA, Dietze PM, Jolley D. Overdose deaths following previous non-fatal heroin overdose: Record linkage of ambulance attendance and death registry data. Drug Alcohol Rev. 2009;28(4):347–52. doi: 10.1111/j.1465-3362.2009.00057.x. [DOI] [PubMed] [Google Scholar]
- 24.Bennett AS, Bell A, Tomedi L, Hulsey EG, Kral AH. Characteristics of an overdose prevention, response, and naloxone distribution program in Pittsburgh and Allegheny County, Pennsylvania. J Urban Health. 2011;88(6):1020–30. doi: 10.1007/s11524-011-9600-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Global News. New coroner’s numbers say Ontario opioid deaths are up even though Oxy’s killing fewer. 2013. [Google Scholar]