Overdose training and take-home naloxone for opiate users: prospective cohort study of impact on knowledge and attitudes and subsequent management of overdoses
Overdose training and take-home naloxone for opiate users: prospective cohort study of impact on knowledge and attitudes and subsequent management of overdoses
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DOI：
10.1111/j.1360-0443.2008.02314.x
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发表时间：
2008-10-01
期刊：
影响因子：
6
通讯作者：
Semmler, Claudia
中科院分区：
文献类型：
--
作者：
Strang, John;Manning, Victoria;Semmler, Claudia
目的审查过量管理和提供纳洛酮方面的培训对当前阿片剂使用者的知识和信心的影响；并记录3个月随访期间发生的过量管理情况。设计重复措施设计，以检查过量药物管理培训后立即知识和信心的变化；在3个月时保持知识和信心；以及前瞻性队列研究设计，以记录在培训后过量情况下应用的实际干预措施。方法对239名阿片类药物吸毒者进行培训前的过量管理和纳洛酮应用问卷调查，并在培训后即刻进行复评，并给予带回家的纳洛酮应急补给。三个月后，他们再次接受了采访。结果患者对过量用药风险、过量用药特征及应采取的适当措施的认识有显著提高，对纳洛酮用药的信心也有明显提高。随访率达到78%(239人中有186人)，其中对过量用药的风险和身体/行为特征以及建议的管理措施的知识被很好地保留了下来。在培训和随访之间的3个月期间，发生了18次服药过量(经历或目睹)。使用纳洛酮12次(一名训练有素的病人自己供应10次)。在未使用纳洛酮的六种过量药物中，有一例死亡。在使用纳洛酮的情况下，所有12例均成功逆转。结论通过过量管理培训，可训练阿片类药物使用者执行适当的行动，以帮助成功逆转潜在的致命过量。更广泛的规定可能会进一步减少与毒品有关的死亡。今后的研究应审查更广泛的过量管理培训和提供纳洛酮的公共政策是否可以减少阿片类药物过量死亡的程度，特别是在公认的风险增加的时候。
Aim To examine the impact of training in overdose management and naloxone provision on the knowledge and confidence of current opiate users; and to record subsequent management of overdoses that occur during a 3-month follow-up period. Design Repeated-measures design to examine changes in knowledge and confidence immediately after overdose management training; retention of knowledge and confidence at 3 months; and prospective cohort study design to document actual interventions applied at post-training overdose situations. Method A total of 239 opiate users in treatment completed a pre-training questionnaire on overdose management and naloxone administration and were re-assessed immediately post-training, at which point they were provided with the take-home emergency supply of naloxone. Three months later they were re-interviewed. Results Significant improvements were seen in knowledge of risks of overdose, characteristics of overdose and appropriate actions to be taken; and in confidence in the administration of naloxone. A 78% follow-up rate was achieved (186 of 239) among whom knowledge of both the risks and physical/behavioural characteristics of overdose and also of recommended management actions was well retained. Eighteen overdoses (either experienced or witnessed) had occurred during the 3 months between the training and the follow-up. Naloxone was used on 12 occasions (a trained client's own supply on 10 occasions). One death occurred in one of the six overdoses where naloxone was not used. Where naloxone was used, all 12 resulted in successful reversal. Conclusions With overdose management training, opiate users can be trained to execute appropriate actions to assist the successful reversal of potentially fatal overdose. Wider provision may reduce drug-related deaths further. Future studies should examine whether public policy of wider overdose management training and naloxone provision could reduce the extent of opiate overdose fatalities, particularly at times of recognized increased risk.