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
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
复制标题
DOI：
10.1186/1471-2458-14-297
复制
发表时间：
2014-04-01
影响因子：
4.5
通讯作者：
Walley, Alexander Y.
中科院分区：
文献类型：
--
作者：
Doe-Simkins, Maya;Quinn, Emily;Walley, Alexander Y.
工作背景：预防阿片类药物过量的一种方法是提供过量教育和纳洛酮分配（OEND）。两个悬而未决的问题，为OEND实施包括1）传播的OEND培训从受过训练的社区成员;和2）的关注，OEND提供了一个虚假的安全感，导致阿片类药物的使用增加use.Methods：比较过量救援行为之间的受过训练的和未经训练的救援人员报告纳洛酮急救包使用的人;并确定海洛因使用是否改变后，开放式结束，我们进行了一项回顾性队列研究，在物质使用者在马萨诸塞州开放式结束计划，从2006年至2010年。我们使用卡方和t检验统计量来比较受过训练的参与者与未经训练的参与者在过量用药管理特征方面的差异。我们采用Wilcoxon签署秩检验比较两个重复措施的物质使用的参与者之间的药物使用信息收集超过一次的中位数difference.Results：在4,926物质使用的参与者，295培训和78未经培训的参与者报告一个或多个救援，导致599救援报告。我们发现，经过训练的救援人员与未经训练的救援人员在寻求帮助（p = 0.41）、救援呼吸（p = 0.54）、与受害者呆在一起（p = 0.84）或纳洛酮给药成功率（p = 0.69）方面没有统计学显著差异。我们确定了325名OEND参与者，他们不止一次收集了药物使用信息。我们发现在过去的30天中使用海洛因的天数没有显着的总体变化（减少38%，增加35%，没有变化27%，p = 0.52）。结论：在4926名物质使用者谁参加了OEND，373（7.6%）报告给纳洛酮在过量抢救。我们发现受过训练和未经训练的过量救援人员之间的行为差异不大。需要进行前瞻性研究，以确定最佳培训水平以及纳洛酮急救包是否符合非处方标准。由于没有明确的证据表明海洛因使用量增加，这种担忧不应阻碍支持海洛因使用的开放教育和发展计划或政策的扩大。
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).Conclusion: 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.