Total Overdose Trainer 12.epub

[Hanne Rylaarsdam]

A total of 440 individuals participated in the training; 381 completed all or the majority of the survey. Participants came from a diverse set of backgrounds, ages, and experiences. All three knowledge questions showed significant improvements. For attitude questions, significant improvements were found in all three questions evaluating confidence, two of three questions assessing attitudes towards overdose reversal, and four of five questions evaluating stigma and attitudes towards individuals with OUD.
To improve care of those with OUD, direct educational interventions must be implemented at the level of curricular changes in undergraduate, graduate, and continuing medical education. Other community members, such as police officers, should also be strongly encouraged to attend training sessions. As mentioned, this training should be focused not only on overdose reversal but also harm reduction, stigma, and upstream overdose prevention. We believe this is the best method to transform our society from reactionary prevention of deaths from overdose via naloxone to proactive prevention of overdose by way of systemic change. Future studies are currently underway to determine if changes in knowledge and attitudes persist over time and to quantify the total number of overdoses reversed by participants.

Total Overdose Trainer 12.epub

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In many communities, laypersons can obtain naloxone at different locations which provide varied information about overdose and naloxone. This education differs across several potentially important variables which could alter the impact of OEND programs. First, the material may be conveyed in multiple formats. Commonly utilized techniques include: didactic education, hand-out media such as pamphlets, and/or media like video that is consumed while at the training session. Some programs utilize hands-on training via a demo device, while in some locations this may not be available. Second, who delivers the content and for how long is not standardized. In some places, trained community members provide instruction while in more formal medical settings, physicians, nurses, or pharmacists may lead overdose education and naloxone training. Third, the length of OEND training also fluctuates between settings, trainers, and trainees. Space, trainer time, and trainee time may be limited and trainee knowledge and cognition may require different training intensity. Further study into how best to educate laypersons about overdose and naloxone is needed to optimize the effectiveness and efficiency of OEND. Standardization of the core elements of OEND training, yet allowing for some flexibility of other elements of the training, will help ensure the future rescuer achieves a minimum competency and comfort level with naloxone. Standardizing and tailoring OEND curriculum will need to evolve as more naloxone devices with various concentrations, doses, and delivery mechanisms become available to wider groups of potential rescuers.

Results:  A total of 204 staff were trained and credentialed to provide the ORTHN intervention. Most (60%) were nurses, followed by needle syringe program workers and allied health/counsellors (32%). Linear and logistic regression analyses indicated that the training program was associated with significant improvements in staff knowledge and attitudes towards overdose and THN; however, only attitudinal improvements were maintained over time. There were high rates of staff satisfaction with the ORTHN intervention and training.

An electronic literature search of published papers was conducted of the following databases: PubMed, PsycInfo, and the National Criminal Justice Reference Service (NCJRS). Two reviewers worked on the search that was conducted the week of February 24, 2020. The lead project manager then reviewed all results across reviewers and provided feedback for consistency. Two sets of search terms were used: one set pertaining to overdose prevention and naloxone terms (11 terms) and one set pertaining to criminal justice terms (6 terms). Each of the overdose prevention terms were searched in combination with each of the criminal justice terms for a total of 66 search term pairs searched across each of the databases identified.

Three studies evaluated naloxone training programs in criminal justice settings. Huxley-Reicher et al. [29] evaluated outcomes of a training session on overdose rescue for visitors to Rikers Island Jail in New York City. Individuals who completed the training and returned to request a naloxone kit were recruited into the study. Of those who completed a 6-month follow-up, 14% had witnessed one or more overdoses, for a total of 70 overdose events; 17% of these were among individuals who had been recently released from prison or jail. Ten percent of the participants administered naloxone at least once over the study period; 87% of the recipients survived the overdose. The authors concluded that the corrections-based visitor training program was effective in reaching individuals who were likely to be present at an overdose and equipping them to respond.

These same challenges were echoed by Horsburgh & McAuley [36] in their description of the National Naloxone Programme within the Scottish Prison Service. The program was developed in conjunction with a community-based peer education training program, the Scottish Drugs Forum, and initially implemented in 4 prisons. They documented logistical challenges, including scheduling key personnel (i.e., trainers and participants) to be present at the same time/place, competing priorities for prisoners leading to high participation refusal rates, limited time availability of staff, and additional staff needed to escort prisoners to groups. From an individual perspective, individuals were reluctant to discuss emotionally charged issues in groups within prison, such as personal experiences of overdose or loss of others by overdose; having to practice basic life support may have been intimidating for some in a group setting. From the organizational perspective, prison officers lacked understanding about naloxone and often neglected to follow-through in placing naloxone kits with prisoner possessions for collection at discharge.

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