Naloxone distribution and cardiopulmonary resuscitation training for injection drug users to prevent heroin overdose death: A pilot intervention study
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Fatal heroin overdose has become a leading cause of death among injection drug users (IDUs). Several recent feasibility studies have concluded that naloxone distribution programs for heroin injectors should be implemented to decrease heroin overdose deaths, but there have been no prospective trials of such programs in North America. This pilot study was undertaken to investigate the safety and feasibility of training injection drug using partners to perform cardiopulmonary resuscitation (CPR) and administer naloxone in the event of heroin overdose. During May and June 2001, 24 IDUs (12 pairs of injection partners) were recruited from street settings in San Francisco. Participants took part in 8-hour training in heroin overdose prevention, CPR, and the use of naloxone. Following the intervention, participants were prospectively followed for 6 months to determine the number and outcomes of witnessed heroin overdoses, outcomes of participant interventions, and changes in participants’ knowledge of overdose and drug use behavior. Study participants witnessed 20 heroin overdose events during 6 months follow-up. They performed CPR in 16 (80%) events, administered naloxone in 15 (75%) and did one or the other in 19 (95%). All overdose victims survived. Knowledge about heroin overdose management increased, whereas heroin use decreased. IDUs can be trained to respond to heroin overdose emergencies by performing CPR and administering naloxone. Future research is needed to evaluate the effectiveness of this peer intervention to prevent fatal heroin overdose.
- Sporer KA. Strategies for preventing heroin overdose. BMJ 2003;326:442–444. CrossRef
- Drucker E, Garfield J. Overdose trends in five US cities: 1988–1997. Paper presented at: Preventing Heroin Overdose: pragmatic approaches: January 13–14, 2000; Seattle, Washington, DC.
- Latkin CA, Hua W, Tobin K. Social network correlates of self-reported non-fatal overdose. Drug Alcohol Depend. 2004;73:61–67. CrossRef
- Davidson PJ, McLean RL, Kral AH, Gleghorn AA, Edlin BR, Moss AR. Fatal heroin-related overdose in San Francisco, 1997–2000: a case for targeted intervention. J Urban Health. 2003;80:261–273. CrossRef
- Burris S, Noreland J, Edlin B. Legal aspects of providing naloxone to heroin users in the United States. Int J Drug Policy. 2001;12:237–248. CrossRef
- Darke S, Zador D. Fatal heroin “overdose”: a review. Addiction. 1996;91:1765–1772. CrossRef
- Powis B, Strang J, Griffiths P, et al, Self-reported overdose among injecting drug users in London: extent and nature of the problem. Addiction. 1999;94:471–478. CrossRef
- Strang J, Best D, Man L, Noble A, Gossop M. Peer-initiated. Int J Drug Policy. 2000;11:437–445. CrossRef
- Sporer KA. Acute heroin overdose. Ann Intern Med. 1999;130:584–590. CrossRef
- Strang J, Powis B, Best D, et al. Preventing opiate overdose fatalities with take-home naloxone: pre-launch study of possible impact and acceptability. Addiction. 1999;94:199–204. CrossRef
- Darke S, Hall W. The distribution of naloxone to heroin users. Addiction. 1997;92:1195–1199. CrossRef
- Dettmer K, Saunders B, Strang J. Take home naloxone and the prevention of deaths from opiate overdose: two pilot schemes. BMJ. 2001;322:895–896. CrossRef
- Ronconi S. Prevention of overdoses among current heroin users in Torino Italy for the period 1995–1998. Paper presented at: Preventing Heroin Overdose: pragmatic approaches; January 13–14, 2000; Seattle, Washington, DC.
- Bigg D. Data on take home naloxone are unclear but not condemnatory (letter). BMJ. 2002;324:678. CrossRef
- Baca C, Richards M, Grant KJ. Take-home naloxone to prevent deaths from opiate overdose [rapid response]. BMJ [serial online]. May 21, 2001. Available at: http://bmj.com/cgi/eletters/322/7291/895 14648.
- Mountain D. Take home naloxone for opiate addicts. Big conclusions are drawn from little evidence. BMJ. 2001;323:934. CrossRef
- Ashworth AJ, Kidd A. Take home naloxone for opiate addicts. Apparent advantages may be balanced by hidden harms. BMJ. 2001;323:935. CrossRef
- Seal KH, Downing M, Kral AH, et al. Attitudes about prescribing take-home naloxone to injection drug users for the management of heroin overdose. J Urban Health. 2003;80:291–301. CrossRef
- Chicago Recovery Alliance. CRA’s opiate overdose prevention program 2002 and opiate overdose prevention/intervention training slide show [on-line]. Available at: http://www.anypositivechange.org/res.html.
- Centers for Disease Control and Prevention. Transmission of hepatitis B and C viruses in outpatient settings—New York, Oklahoma, and Nebraska, 2000–2002, MMWR Morb Mortal Wkly Rep. 2003;52:901–906.
- SAS Release. Version 8.02. (1999–2001) by SAS Institute Inc., Cary, NC, USA.
- Lenton SR, Hargreaves KM. Should we conduct a trial of distributing naloxone to heroin users for peer administration to prevent fatal overdose? Med J Aust. 2000;173:260–263.
- Dietze P, Cantwell K, Burgess S Bystander resuscitation attempts at heroin overdose: does it improve outcomes? Drug Alcohol Depend. 2002;67:213–218. CrossRef
- Broadhead RS, Heckathorn DD, Weakliem DL, et al. Harnessing peer networks as an instrument for AIDS prevention: results from a peer-driven intervention. Public Health Rep. 1998;113:42–57.
- Watters JK, Needle R, Brown BS, Weatherby N, Booth R, Williams M. The self-reporting of cocaine use. JAMA. 1992;268:2374–2375. CrossRef
- Dowling-Guyer S, Johnson ME, Fisher DG, et al. Reliability of drug users’ self-reported HIV risk behaviors and validity of self-repored recent drug use. Assessment. 1994;1:383–392.
- Cobb LA, Hallstrom AP. Community-based cardiopulmonary resuscitation. what have we learned? Ann N Y Acad Sci. 1982;382:330–342. CrossRef
- Brennan RT, Braslow A. Skill mastery in public CPR classes. Am J Emerg Med. 1998;16:653–657. CrossRef
- Becker LB, Ostander MP, Barrett J, Kondos GT. Outcome of CPR in a large metropolitan area—where are the survivors? Ann Emerg Med. 1991;20:355–361. CrossRef
- Pane GA, Salnes KA. A survey of participants in a mass CPR training course. Ann Emerg Med. 1987;16:1112–1116. CrossRef
- Naloxone distribution and cardiopulmonary resuscitation training for injection drug users to prevent heroin overdose death: A pilot intervention study
Journal of Urban Health
Volume 82, Issue 2 , pp 303-311
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Heroin-related deaths
- Injection drug use
- Author Affiliations
- 1. Department of Medicine, San Francisco VA Medical Center, University of California, 4150 Clement Street, Box 111-A1, 94121, San Francisco, CA
- 2. The Urban Health Study, University of California, San Francisco, California
- 3. San Francisco Department of Public Health, San Francisco, California
- 4. Center for the Study of Hepatitis C, Weill Medical College of Cornell University, New York, New York