Journal of Urban Health

, Volume 82, Issue 2, pp 303–311 | Cite as

Naloxone distribution and cardiopulmonary resuscitation training for injection drug users to prevent heroin overdose death: A pilot intervention study

  • Karen H. SealEmail author
  • Robert Thawley
  • Lauren Gee
  • Joshua Bamberger
  • Alex H. Kral
  • Dan Ciccarone
  • Moher Downing
  • Brian R. Edlin


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.


Heroin Heroin-related deaths Injection drug use Overdose Prevention 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Sporer KA. Strategies for preventing heroin overdose. BMJ 2003;326:442–444.PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    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.Google Scholar
  3. 3.
    Latkin CA, Hua W, Tobin K. Social network correlates of self-reported non-fatal overdose. Drug Alcohol Depend. 2004;73:61–67.PubMedCrossRefGoogle Scholar
  4. 4.
    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.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    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.CrossRefGoogle Scholar
  6. 6.
    Darke S, Zador D. Fatal heroin “overdose”: a review. Addiction. 1996;91:1765–1772.PubMedCrossRefGoogle Scholar
  7. 7.
    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.PubMedCrossRefGoogle Scholar
  8. 8.
    Strang J, Best D, Man L, Noble A, Gossop M. Peer-initiated. Int J Drug Policy. 2000;11:437–445.PubMedCrossRefGoogle Scholar
  9. 9.
    Sporer KA. Acute heroin overdose. Ann Intern Med. 1999;130:584–590.PubMedCrossRefGoogle Scholar
  10. 10.
    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.PubMedCrossRefGoogle Scholar
  11. 11.
    Darke S, Hall W. The distribution of naloxone to heroin users. Addiction. 1997;92:1195–1199.PubMedCrossRefGoogle Scholar
  12. 12.
    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.PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    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.Google Scholar
  14. 14.
    Bigg D. Data on take home naloxone are unclear but not condemnatory (letter). BMJ. 2002;324:678.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    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: 14648.Google Scholar
  16. 16.
    Mountain D. Take home naloxone for opiate addicts. Big conclusions are drawn from little evidence. BMJ. 2001;323:934.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Ashworth AJ, Kidd A. Take home naloxone for opiate addicts. Apparent advantages may be balanced by hidden harms. BMJ. 2001;323:935.PubMedCrossRefGoogle Scholar
  18. 18.
    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.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Chicago Recovery Alliance. CRA’s opiate overdose prevention program 2002 and opiate overdose prevention/intervention training slide show [on-line]. Available at: Scholar
  20. 20.
    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.Google Scholar
  21. 21.
    SAS Release. Version 8.02. (1999–2001) by SAS Institute Inc., Cary, NC, USA.Google Scholar
  22. 22.
    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.PubMedGoogle Scholar
  23. 23.
    Dietze P, Cantwell K, Burgess S Bystander resuscitation attempts at heroin overdose: does it improve outcomes? Drug Alcohol Depend. 2002;67:213–218.PubMedCrossRefGoogle Scholar
  24. 24.
    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.PubMedCentralPubMedGoogle Scholar
  25. 25.
    Watters JK, Needle R, Brown BS, Weatherby N, Booth R, Williams M. The self-reporting of cocaine use. JAMA. 1992;268:2374–2375.PubMedCrossRefGoogle Scholar
  26. 26.
    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.Google Scholar
  27. 27.
    Cobb LA, Hallstrom AP. Community-based cardiopulmonary resuscitation. what have we learned? Ann N Y Acad Sci. 1982;382:330–342.PubMedCrossRefGoogle Scholar
  28. 28.
    Brennan RT, Braslow A. Skill mastery in public CPR classes. Am J Emerg Med. 1998;16:653–657.PubMedCrossRefGoogle Scholar
  29. 29.
    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.PubMedCrossRefGoogle Scholar
  30. 30.
    Pane GA, Salnes KA. A survey of participants in a mass CPR training course. Ann Emerg Med. 1987;16:1112–1116.PubMedCrossRefGoogle Scholar

Copyright information

© Oxford University Press on behalf of the New York Academy of Medicine 2005

Authors and Affiliations

  • Karen H. Seal
    • 1
    Email author
  • Robert Thawley
    • 2
  • Lauren Gee
    • 2
  • Joshua Bamberger
    • 3
  • Alex H. Kral
    • 2
  • Dan Ciccarone
    • 2
  • Moher Downing
    • 2
  • Brian R. Edlin
    • 2
    • 4
  1. 1.Department of Medicine, San Francisco VA Medical CenterUniversity of CaliforniaSan Francisco
  2. 2.The Urban Health StudyUniversity of CaliforniaSan Francisco
  3. 3.San Francisco Department of Public HealthSan Francisco
  4. 4.Center for the Study of Hepatitis CWeill Medical College of Cornell UniversityNew York

Personalised recommendations