Journal of addiction medicine
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Review
A systematic review of community opioid overdose prevention and naloxone distribution programs.
Community-based opioid overdose prevention programs (OOPPs) that include the distribution of naloxone have increased in response to alarmingly high overdose rates in recent years. This systematic review describes the current state of the literature on OOPPs, with particular focus on the effectiveness of these programs. ⋯ Principal findings included participant demographics, the number of naloxone administrations, percentage of survival in overdose victims receiving naloxone, post-naloxone administration outcome measures, OOPP characteristics, changes in knowledge pertaining to overdose responses, and barriers to naloxone administration during overdose responses. The current evidence from nonrandomized studies suggests that bystanders (mostly opioid users) can and will use naloxone to reverse opioid overdoses when properly trained, and that this training can be done successfully through OOPPs.
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Opioid abuse and dependence rates continue to rise among U.S. adolescents. Medication-assisted treatment with buprenorphine/naloxone (BUP/NAL) has been shown to be effective up to 12 weeks. Few data are available regarding extended treatment outcomes. The objective of this study was to describe 1-year retention and compliance of a specific pediatric, outpatient BUP/NAL treatment program for opioid-dependent adolescents and young adults. ⋯ Although patient retention was the largest barrier to success, a subset of opioid-dependent adolescents and young adults achieved long-term sobriety in our specific clinic program with continued outpatient BUP/NAL therapy. Retention correlated with UDS negative for opioids, negative for tetrahydrocannabinol, and positive for BUP/NAL.
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This case study of the development and implementation of an opioid overdose prevention program is based on an actual clinic's experience, but information about the clinic, including details of implementation and outcome measures, has been changed. Four experts reflect on the medical, administrative, peer-support, community, and evaluation aspects of this case. This discussion highlights challenges and important considerations in the creation of programs to address the ever-increasing risk for opioid overdose.