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ABSTRACT
Background: In an effort to prevent opioid overdose mortality among Veterans, Department of Veterans Affairs (VA) facilities began implementing opioid overdose education and naloxone distribution (OEND) in 2013 and a national program began in 2014. VA is the first national health care system to implement OEND. The goal of this study is to examine patient perceptions of OEND training and naloxone kits. Methods: Four focus groups were conducted between December 2014 and February 2015 with 21 patients trained in OEND. Participants were recruited from a VA residential facility in California with a substance use disorder treatment program (mandatory OEND training) and a homeless program (optional OEND training). Data were analyzed using matrices and open and closed coding approaches to identify participants' perspectives on OEND training including benefits, concerns, differing opinions, and suggestions for improvement. Results: Veterans thought OEND training was interesting, novel, and empowering, and that naloxone kits will save lives. Some veterans expressed concern about using syringes in the kits. A few patients who never used opioids were not interested in receiving kits. Veterans had differing opinions about legal and liability issues, whether naloxone kits might contribute to relapse, and whether and how to involve family in training. Some veterans expressed uncertainty about the effects of naloxone. Suggested improvements included active learning approaches, enhanced training materials, and increased advertisement. Conclusions: OEND training was generally well received among study participants, including those with no indication for a naloxone kit. Patients described a need for OEND and believed it could save lives. Patient feedback on OEND training benefits, concerns, opinions, and suggestions provides important insights to inform future OEND training programs both within VA and in other health care settings. Training is critical to maximizing the potential for OEND to save lives, and this study includes specific suggestions for improving the effectiveness and acceptability of training.
Acknowledgments
The views expressed here are the authors' and do not necessarily represent those of the Department of Veterans Affairs. We gratefully acknowledge the sacrifices of the men and women who have served in our military and thank the veterans who volunteered to participate in our study. We would also like to thank the VA OEND National Support and Development Workgroup for their feedback on the focus group guide used in this study.
Author contributions
Conception and design: E. M. Oliva, M. D. McCaa, E. T. Lewis, M. F. Cochran, P. E. Konicki, and C. M. Wilder. Data collection: E. M. Oliva, A. Nevedal, and M. D. McCaa. Analysis of the data: A. Nevedal, E. T. Lewis, and E. M. Oliva. Drafting of the manuscript: E. M. Oliva, A. Nevedal, E. T. Lewis, and M. D. McCaa. Critical revision of the article for important intellectual content: E. M. Oliva, A. Nevedal, M. D. McCaa, E. T. Lewis, M. F. Cochran, P. E. Konicki, C. M. Wilder, and C. S. Davis. Administrative, technical, or logistic support: M. D. McCaa, M. F. Cochran, P. E. Konicki, and C. M. Wilder.
Funding
We thank the VA Health Services Research and Development's Quality Enhancement Research Initiative for funding this project, RRP 13-446 (Principal Investigator: Oliva). The funding provided paid for staff to conduct the research described in this study as well as participant compensation for their time. The authors declare that they have no conflicts of interest.
