Opioid overdose prevention in a residential care setting: Naloxone education and distribution

ABSTRACT

Background: Patients with opioid use disorders are at an increased risk for overdose death if they had a previous overdose, have co-occurring medical and psychiatric comorbidity, and are high-dose opioid users transitioning to relative abstinence or abstinence, i.e., those individuals discharging from drug treatment programs. Despite the success of opioid overdose prevention programs utilizing naloxone, residential substance abuse treatment centers often emphasize abstinence-based care for those suffering from addiction and do not adopt harm reduction approaches such as naloxone education and distribution. This performance improvement project reports the implementation of an opioid overdose prevention program provided to patients and their family members in a residential treatment setting. Methods: Opioid-dependent inpatients (N = 47) along with their family members received overdose prevention training consistent with guidelines established by the Harm Reduction Coalition. Patient family members were queried regarding their awareness of past opioid overdose by the patient. A pre- and post-training questionnaire based on a 5-point Likert scale assessing ability to recognize overdose, fear of overdose, comfort in assisting with overdose, perception of life-threatening nature of addiction, and the value of overdose management was administered. Pre and post scores for each Likert scale were analyzed using paired 2-tailed t tests. Results: Thirty-two percent of patient family members were aware that the patient had a prior overdose. Statistically significant improvements in the ability of patients and families to recognize an opioid overdose as well as in their comfort to assist with an overdose were demonstrated. The pre- and post-education responses were both notably high for perceived value in learning about overdose and prevention. Conclusions: Implementation of opioid overdose prevention programs within residential treatment programs, sober living homes, and therapeutic communities would be well received and is strongly encouraged.

KEYWORDS:

• Opioids
• overdose
• prevention
• residential treatment

Acknowledgments

The authors would like to express their appreciation to Steve Millette, executive director of the Center for Dependency, Addiction and Rehabilitation (CeDAR) at the University of Colorado Hospital, and Alyssa J. Wolfer, the director of the Family Program at CeDAR, for their ongoing support and assistance. The authors declare that they have no conflicts of interest.

Author contributions

P. Fehling and P. Pade conceived of the project. P. Pade and P. Fehling developed and conducted the training seminars. L. Martin performed the statistical review and prepared the institutional review board documentation. S. Collins collected and reviewed data. All authors interpreted the data. P. Pade drafted the manuscript. All authors reviewed and provided revisions to the manuscript.