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.
The Full Text of this article is available as a PDF
These references are in PubMed. This may not be the complete list of references from this article.
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.
3. Latkin CA, Hua W, Tobin K. Social network correlates of self-reported non-fatal overdose. Drug Alcohol Depend. 2004;73:61–67. doi: 10.1016/j.drugalcdep.2003.09.005. [PubMed] [Cross Ref] 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. doi: 10.1093/jurban/jtg029. [PMC free article] [PubMed] [Cross Ref] 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. doi: 10.1016/S0955-3959(01)00080-9. [Cross Ref] 6. Darke S, Zador D. Fatal heroin “overdose”: a review. Addiction. 1996;91:1765–1772. doi: 10.1111/j.1360-0443.1996.tb03800.x. [PubMed] [Cross Ref] 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. doi: 10.1046/j.1360-0443.1999.9444712.x. [PubMed] [Cross Ref] 8. Strang J, Best D, Man L, Noble A, Gossop M. Peer-initiated. Int J Drug Policy. 2000;11:437–445. doi: 10.1016/S0955-3959(00)00070-0. [PubMed] [Cross Ref] 9. Sporer KA. Acute heroin overdose. Ann Intern Med. 1999;130:584–590. doi: 10.7326/0003-4819-130-7-199904060-00019. [PubMed] [Cross Ref] 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. doi: 10.1046/j.1360-0443.1999.9421993.x. [PubMed] [Cross Ref] 11. Darke S, Hall W. The distribution of naloxone to heroin users. Addiction. 1997;92:1195–1199. doi: 10.1111/j.1360-0443.1997.tb03681.x. [PubMed] [Cross Ref] 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. doi: 10.1136/bmj.322.7291.895. [PMC free article] [PubMed] [Cross Ref]
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.
14. Bigg D. Data on take home naloxone are unclear but not condemnatory (letter) BMJ. 2002;324:678–678. doi: 10.1136/bmj.324.7338.678. [PMC free article] [PubMed] [Cross Ref]
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: http://bmj.com/cgi/eletters/322/7291/895 14648.
16. Mountain D. Take home naloxone for opiate addicts. Big conclusions are drawn from little evidence. BMJ. 2001;323:934–934. doi: 10.1136/bmj.323.7318.934. [PubMed] [Cross Ref] 17. Ashworth AJ, Kidd A. Take home naloxone for opiate addicts. Apparent advantages may be balanced by hidden harms. BMJ. 2001;323:935–935. doi: 10.1136/bmj.323.7306.230/a. [PubMed] [Cross Ref] 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. doi: 10.1093/jurban/jtg032. [PMC free article] [PubMed] [Cross Ref]
19. 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.
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. [PubMed]
21. SAS Release. Version 8.02. (1999–2001) by SAS Institute Inc., Cary, NC, USA.
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. [PubMed] 23. Dietze P, Cantwell K, Burgess S. Bystander resuscitation attempts at heroin overdose: does it improve outcomes? Drug Alcohol Depend. 2002;67:213–218. doi: 10.1016/S0376-8716(02)00063-7. [PubMed] [Cross Ref] 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. [PMC free article] [PubMed] 25. Watters JK, Needle R, Brown BS, Weatherby N, Booth R, Williams M. The self-reporting of cocaine use. JAMA. 1992;268:2374–2375. doi: 10.1001/jama.268.17.2374. [PubMed] [Cross Ref]
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.
27. Cobb LA, Hallstrom AP. Community-based cardiopulmonary resuscitation. what have we learned? Ann N Y Acad Sci. 1982;382:330–342. doi: 10.1111/j.1749-6632.1982.tb55228.x. [PubMed] [Cross Ref] 28. Brennan RT, Braslow A. Skill mastery in public CPR classes. Am J Emerg Med. 1998;16:653–657. doi: 10.1016/S0735-6757(98)90167-X. [PubMed] [Cross Ref] 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. doi: 10.1016/S0196-0644(05)81654-3. [PubMed] [Cross Ref] 30. Pane GA, Salnes KA. A survey of participants in a mass CPR training course. Ann Emerg Med. 1987;16:1112–1116. doi: 10.1016/S0196-0644(87)80466-3. [PubMed] [Cross Ref]