Angela Clark

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. We used systematic search criteria to identify relevant articles, which we abstracted and assigned a quality assessment score. Nineteen articles evaluating OOPPs met the search criteria for this systematic review. 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.

Development and implementation of an opioid overdose prevention program within a preexisting substance use disorders treatment center.

This case study of the development and implementation of an opioid overdose prevention program is based on an actual clinics 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.

Transforming Nursing Education With Apple Technology.

The widespread adoption of technology has the potential to redefine nursing education. Currently, there is limited knowledge of how to implement technological advancements in nursing curricula. This article describes 1 colleges journey to transform nursing education through leadership, professional development, and innovative learning and teaching. The iPad opens the classroom experience to resources and learning opportunities for students. Facilitating the culture change required to adopt the iPad as a teaching and learning tool required a supportive vision, strong leadership, commitment to provide adequate technological support, early adopters, and planning.

The Impact of Patient Characteristics and Postoperative Opioid Exposure on Prolonged Postoperative Opioid Use: An Integrative Review

Objectives The United States is experiencing an opioid overdose crisis. Research suggests prolonged postoperative opioid use, a common complication following surgery, is associated with opioid misuse, which, in turn, is the greatest risk factor of heroin misuse. The objective of this review is to evaluate how postoperative opioid exposure relates to prolonged use and to identify factors that predict prolonged postoperative opioid use. Design An integrative review of the literature. Data Sources Electronic and hand searching methods were used in PubMed, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, and SCOPUS. Search terms included opioid, opiate, postoperative pain, drug administration, prescribing pattern, prescription, inappropriate prescribing, self‐medication, patient‐controlled analgesia, opioid‐naïve patients, and prolonged opioid use. Review/Analysis Methods Data were synthesized by identifying themes reflecting the results of the review. A quality assessment of the articles was also conducted. Results Fourteen articles were included and two main themes emerged: (1) Surgery places opioid naïve patients at risk for prolonged opioid use and (2) Certain patient characteristics may be predictive of prolonged postoperative opioid use. Conclusions Prolonged postoperative opioid use is related to factors in addition to prescribing practices. Researchers consistently found that patients who are already on opioids, benzodiazepines, or addicted to alcohol; who have mental health disorders, depressive symptoms, or a self‐perceived risk of addiction; and patients with multiple co‐morbidities are at greater risk of prolonged use; demographics were inconsistent. Nursing Implications Studies are needed to determine the predicting characteristics of prolonged postoperative opioid use, the type of surgeries that place patients at most risk, and the effect postoperative exposure to opioids has on prolonged use. This information can be used to develop and implement protocols to prevent misuse among high‐risk patients.

Implementation of an inpatient opioid overdose prevention program.

In 2008, drug overdose surpassedmotor vehicle accident fatalities as the leading of cause of injury death in the United States (Centers for Disease Control and Prevention, 2014). Opioid overdoses have more than tripled in the past decade leaving communities and families fragmented and in need of overdose prevention services (Centers for Disease Control and Prevention, 2014). In 1996, opioid overdose prevention programs (OOPPs) began distributing naloxone hydrochloride, brand name Narcan® to individuals at high risk for witnessing or experiencing an opioid overdose (Wheeler, Davidson, Jones, & Irwin, 2012). Narcan® competitively binds to opioid receptors and reverses the effects of an opioid overdose thereby preventing a fatality (Boyer, 2012; Sporer & Kral, 2007). See Figs. 1 and 2

Implementation of nasal naloxone across health- care settings: a case report from Ohio

Drug overdose is now the leading cause of injury death in the United States, surpassing deaths from motor vehicle accidents in 2008 [1]. Naloxone, a short-acting mu opioid receptor antagonist, can reverse an opioid overdose and prevent fatality [2]. Opioid overdose prevention programs (OOPPs) provide education on overdose prevention and some have begun to distribute naloxone. As of June 2010, there were an estimated 188 OOPPs operating in the United States [3]; despite the fact that Ohio has one of the highest overdose fatality rates, there were no OOPPs at that time. The purpose of this study is to: 1) describe overdose prevention education and/or naloxone distribution programs in Ohio across various health-care settings; and 2) identify implementation barriers. A two-page survey was emailed to known Ohio OOPPs and snowball sampling was used to identify other programs. OOPP staff were contacted by phone to confirm their interest in study participation, and 19 of 21 programs completed the survey and are included in this analysis. As of October 2014 these 19 OOPPs were operating in 14 Ohio cities. The primary funding sources were: 1) Ohio Department of Health; 2) Interact for Health (a foundation serving southwest Ohio); and 3) other local public and private agencies. Overall, these programs have distributed 1935 naloxone kits and reported 152 confirmed overdose reversals. There was significant expansion of OOPPs in Ohio after the passage of House Bill 170 in 2014, which removed criminal and civil penalties for clinicians that prescribe naloxone and bystanders that administer naloxone. Identified barriers to OOPPs include: 1) cost in terms of both the provision of naloxone kits and the operational costs associated with prescribing naloxone; 2) stigma of addiction and perceptions of naloxone as a harm reduction strategy that would enable continued drug use; 3) legal/administrative concerns related to possession and distribution of naloxone; and 4) lack of standardized protocols or models that would facilitate operational integration of OOPPs into existing programming. In conclusion, OOPPs have recently expanded significantly in Ohio. Additional research is needed to determine whether this expansion is associated with a decrease in overdose fatalities. Language: en