Take-home naloxone in multicentre emergency settings: the TIME feasibility cluster RCT DOI Creative Commons
Helen Snooks, Jonathan Benger, Fiona Bell

et al.

Health Technology Assessment, Journal Year: 2024, Volume and Issue: unknown, P. 1 - 69

Published: Oct. 1, 2024

Background Opioids kill more people than any other drug. Naloxone is an opioid antagonist which can be distributed in take-home ‘kits’ for peer administration (take-home naloxone). Aim To determine the feasibility of carrying out a definitive randomised controlled trial naloxone emergency settings. Design We used Welsh routine data (2015–21) to test developing discriminant function identify at high risk fatal overdose. carried cluster and qualitative study examine experiences service users providers. assessed intervention methods against predetermined progression criteria related to: site sign-up, staff trained, identification eligible patients, proportion given kits, who died poisoning, linkage retrieval outcomes. Setting This was environment; sites comprised department associated ambulance catchment area. Participants At sites, we invited clinicians paramedics participate. recruited adult patients arrived or were attended by problem use with capacity consent receiving training. Interventions Usual care basic life support plus staff. The offered addition usual care, guidance recipients on support, importance calling services, duration effect, safety legality administration. Results Discriminant With low numbers opioid-related deaths (1105/3,227,396) having no contact health services year before death, predictive link between death healthcare events weak. Logistic regression models indicated would need monitor one-third population capture 75% decedents from overdose 1-year follow-up. Randomised Four participated 299 687 (44%) clinical trained. Sixty kits supplied during recruitment. Eligible not 164 times: ‘forgot’ ( n = 136); ‘too busy’ 15); suspected intentional 3). Qualitative interviews Service had levels knowledge about naloxone. They supportive but noted concerns withdrawal resistance attending hospital providers positive reported barriers including difficulty consenting training high-risk users. Health economics able calculate costs train three (£40 per AS £17 Site 1 ED). No adverse reported. Progression met – fewer 50% received outcomes retrieved within reasonable timescales. Future work needs developed evaluated settings, appropriate methods. Limitations Take-home Intervention Multicentre Emergency setting interrupted coronavirus disease. Conclusions did meet feasibility, so followed up fully powered planned. Trial registration registered as ISRCTN13232859. Funding award funded National Institute Care Research (NIHR) Technology Assessment programme (NIHR ref: 16/91/04) published full ; Vol. 28, No. 74. See NIHR Awards website further information.

Language: Английский

Flexible delivery of opioid agonist treatment during COVID-19 in Norway: qualitative and quantitative findings from an online survey of provider experiences DOI Creative Commons
Rebecca McDonald, Anne Berit Bech, Thomas Clausen

et al.

BMC Health Services Research, Journal Year: 2023, Volume and Issue: 23(1)

Published: Sept. 7, 2023

For patients receiving daily opioid agonist treatment (OAT) for dependence, several countries relaxed guidelines at the beginning of COVID-19 pandemic. This involved longer take-home intervals methadone and buprenorphine doses as well a reduction in supervised dosing drug screening. To date, little is known about medium or long-term experience OAT deregulation. Therefore, we conducted survey to explore how providers perceived greater flexibility service delivery end second year pandemic.Nationwide cross-sectional study twenty-three units 19 publicly funded hospital trusts Norway. were sent 29-item online questionnaire comprising closed-format open-ended questions on provider experiences changes during past 12 months (January December 2021).Twenty-three (of whom female: 14; 60.8%) managers lead physicians completed reporting that, 2021, most (91.3%, n = 21) still practiced some adjusted approaches established The common adaptions special protocols cases (95.7%, 22), increased use telephone- video consultations (87.0%, 20), medications (52.2%, 12). depot also substantially According providers, handled flexible provision well. In individual cases, patients' substance was identified key factor necessitating reintroduction Collaboration with general practitioners municipal health social services generally crucial successful delivery.Overall, Norwegian system proved resilient pandemic, its healthcare workforce embraced innovation technology (telemedicine) development (depot buprenorphine). our nationally representative sample compliant buprenorphine. Our findings suggest that telemedicine can be useful adjunct face-to-face provide patients.

Language: Английский

Citations

6
Sweden’s first Take-Home Naloxone program: participant characteristics, dose endpoints and predictors for overdose reversals DOI Creative Commons
Elin Holmén,

Anna Warnqvist,

Martin Kåberg

et al.

Substance Abuse Treatment Prevention and Policy, Journal Year: 2023, Volume and Issue: 18(1)

Published: April 22, 2023

Opioid overdoses are a growing concern, particularly among people who inject drugs. Sweden, with comparatively high proportion of drug-related mortality, introduced its first Take-Home Naloxone (THN) program in 2018, at the Stockholm needle and syringe (NSP). In this study we compare THN participant characteristics regarding refills overdose reversals as well investigate predictors associated number reversals. We also interventions performed situations endpoints for naloxone doses.This was prospective open inclusion cohort conducted between January 24th 2018 March 31st 2022 NSP. Participants received THN, free charge, after training session provided data drug use experiences. During refill visits, participants reported if used reversal and, so, responded to ten-item questionnaire which included stating whether recipient themselves or somebody else. Questionnaire combined NSP database demographic data. Zero-inflated Poisson regression applied analyse reversals.Among (n = 1,295), 66.5% stated opioids their primary drug, 61.4% 81.0% had previous experience personal witnessed overdose, respectively. Overall, 44.0% total 1,625 victim known have survived 95.6% cases. Stimulant (aIRR 1.26; 95% CI 1.01, 1.58), benzodiazepine 1.75; 1.1, 2.78) homelessness 1.35; 1.06, 1.73) were an increased Mortality higher those least one (HR 3.4; 2.2, 5.2).An NSP's existent framework can be utilised effectively implement program, provide basic reach numerous high-risk individuals. four-year study, reversed sizeable potentially fatal overdoses, many by whose not opioids. rate high, indicating that motivated maintain supply case future events.

Language: Английский

Citations

4
Substance use disorders and COVID-19: reflections on international research and practice changes during the “poly-crisis” DOI Creative Commons
Hannah Carver,

Teodora Ciolompea,

Anna Conway

et al.

Frontiers in Public Health, Journal Year: 2023, Volume and Issue: 11

Published: July 17, 2023

Since March 2020, the COVID-19 pandemic has had a disproportionately high toll on vulnerable populations, coinciding with increased prevalence of alcohol-and drug-related deaths and pre-existing societal issues such as rising income inequality homelessness. This poly-crisis posed unique challenges to service delivery for people substance use disorders, innovative approaches have emerged. In this Perspectives paper we reflect changes research practice those experiencing following work undertaken part InterGLAM project (part 2022. Lisbon Addictions conference). The authors, who were an working group, identified range creative novel responses by gathering information from conference attendees about COVID-19-related disorder treatment in their countries. describe these across countries, focusing telehealth, provision medications opioid alcohol harm reduction, well how was conducted. Implications include better equity access technology secure data systems; prescribed safer supply countries where currently does not exist; flexible medication disorder; scale up reduction disorders; greater involvement lived/living experience research; additional support low- middle-income changed addictions field there are lessons ongoing emerging crises.

Language: Английский

Citations

4
Closing doors, opening windows – Adaptations and opportunities for harm reduction services during the COVID-19 pandemic in Europe DOI
Rafaela Rigoni, Tuukka Tammi

Drugs Education Prevention and Policy, Journal Year: 2024, Volume and Issue: unknown, P. 1 - 12

Published: June 5, 2024

Background Across Europe, harm reduction services experienced significant disruptions during the COVID-19 pandemic. This study analyses experiences of service providers pandemic in 34 European cities, focusing on their main challenges, adaptations, and opportunities for change. A closer examination Athens Dublin offers an in-depth look into these experiences.

Language: Английский

Citations

1
Approaches to enabling rapid evaluation of innovations in health and social care: a scoping review of evidence from high-income countries DOI Creative Commons
Gill Norman, Thomas Mason, Jo C Dumville

et al.

BMJ Open, Journal Year: 2022, Volume and Issue: 12(12), P. e064345 - e064345

Published: Dec. 1, 2022

Objective The COVID-19 pandemic increased the demand for rapid evaluation of innovation in health and social care. Assessment methodologies is lacking although challenges ensuring rigour effective use resources are known. We mapped reports evaluations care innovations, categorised different approaches to evaluation, explored comparative benefits identified knowledge gaps. Design Scoping review. Data sources MEDLINE, EMBASE Health Management Information Consortium (HMIC) databases were searched through 13 September 2022. Eligibility criteria selecting studies included publications reporting primary research or methods interventions services high-income countries. extraction synthesis Two reviewers developed piloted a data form. One reviewer extracted data, second checked 10% studies; disagreements uncertainty resolved consensus. used narrative map conducting evaluation. Results 16 759 records 162 which met inclusion criteria. four main evaluation: (1) Using methodology designed specifically evaluation; (2) Increasing rapidity by doing less using time-intensive methodology; (3) alternative technologies and/or increase speed existing method; (4) Adapting part non-rapid resulted an some limited changes methods. found little comparing Conclusions lack clarity about what ‘rapid evaluation’ means but useful preliminary categories. There need consistency constitutes consistent terminology as rapid; development specific making more assessment advantages disadvantages terms rigour, cost impact.

Language: Английский

Citations

7
Disruptions to naloxone training among lay and occupational responders in Maryland during the emergence of COVID-19: Early impacts, recovery, and lessons learned DOI Creative Commons
Himani Byregowda, Catherine Tomko, Kristin E. Schneider

et al.

Drug and Alcohol Dependence Reports, Journal Year: 2023, Volume and Issue: 8, P. 100173 - 100173

Published: June 16, 2023

: Opioid overdose death rates increased during the COVID-19 pandemic. Disruptions in community-based naloxone trainings could have reduced likelihood of reversal and chances a fatal overdose. We investigated changes number people trained administration distribution Maryland before, during, after COVID-related stay-at-home orders. Data on training are from Department Health. used interrupted time series models to estimate average monthly trained: [1] pre-interruption (4/2019-3/2020), [2] 1-month post-interruption (4/2020-5/2020), [3] 12-months (4/2020-3/2021). Trainees were classified as lay (e.g., who use drugs) or occupational law enforcement officers harm reduction workers) responders. There 101,332 trainees; 54.1% lay, 21.5% occupational, 23.4% unknown responder status. observed decrease trainees period (-235, p<0.001), larger 93.2% (-846, p=0.013), an increase (+217, p<0.001). was significant among responders post-interruption, 12-month period. Findings suggest marked immediately order, followed by moderate rebound order. The may limited access naloxone, but would likely been offset increases trained. Strengthening connections maintain public health crises.

Language: Английский

Citations

2
National increase in the community supply of take‐home naloxone associated with a mass media campaign in Scotland: a segmented time series analysis DOI

KMA Trayner,

Alan C. Yeung, Harry Sumnall

et al.

International Journal of Drug Policy, Journal Year: 2023, Volume and Issue: 131, P. 104106 - 104106

Published: Aug. 8, 2023

Language: Английский

Citations

2
Is a definitive trial of Take-Home Naloxone in emergency settings indicated? Results of a cluster randomised feasibility study DOI Creative Commons
Helen Snooks, Jenna Jones, Fiona Bell

et al.

Research Square (Research Square), Journal Year: 2024, Volume and Issue: unknown

Published: March 15, 2024

Abstract Background Opioids kill more people than any other class of drug. Naloxone is an opioid antagonist which can be distributed in kits for peer administration. We aimed to determine feasibility undertaking a definitive randomised controlled trial (RCT) Take-home (THN) emergency settings. Methods Using individual-level-routine health records (2015-21) we tested developing discriminant function identify at high-risk fatal poisoning outcome comparisons. undertook clustered RCT on paired UK Emergency Department (ED) and ambulance service sites. At intervention sites, recruited practitioners administer THN patients presenting with overdose or related condition during ta 1year recruitment period, 2019 – 21. assessed methods against predetermined progression criteria. Results Within routine the population Wales (~3,200,000), identified 1,105 adult deaths from poisoning, whom 307 (27.8%) had no ED drugs contacts year before death. predicted probability threshold 0.0003, based demographics recent healthcare 809 within 1 (sensitivity 74.7%) 989,151 people, missing 274 cases. Lowering 0.0002 increased sensitivity 86.1% but included further 608,191 non-cases; raising it 0.0004 reduced 65.4% inclusion non-cases 646,750. two randomly selected 4: 299/687 (43.5%) clinical staff were trained; 60/277 eligible (21.7%) supplied kit adverse events reported. Conclusion With low incidence opioid-related death significant proportion contact drug services death, numbers needed reach reasonable was very high. This study did not meet criteria, fully powered planned. Trial Registration ISRCTN13232859 (Registered 16/02/2018)

Language: Английский

Citations

0
Take-home naloxone administered in emergency settings: feasibility of intervention implementation in a cluster randomized trial DOI Creative Commons
Helen Snooks, Jenna Jones, Fiona Bell

et al.

BMC Emergency Medicine, Journal Year: 2024, Volume and Issue: 24(1)

Published: Aug. 29, 2024

Opioids kill more people than any other class of drug. Naloxone is an opioid antagonist which can be distributed in kits for peer administration. We assessed the feasibility implementing a Take-home (THN) intervention emergency settings, as part designing definitive randomised controlled trial (RCT).

Language: Английский

Citations

0
Take-home naloxone in multicentre emergency settings: the TIME feasibility cluster RCT DOI Creative Commons
Helen Snooks, Jonathan Benger, Fiona Bell

et al.

Health Technology Assessment, Journal Year: 2024, Volume and Issue: unknown, P. 1 - 69

Published: Oct. 1, 2024

Background Opioids kill more people than any other drug. Naloxone is an opioid antagonist which can be distributed in take-home ‘kits’ for peer administration (take-home naloxone). Aim To determine the feasibility of carrying out a definitive randomised controlled trial naloxone emergency settings. Design We used Welsh routine data (2015–21) to test developing discriminant function identify at high risk fatal overdose. carried cluster and qualitative study examine experiences service users providers. assessed intervention methods against predetermined progression criteria related to: site sign-up, staff trained, identification eligible patients, proportion given kits, who died poisoning, linkage retrieval outcomes. Setting This was environment; sites comprised department associated ambulance catchment area. Participants At sites, we invited clinicians paramedics participate. recruited adult patients arrived or were attended by problem use with capacity consent receiving training. Interventions Usual care basic life support plus staff. The offered addition usual care, guidance recipients on support, importance calling services, duration effect, safety legality administration. Results Discriminant With low numbers opioid-related deaths (1105/3,227,396) having no contact health services year before death, predictive link between death healthcare events weak. Logistic regression models indicated would need monitor one-third population capture 75% decedents from overdose 1-year follow-up. Randomised Four participated 299 687 (44%) clinical trained. Sixty kits supplied during recruitment. Eligible not 164 times: ‘forgot’ ( n = 136); ‘too busy’ 15); suspected intentional 3). Qualitative interviews Service had levels knowledge about naloxone. They supportive but noted concerns withdrawal resistance attending hospital providers positive reported barriers including difficulty consenting training high-risk users. Health economics able calculate costs train three (£40 per AS £17 Site 1 ED). No adverse reported. Progression met – fewer 50% received outcomes retrieved within reasonable timescales. Future work needs developed evaluated settings, appropriate methods. Limitations Take-home Intervention Multicentre Emergency setting interrupted coronavirus disease. Conclusions did meet feasibility, so followed up fully powered planned. Trial registration registered as ISRCTN13232859. Funding award funded National Institute Care Research (NIHR) Technology Assessment programme (NIHR ref: 16/91/04) published full ; Vol. 28, No. 74. See NIHR Awards website further information.

Language: Английский

Citations

0