Gerald Cochran, MSW, PhD; 1 Bethany Brodie, MSW; 1 Alice Bell, MSW, LCSW; 2 Alex Bennett, PhD3

 1University of Pittsburgh, Pittsburgh PA; 2Prevention Point Pittsburgh, Pittsburgh PA; 3National Development and Research Institute, New York

PATIENT CHARACTERISTICS AND FACTORS ASSOCIATED OPIOID OVERDOSE AND RESUSCITATION

Background In 2011, overdose deaths surpassed motor vehicle

deaths to become the number one cause of injury death in the U.S. Of the 41,340 overdose deaths, the majority involved some type of opioid.

In the decade from 2002 to 2011, the annual number of drug poisoning deaths involving heroin doubled, from 2,089 deaths in 2002 to 4,397 deaths in 2011.

Deaths in 2010 involving prescription opioid

painkillers (N=16,651) accounted for 45% of all illicit and prescription drug overdose deaths combined.

Background Overdose prevention and response trainings have

been established in cities nationwide in order to address the rising toll of opioid-related overdoses.

Naloxone is an opioid antagonist that has been shown to safely reverse the sedative and respiratory depressing effects of a drug overdose involving opiates.

Little research is available regarding the patient characteristics and administration factors associated with naloxone.

Purpose

This exploratory retrospective data analysis examined factors associated with: Naloxone administration for an opioid

overdose Factors associated with auxiliary life-saving

efforts (rescue breathing/calling 911) in connection with naloxone administration

Methods Program and Participants

Naloxone resuscitation incident information data collected by a community-based overdose prevention program in southwestern Pennsylvania

This program provides naloxone training, prescribing, and dispensing to community members who use opioids and are interested in having naloxone available for opioid overdose resuscitation

Ethics These data were shared by program administrators with the research

team from the University of Pittsburgh.

The current research project and the analyses conducted herein were reviewed by the University of Pittsburgh Institutional Review Board and granted exempt status

Methods Data sources

Two program questionnaires○ Medical history form (cross-sectional at program entry)○ Naloxone use form (multiple observations per

participant)

Analyses Two logistic regression models

○ Forward stepwise procedure○ Predictors of naloxone administration using cross-

sectional data with longitudinal outcome○ Predictors of rescue breathing or calling 9-1-1 using

clustered SEs for multiple observationsAll analyses conducted in Stata/SE 13.1

Results Univariate description of program participantsDemographics %/ Mean n / SDWhite 88.5 822Age* 40 12.6Male 65.7 633Subsequently used naloxone from PPP for OD reversal 26.9 260

Previous OD experience Previous OD 41.3 395Previous OD taken to hospital 53.6 192Called 911 for previously witnessed OD 59.5 435Previously witness OP taken to hospital 55.1 400Witness previous OD death 20.7 147

Baseline substance use Age first opioid use* 19.7 6.8Age first needle use* 23.6 8.3Uses heroin 92.6 888Daily heroin use 80.8 665Rx opioid use 84.1 668Stimulant use last 6 months 51.7 465Occasional ETOH use last 6 months 39.6 331Daily ETOH use last 6 months 9.1 76Benzodiazepine use last 6 months 51.4 447

Baseline health statusHad a previous abscess 32.9 302Taking other medications 29.7 280Previous HIV testing 86.9 616Previous HEP-C testing 84.8 563Went to ER in previous 2 years 50.4 463Admitted to hospital in previous 2 years 31.7 289

*Mean, SD

ResultsUnivariate description of program participantsVictim had blue lips 77.5 654Victim had depressed respiration 58.1 490Victim appeared to be unconscious 41.5 350Used >2mg of naloxone 18.9 159Used on another person 91.4 7932-4 miles from a hospital 18.5 161>4 miles from a hospital 45.5 397Opioids involved in current OD 87.8 766Other drugs involved in current OD 62.7 547

ResultsBivariate and multivariate associations with use of naloxone    Bivariate associations Final multivariate model  Characteristics OR SE p   95% CI     OR SE p   95% CI  White 1.22 0.29 0.408 ( 0.8 - 2.0 )                  Age 1.03 0.01 0.000 ( 1.0 - 1.0 )   1.04 0.01 0.000 ( 1.02- 1.1)Male 1.26 0.20 0.136 ( 0.9 - 1.7 )   1.03 0.29 0.919 ( 0.6- 1.8)

Substance use  Stimulant use last 6 months 1.35 0.20 0.047 ( 1.0 - 1.8 )                  Occasional ETOH use last 6 months 0.76 0.13 0.104 ( 0.5 - 1.1 )                  Daily ETOH use last 6 months 1.06 0.29 0.843 ( 0.6 - 1.8 )                  Benzodiazepine use last 6 months 1.52 0.23 0.006 ( 1.1 - 2.1 )   1.81 0.51 0.035 ( 1.0 - 3.1)

OD experience  Previously experienced an OD 1.61 0.24 0.001 ( 1.2 - 2.1 )   0.63 0.58 0.613 ( 0.1 - 3.8)Taken to hospital for OD 1.63 0.38 0.037 ( 1.0 - 2.6 )   2.00 0.55 0.012 ( 1.2 - 3.4)Previously witnessed OD 1.82 0.34 0.001 ( 1.3 - 2.6 )   1.05 0.64 0.930 ( 0.3 - 3.4)Called 911 for previously witnessed OD 1.27 0.21 0.152 ( 0.9 - 1.8 )   0.74 0.22 0.310 ( 0.4 - 1.3)Witness previous OD death 1.08 0.22 0.707 ( 0.7 - 1.6 )                  

Health Status  Had a previous abscess 1.46 0.23 0.014 ( 1.1 - 2.0 )                  Taking other medications 2.07 0.32 0.000 ( 1.5 - 2.8 )   1.52 0.42 0.128 ( 0.9 - 2.6)Previous HIV/HepC screening 0.92 0.20 0.721 ( 0.6 - 1.4 )                  Went to ER in previous 2 years 1.31 0.20 0.075 ( 1.0 - 1.8 )                  

ResultsBivariate and multivariate associations with rescue breathing and/or calling 911

Bivariate associations Final multivariate modelCharacteristic OR SE p 95%OR   OR SE p 95%ORWhite 2.38 0.69 0.003 ( 1.3 - 4.2 )   1.17 0.68 0.785 ( 0.4-3.7 )Age 0.98 0.01 0.005 ( 1.0 - 1.0 )                  Male 0.54 0.15 0.032 ( 0.3 - 0.9 )   1.23 0.65 0.688 ( 0.4-3.5 )

Current ODVictim had blue lips 2.37 0.52 0.000 ( 1.5 - 3.7 )   1.99 0.76 0.070 ( 0.9-4.2 )Victim had depressed respiration 2.12 0.54 0.003 ( 1.3 - 3.5 )   3.45 1.33 0.001 ( 1.6-7.4 )Victim appeared to be unconscious 1.14 0.31 0.612 ( 0.7 - 1.9 )   0.81 0.33 0.603 ( 0.4-1.8 )Amount of naloxone used 1.85 0.49 0.019 ( 1.1 - 3.1 )                  Used on another person 1.55 0.62 0.270 ( 0.7 - 3.4 )   0.30 0.32 0.263 ( 0.0-2.4 )2-4 miles from a hospital 1.27 0.34 0.377 ( 0.7 - 2.1 )   1.89 0.84 0.153 ( 0.8-4.5 )>4 miles from a hospital 1.19 0.31 0.509 ( 0.7 - 2.0 )   1.54 0.62 0.289 ( 0.7-3.4 )Opioids involved in current OD 1.16 0.27 0.532 ( 0.7 - 1.8 )   1.89 0.97 0.211 ( 0.7-5.2 )Other drugs involved in current OD 1.22 0.27 0.373 ( 0.8 - 1.9 )                  

OD Experience Previously experienced an OD 1.26 0.34 0.392 ( 0.7 - 2.1 )                  Taken to hospital for OD 0.93 0.33 0.850 ( 0.5 - 1.9 )   0.94 0.89 0.950 ( 0.1-6.0 )Previously witnessed OD 1.93 0.62 0.040 ( 1.0 - 3.6 )                  Called 911 for previously witnessed OD 1.50 0.41 0.145 ( 0.9 - 2.6 )   1.32 0.65 0.570 ( 0.5-3.5 )Witness previous OD death 0.63 0.19 0.122 ( 0.3 - 1.1 )   1.09 0.63 0.883 ( 0.4-3.4 )

Substance useStimulant use last 6 months 1.36 0.38 0.273 ( 0.8 - 2.3 )   3.75 2.14 0.021 ( 1.2-11.5 )Occasional ETOH use last 6 months 1.04 0.41 0.926 ( 0.5 - 2.2 )   0.72 0.33 0.477 ( 0.3-1.8 )Daily ETOH use last 6 months 0.98 0.27 0.938 ( 0.6 - 1.7 )   0.29 0.37 0.327 ( 0.0-3.4 )Benzodiazepine use last 6 months 1.31 0.39 0.364 ( 0.7 - 2.3 )   1.38 0.65 0.494 ( 0.5-3.5 )

Health statusHad a previous abscess 0.99 0.27 0.983 ( 0.6 - 1.7 )   0.54 0.32 0.300 ( 0.2- 1.7 )Taking other medications 1.20 0.33 0.500 ( 0.7 - 2.0 )   1.73 0.81 0.244 ( 0.7- 4.3 )Previous HIV/HepC screening 4.03 2.22 0.012 ( 1.4 - 11.9 )   4.33 3.01 0.035 ( 1.1- 16. 9 )Went to ER in previous 2 years 2.13 0.53 0.002 ( 1.3 - 3.5 )   1.82 0.82 0.183 ( 0.8- 4.4 )

Discussion Increased odds for naloxone administration:

Those with a history of concomitant benzodiazepine use○ Somewhat consistent with OD literature ○ Should additional screening take place to find out more about

possible medication (ie, benzos) abuse at baseline? ○ Should those who abuse medications (ie, benzos) receive added

training or prevention education?

When personal ODs have been serious enough to merit a trip to the hospital○ Should additional screening take place to find out more of the

seriousness of previous OD experience? ○ Should those who have previously gone to hospital for OD receive

some added training or prevention education?○ What is it about having gone to the hospital previously for an OD is

driving increased naloxone administration?

Discussion Increased odds for auxiliary lifesaving efforts

Victim appeared to have depressed respiration○ Should other signs and symptoms be emphasized in

training as indicators to initiate additional lifesaving efforts? ○ Why not blue lips or unconsciousness?

HIV or HepC screening previous to receiving naloxone Rx○ Does self-care explain this relationship?○ Does length of time involved in drug use explain this

relationship? Stimulants use in 6 months previous to receiving

naloxone Rx○ Possible mediators to this relationship?

Thank you

gcochran@pitt.edu