Via Research Recognition Day 2024 VCOM-Carolinas

Educational Reports

Self-Administered Naloxone as an Adjunct to Reduce Mortality and Morbidity Rate in Opioid Overdose Deaths Anna Marchek OMS-II, Julia Wolf OMS- II, Georgia O’Leary OMS -II, Gabriela Pages OMS-II, Madison Benefield OMS-II, Brooke Bennett OMS-II, Priyanka Arunkumar OMS-I, Marc Burrows LMSW, Alexis Stoner PhD, Jeff Cashman D.O.

Introduction

Results

Discussion and Conclusion

. Context: Laurens County, South Carolina has the 6th highest rate of drug overdose deaths in the state (SC DHEC, 2020). 19.2% of individuals in Laurens County live below the poverty line, which is 1.5 times the rate in the United States (SC DHEC, 2020). Additionally, Laurens County has the 9th highest rate of naloxone administration in the state of South Carolina (US DHHS, 2020). Rationale: While efforts are being made to reduce the deaths and overdoses associated with opioid use through naloxone administration, opioid overdose is still a leading cause of mortality in South Carolina. Therefore, it is imperative we address this problem through implementing education strategies that empower individuals on self-administering naloxone and reduce the overall mortality associated with opioid overdose. Research YƵĞƐƚŝŽŶ : This study investigated whether education on naloxone administration would instill confidence in individuals in the presence of an opioid overdose, to hopefully reduce the associated morbidity and mortality. The research was conducted through a partnership with Challenges INC., a mobile overdose prevention harm reduction service as well as Gateway Counseling Center, which is an outpatient substance abuse treatment program. Study Population : Interested individuals 18 years or older present at Gateway Counseling Center were included in the study following verbal consent. Our anticipated enrollment goal was 20 participants. Intervention: Participants completed a survey before and after receiving hands-on education for proper naloxone administration techniques. Baseline non-identifiable demographics, ease of accessibility, and pre- and post- opioid related measures were collected. Pre-naloxone education measures included the following questions: ● Have you ever witnessed an opioid overdose? ● Do you agree with the following statement? “I feel comfortable administering Naloxone/Narcan.” ● Have you had prior education on administering Naloxone/Narcan? Participants were then asked how confident they felt in their ability to administer naloxone after the educational session, and if they had any additional questions. Finally, if the participants chose, they received a small supply of Naloxone/Narcan. Outcomes Assessed: ● Primary outcome measures: amount of participants educated, confidence following education, and amount of naloxone distributed to participants. ● Secondary outcome measures: demographic non-identifiable information including age, sex, ease of access, prior education on naloxone, and witness of an opioid overdose. Methods Study Design: Community-based cross-sectional, quantitative research study in Laurens County, SC that included one day of data collection and no follow-up.

Study Results:

Discussion: This study exceeded enrollment goals and successfully educated patients on safe naloxone use. Naloxone was provided to 15 of the 23 participants to better prepare individuals if faced with an opioid overdose. There were no participants between the ages of 18 and 24 (Table 1). Data from 2021 shows that people under 24 have a lower percentage of opioid overdoses (17.2 deaths/100,000) than those between 25 and 64 years old (Spencer, et. al 2022). Further research should include how to better reach younger populations. CDC data from 2021 shows that the population with the highest rates of opioid overdose are between 35 and 44 years of age, which is consistent with our data showing 39.1% of participants within this age range (Table 1). One hundred percent of participants educated on naloxone administration verbalized confidence following education (Figure 2). This finding agrees with previous literature that found that personally-tailored opioid overdose prevention education increased knowledge of overdoses and decreased overdose-risk related behaviors (Winhusen 2020). Increasing bystander confidence in administering naloxone can decrease the rates of opioid-related deaths. Of the 3 participants that chose to not be educated on naloxone administration, 2 had prior experience using naloxone, and one participant declined due to personal beliefs. Conclusion : The results of our study showed that participants were more confident in administering naloxone following adequate education. Future studies should determine whether an increase in naloxone education and distribution increases community awareness of the opioid pandemic and aids to reduce mortality and morbidity rates related to opioid overdoses. In addition, this study was also limited to individuals within the vicinity of a substance use outpatient program. Therefore, including a more widespread study population could strengthen outcomes.

Table 1: Baseline Demographics Twenty-three participants were enrolled into the study. Age ranges and sex were collected, shown in the table below. The majority of the participants were between the ages of 25 and 44 years old, with no participants between the ages of 18 and 24. Ease of access was also assessed, where 87.0% of the participants found the Challenges Bus/Event to be accessible.

Figure 1: Pre-Naloxone Education Survey Self reported survey data prior to naloxone education using a binary (Y/N) scale (A) and a likert scale (B). ● (A) 10 of the 23 participants (43.5%) reported witnessing an opioid overdose. 11 participants (47.8%) also reported having prior naloxone education. ● (B) 15 of the 23 participants (65.2%) expressed comfort (strongly agree or agree) with administering naloxone prior to naloxone education.

Figure 2: Post-Naloxone Education Survey Reported data post-naloxone education was collected by research personnel using binary (Y/N) scales: ● (A) 20 of the 23 participants (87.0%) were educated on naloxone administration. ● (B) 14 of the 20 participants educated (70%) took a sample of naloxone. ● (C) 20 of the 20 participants educated (100%) verbalized confidence in administering naloxone (compared to the 65.2% prior to the session).

References

Hanson, Bridget L et al. “Preventing opioid overdose with peer - administered naloxone: findings from a rural state.” Harm reduction journal vol. 17,1 4. 9 Jan. 2020, doi:10.1186/s12954-019-0352-0 Miller, Nicole M et al. “How do naloxone - based interventions work to reduce overdose deaths: a realist review.” Harm reduction journal vol. 19,1 18. 23 Feb. 2022, doi:10.1186/s12954-022-00599-4 Strang, John et al. “Take -Home Naloxone for the Emergency Interim Management of Opioid Overdose: The Public Health Application of an Emergency Medicine.” Drugs vol. 79,13 (2019): 1395-1418. doi:10.1007/s40265-019-01154 5 Winhusen, Theresa et al. “Evaluation of a personally -tailored opioid overdose prevention education and naloxone distribution intervention to promote harm reduction and treatment readiness in individuals actively using illicit opioids.” Drug and alcohol dependence vol. 216 (2020): 108265. doi:10.1016/j.drugalcdep.2020.108265 “SC DHEC Health Initiative.” Ten at the Top , 20 Mar. 2023, tenatthetop.org/health-data-walks/. U.S. Census Bureau (2021). American Community Survey 1-year estimates. Retrieved from Census Reporter Profile page for Laurens County, SC “Where to Go for Help.” SCDHHS , South Carolina Department of Health and Human Services, www.scdhhs.gov/members/where-go-help. Accessed 17 Sept. 2023.

Acknowledgements

Thank you to Challenges INC., Gateway Counseling Center and the VCOM-Carolinas campus for their collaboration and support during this project. Edward Via College of Osteopathic Medicine Institutional Review Board, Blacksburg, VA

Basic Statistical Approach : Descriptive statistical analysis.

IRB Number: 2023-091 Approval: 08/07/2023

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2024 Research Recognition Day