Provision of naloxone to injection drug users as an overdose prevention strategy: Early evidence from a pilot study in New York City

Abstract

Introduction

Naloxone, an opiate antagonist that can avert opiate overdose morality, has long been prescribed to drug users in Europe and in a few US cities. However, there has been little documented evidence of naloxone distribution programs and their feasibility in the peer reviewed literature in the US.

Methods

A pilot overdose prevention and reversal program was implemented in a New York City syringe exchange program. We assessed demographics, drug use, and overdose history, experience, and behavior at baseline, when participants returned for prescription refills, and 3 months after baseline assessment.

Results

25 participants were recruited. 22 (88%) participants were successfully followed-up in the first 3 months; of these, 11 (50%) participants reported witnessing a total of 26 overdoses during the follow-up period. Among 17 most-recent overdoses witnessed, naloxone was administered 10 times; all persons who had naloxone administered lived.

Discussion

Naloxone administration by injection drug users is feasible as part of a comprehensive overdose prevention strategy and may be a practicable way to reduce overdose deaths on a larger scale.

Introduction

Approximately half of all illicit drug users report at least one nonfatal overdose during their lifetime, and death rates from accidental drug overdose have been increasing throughout the United States over the past decade (Centers for Disease Control and Prevention (CDC), 2000a, Centers for Disease Control and Prevention (CDC), 2000b, Davidson et al., 2002, Ochoa et al., 2001, Seal et al., 2001). Naloxone is a specific opioid receptor antagonist used clinically to reverse an opiate overdose or the effects of opiate analgesia. Effects occur within 1–2 min of administration and last 45 to 90 min (Chamberlain & Klein, 1994). Opiate overdose reversal with naloxone is nearly universal, and adverse effects are rare at therapeutic doses (Sporer, 1999, Strang et al., 1996).

Naloxone was prescribed to illicit drug users in conjunction with rescue breathing training in a trial in 2001–2002 in San Francisco, California, since 1999 in Chicago, Illinois, as part of a state overdose prevention initiative in New Mexico since 2001, and beginning in 2003, through the Baltimore Department of Health (Bigg & Maxwell, 2002, Seal et al., 2005). Since the 1980s, naloxone has been available as an over-the-counter medication in Italy and distributed through low-threshold services in Berlin, Germany, and Jersey, United Kingdom (Campana, 2000, Dettmer et al., 2001). Preliminary results from Berlin, Jersey, and San Francisco document lifesaving events through peer administration of naloxone without observed adverse effects (Lenton & Hargreaves, 2000, Seal et al., 2005, Strang et al., 1999).

There has been little documented evidence, however, of naloxone distribution programs and their feasibility in the peer reviewed literature in the US. This is a particular problem when recognizing that opposition to all manners of risk reduction strategies persist in the US and that drug overdose deaths continue substantially unabated in many large US cities. Nationwide, the largest number of drug-induced deaths are in New York City (NYC); approximately 800 to 900 persons a year die from a drug-induced death in New NYC (Coffin et al., 2003). For the past 5 years, the annual overdose death rate has been higher than the annual homicide death rate and deaths due to drug abuse currently rank among the five leading causes of death in 15–54 year olds (New York City Department of Health and Mental Hygiene, 2003). This report summarises pilot data about the first systematic naloxone distribution program in NYC.