The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #65486

Karen H. Seal, MD, MPH¹, Robert Thawley², Jon Paul Hammond², Moher Downing¹, Joshua Bamberger, MD, MPH³, Dan Ciccarone, MD, MPH⁴, Alex H. Kral, PhD², and Brian R Edlin, MD¹. (1) Urban Health Study, Department of Family and Community Medicine, University of California, San Francisco, 3180 18th Street, Suite 302, San Francisco, CA 94110, 415 502-1326, karens@itsa.ucsf.edu, (2) Urban Health Study, University of California, San Francisco, Box 1304, San Francisco, CA 94143-1304, (3) Housing and Urban Health, San Francisco Department of Public Health, 101 Grove St., Rm 321, San Francisco, CA 94102, (4) Urban Health Study, Dept. of Family and Community Medicine, University of California, San Francisco, 3180 18th St. Suite 302, Campus Box 1304, San Francisco, CA 94110

Aims: Preventable heroin overdose deaths occur in San Francisco at epidemic levels. We designed an intervention to reduce overdose deaths by training heroin injectors in resuscitation techniques and the use of naloxone (an injectable opiate antagonist). Methods: The Urban Health Study developed an overdose management program with the San Francisco Department of Public Health and other community organizations. Twelve heroin injection partner dyads (n=24) were enrolled in 8/01 and underwent 8 hours of education and skills training in heroin overdose prevention, resuscitation techniques, and the administration of naloxone. Participants were followed for 6 months with quantitative and qualitative interviews monthly, and after each overdose event. Results: From 9/01-2/02, participants directly experienced or intervened in 23 reported heroin overdose events and actively performed resuscitation in 21/23 (91%). Participants administered naloxone in 14/21 (67%) overdose events, mostly in conjunction with CPR and/or rescue breathing (79%). In 7/21 cases in which naloxone was not administered, CPR was performed and/or 911 or medical help was accessed. All 14 participant interventions with naloxone were successful. Of two deaths, one did not involve participant intervention and was largely attributed to underlying medical problems, while the other was never confirmed by authorities. At 6 months follow-up, there were statistically significant increases in knowledge of heroin overdose prevention and management and entry into drug treatment, while there were decreases in the frequency of heroin overdose and heroin injection. Conclusions: Providing naloxone to IDUs can save lives and does not appear to cause increased drug use or heroin overdose.

Learning Objectives:

At the conclusion of this session, the attendee will be able to:
• List key features of a heroin overdose prevention and management curriculum,
• Describe the use of naloxone and resuscitation techniques by heroin injectors to manage heroin overdose, and
• Evaluate outcomes of a pilot heroin overdose management program which included naloxone distribution

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.