Frequent, public drug users may be good candidates for overdose-treatment training

March 26, 2018, Johns Hopkins University Bloomberg School of Public Health

In response to America's opioid crisis, public health departments and community organizations across the country have started to train opioid users to reverse overdoses in other users with the opioid-blocker naloxone. The most frequent and public opioid users may be the best available candidates for naloxone training, according to a new study from scientists at Johns Hopkins Bloomberg School of Public Health.

The scientists interviewed 450 Baltimore drug users—the vast majority with histories of —and found that users who had witnessed more drug overdoses tended to be those who engaged in riskier drug use and used drugs in more places.

"A user can't administer naloxone to himself when he's overdosing, so from a standpoint we need to figure out which users are most likely to witness other users' overdoses and thus be in position to revive them," says senior author Carl A. Latkin, PhD, professor in the Bloomberg School's Department of Health, Behavior and Society. "Our results indicate that the likeliest witnesses are the heavier users who use in a wider range of settings."

The study, published in the journal Substance Abuse, comes as the crisis continues to worsen across the U.S. Emergency room visits for opioid overdoses surged by a third during 2016-2017, and the daily opioid-overdose death toll now averages 115, according to government statistics. Maryland, where statistics are dominated by Baltimore, is no exception to the trend. "Every time you look at the annual overdose fatality numbers for the state, they're higher," Latkin says.

Opioid drug overdoses can easily be fatal because these drugs' side effects include the suppression of brain cell activity that controls breathing. Naloxone, which can be administered by injection or nasal spray, powerfully blocks opioids' effects on brain cells, and thus can quickly restore normal breathing and consciousness in an overdose victim. But there is often only a brief window of opportunity for its effective use—particularly when the overdose involves one of the more potent opioids, such as fentanyl. "Since fentanyl is more potent and faster acting than heroin, you really need to ensure that naloxone is immediately available in the case of an overdose," Latkin says.

Maryland, like many other states, allows pharmacists to dispense naloxone without a prescription and sanctions naloxone training and distribution programs by health organizations. How to direct limited supplies of naloxone most effectively is an unanswered question, however.

The study stemmed from a larger HIV risk-reduction project in which hundreds of impoverished Baltimore were interviewed about their drug-use habits. Latkin and colleagues analyzed the interview data to find factors that would allow them to identify users who were most likely to witness overdoses—users who might therefore be good candidates for naloxone training.

The analysis covered 450 participants who had provided relevant information on their drug-use behaviors. Roughly 75 percent of these users reported that they had witnessed an overdose. About 12 percent had witnessed more than five. Not surprisingly, those who had witnessed more overdoses tended to be those whose behaviors indicated a deeper involvement in drug abuse. In the analysis, the behaviors that were most strongly associated with witnessing overdoses included injecting with heroin and/or "speedball" (cocaine plus heroin), snorting heroin, having an overdose history, using city needle-exchange programs and using drugs in a greater variety of places—such as public restrooms, "shooting galleries" and abandoned buildings.

"These results give us some clues about the individuals we should be training in the use of naloxone," Latkin says. "Drug users have consistently demonstrated their abilities to help others prevent HIV and treat overdose victims."

He emphasizes that this fact doesn't make the problem an easily soluble one. "Training users to administer naloxone and distributing it in affected areas is no guarantee that these users will have it with them when needed. It is also important for both drug users and non-using family members to discuss and plan for preventing and treating overdoses," Latkin says.

His group's follow-on projects are now aimed in part at those issues of availability and witnesses' willingness to use it. "Clearly a lot more needs to be done to resolve this crisis," he says. "In addition to addressing causes of opioid abuse, we need to reduce stigma and increase access to effective drug treatments."

"The relationship between drug use settings, roles in the drug economy, and witnessing a overdose in Baltimore, Maryland" was written by Carl A. Latkin, Catie Edwards, Melissa A. Davey-Rothwell, Cui Yang, and Karin E. Tobin.

Explore further: Let's talk about Rx use—recognizing and reversing an overdose

Related Stories

Let's talk about Rx use—recognizing and reversing an overdose

March 23, 2018
According to the National Institute on Drug Abuse, the misuse of and addiction to opioids is a serious national crisis, with more than 115 Americans dying from opioid overdose every day. Knowing how to prevent and recognize ...

Opioid overdoses in ERs up 30 percent as crisis worsens

March 6, 2018
Emergency rooms saw a big jump in overdoses from opioids last year—the latest evidence the nation's drug crisis is getting worse.

Overdose prevention and naloxone rescue among family members of people who use opioids

April 29, 2017
Family members are often the ones who administer naloxone during an opioid overdose and should be considered as part of the larger response to help curb fatal overdoses. These findings, published online in Drug and Alcohol ...

Opioid abuse leads to heroin use and a hepatitis C epidemic, researcher says

February 22, 2018
Heroin is worse than other drugs because people inject it much sooner, potentially resulting in increased risk of injection-related epidemics such as hepatitis C and HIV, a Keck School of Medicine of USC study shows.

Fatal opioid overdoses on the rise in Canada

February 1, 2018
Fatal opioid overdoses jumped in Canada last year, especially in British Columbia, where the potent sedative fentanyl was detected in eight of 10 overdose deaths, according to preliminary figures released Wednesday.

Recommended for you

Rapid response inpatient education boosts use of needed blood-thinning drugs

November 16, 2018
A new study designed to reach hospitalized patients at risk shows that a "real-time" educational conversation, video or leaflet can lower the missed dose rates of drugs that can prevent potentially lethal blood clots in their ...

Drug overdose epidemic goes far beyond opioids, requires new policies

November 7, 2018
Most government-funded initiatives to address the overdose epidemic in the United States have targeted opioids specifically and have neglected other drugs that are increasingly implicated in overdoses, such as cocaine and ...

Zebrafish larvae help in search for appetite suppressants

November 2, 2018
Researchers at the University of Zurich and Harvard University have developed a new strategy in the search for psychoactive drugs. By analyzing the behavior of larval zebrafish, they can filter out substances with unwanted ...

FDA OKs powerful opioid pill as alternative to IV painkiller

November 2, 2018
U.S. regulators on Friday approved a fast-acting, super-potent opioid tablet as an alternative to IV painkillers used in hospitals.

Amphetamine-related hospitalizations surged between 2003 and 2015

November 2, 2018
An analysis conducted by Hennepin Healthcare, University of Minnesota School of Public Health and University of Michigan researchers shows amphetamine-related hospitalizations increased more than 270 percent from 2008 to ...

Cocaine-fentanyl overdoses underscore need for more 'test strips' and rapid response

November 1, 2018
Penn Medicine emergency department physicians are calling for more readily available testing strips to identify the presence of fentanyl in patients experiencing a drug overdose, and a rapid, coordinated response among health ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.