Gerald Cochran, MSW, PhD; 1 Bethany Brodie, MSW; 1 Alice Bell, MSW, LCSW; 2 Alex Bennett, PhD 3 1 University of Pittsburgh, Pittsburgh PA; 2 Prevention Point Pittsburgh, Pittsburgh PA; 3 National 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  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 using clustered SEs for multiple observations All analyses conducted in Stata/SE 13.1

Results Univariate description of program participants Demographics%/ Meann / SD White Age* Male Subsequently used naloxone from PPP for OD reversal Previous OD experience Previous OD Previous OD taken to hospital Called 911 for previously witnessed OD Previously witness OP taken to hospital Witness previous OD death Baseline substance use Age first opioid use* Age first needle use* Uses heroin Daily heroin use Rx opioid use Stimulant use last 6 months Occasional ETOH use last 6 months Daily ETOH use last 6 months9.176 Benzodiazepine use last 6 months Baseline health status Had a previous abscess Taking other medications Previous HIV testing Previous HEP-C testing Went to ER in previous 2 years Admitted to hospital in previous 2 years *Mean, SD

Results Univariate description of program participants Victim had blue lips Victim had depressed respiration Victim appeared to be unconscious Used >2mg of naloxone Used on another person miles from a hospital >4 miles from a hospital Opioids involved in current OD Other drugs involved in current OD

Results Bivariate and multivariate associations with use of naloxone Bivariate associations Final multivariate model CharacteristicsORSEp 95% CI ORSEp 95% CI White ( ) Age (1.0- ) ( ) Male ( ) ( ) Substance use Stimulant use last 6 months ( ) Occasional ETOH use last 6 months ( ) Daily ETOH use last 6 months ( ) Benzodiazepine use last 6 months ( ) ( ) OD experience Previously experienced an OD ( ) ( ) Taken to hospital for OD ( ) ( ) Previously witnessed OD ( ) ( ) Called 911 for previously witnessed OD ( ) ( ) Witness previous OD death ( ) Health Status Had a previous abscess ( ) Taking other medications ( ) ( ) Previous HIV/HepC screening ( ) Went to ER in previous 2 years ( )

Results Bivariate and multivariate associations with rescue breathing and/or calling 911 Bivariate associationsFinal multivariate model CharacteristicORSEp95%OR ORSEp95%OR White ( ) ( ) Age (1.0- ) Male ( ) ( ) Current OD Victim had blue lips ( ) ( ) Victim had depressed respiration ( ) ( ) Victim appeared to be unconscious ( ) ( ) Amount of naloxone used ( ) Used on another person ( ) ( ) 2-4 miles from a hospital ( ) ( ) >4 miles from a hospital ( ) ( ) Opioids involved in current OD ( ) ( ) Other drugs involved in current OD ( ) OD Experience Previously experienced an OD ( ) Taken to hospital for OD ( ) ( ) Previously witnessed OD ( ) Called 911 for previously witnessed OD ( ) ( ) Witness previous OD death ( ) ( ) Substance use Stimulant use last 6 months ( ) ( ) Occasional ETOH use last 6 months ( ) ( ) Daily ETOH use last 6 months ( ) ( ) Benzodiazepine use last 6 months ( ) ( ) Health status Had a previous abscess ( ) ( ) Taking other medications ( ) ( ) Previous HIV/HepC screening ( ) ( ) Went to ER in previous 2 years ( ) ( )

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?

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