Opioid Overdose Prevention
with Naloxone
an Adjunct to Basic Life Support Training
for First Year Medical Students
Noah Berland MS3 MS†, Babak Tofighi MD†#,
Aaron Fox MD MS⃰, and Kathleen Hanley MD†‡#
†New
York University School of Medicine
⃰Albert Einstein College of Medicine, Division of General Internal Medicine
‡Department of Medicine
#Department of Population Health
Disclosure
•None of the Authors have any Conflicts to Disclose
2
New York University SOM
and Bellevue Hospital Center
3
Current Landscape
•Deaths attributed to opioid analgesics have more
than quadrupled since 19991
•Community based Opioid Overdose Prevention
Programs have been successful and cost-effective2
•Medical education does not adequately address
substance use disorders, including opioid OD3
1.
2.
3.
QuickStats: Rates* of Deaths from Drug Poisoning† and Drug Poisoning Involving Opioid AnalCDC Vital Signs,
Opioid Painkiller Prescribing, July 2014
Coffin PO, Sullivan SD. Cost-effectiveness of distributing naloxone to heroin users for lay overdose reversal. Ann
Intern Med. 2013;158(1):1-9.
CASA Columbia Report on Addiction Treatment, 2012
4
Objectives
•Increase student Knowledge relating to Opioid
Overdoses
•Make students feel more Prepared to manage an
individual overdosing on opioids
•Improve student Attitudes towards patients with
substance use disorders
5
The Intervention
The Training
Pre-Test
Made
Available
Naloxone, Signs,
Symptoms, Risk
Factors for OD
How
Respond to
an OD
Standard
BLS
Training
Post-Test and
Training
Feedback
Teach Back
6
Evaluation Instrument
•Demographics and a Unique Identifier
•Attitudes: 11 question, 6 point Validated Likert
Scale1
•Knowledge test: 16 multiple choice questions2
•Preparedness: 14 Question, 5 point Validated
Likert Scale2
1.
2.
Christison GW, Haviland MG, Riggs ML. The medical condition regard scale: measuring reactions to
diagnoses. Acad Med. 2002;77(3):257-262. http://www.ncbi.nlm.nih.gov/pubmed/11891166.
Williams A V, Strang J, Marsden J. Development of Opioid Overdose Knowledge (OOKS) and Attitudes
(OOAS) Scales for take-home naloxone training evaluation. Drug Alcohol Depend. 2013;132(1-2):383-386.
doi:10.1016/j.drugalcdep.2013.02.007.
7
Analysis
•Unique Identifiers used to pair pre-Test and postTests for paired T-Tests
•Incomplete and unpaired entries were excluded
•Questions with very high rates of correct responses
on pre-Test were excluded
•Controlled for individuals whom had past training
8
Demographics
Measure
Survey N Survey % Admissions N Admissions %
Total
73
149
Male
35
47.9
83
55.7
Female
38
52.1
66
44.3
Age<23
41
56.2
83
55.7
22<Age<25
26
35.6
54
36.2
6
8.2
12
8.1
Asian
28
38.4
51
34.2
Black
0
0.0
3
2.0
White
34
46.6
71
47.7
Other
11
15.1
24
16.1
Age
Age>24
9
Results: Knowledge
18
16
14
12
10
8
6
15.00
10.14
14.89
6.72
7.08
2
14.92
4
0
Unstratified*
D = 2.70
N = 73
No Previous Training*
D = 2.96
N = 65
Pre-Test
Previous Training*
D = 1.67
N=7
Post-Test
*Statistically Significant p<0.05
10
Results: Preparedness
70
60
50
40
30
20
55.14
47.29
57.02
40.43
56.88
41.32
10
0
Unstratified*
D = 2.14
N = 73
No Previous Training*
D = 2.47
N = 65
Pre-Test
Previous Training*
D = 1.14
N=7
Post-Test
*Statistically Significant p<0.05
11
Results: Attitudes
70
60
50
40
30
20
49.14
51.14
45.77
45.40
46.05
45.93
10
0
Unstratified
D = 0.04
N = 73
No Previous Training
D = 0.11
N = 65
Pre-Test
Previous Training
D = 0.39
N=7
Post-Test
12
Feedback
Measure
N % Agree
Enjoyed the Training
47
95.7
Future Classes Should be Trained
47
97.9
Pre Training Survey Helped*
39
74.4
Post Training Survey Helped*
47
93.6
*Helped in understanding of Opioid Overdose Prevention
13
Conclusions
•Integrating OOP training into BLS for MS1s
increases preparedness and knowledge
•OOP training does not acutely change attitudes
towards individuals with SUDs
•Students enjoyed the training and believe that
other medical students should receive the training
14
Next Steps
•Test for durability of training longitudinally
•New Knowledge instrument targeting providers
•Compare class of 2018 with class of 2017
•Expand training to other institutions
•Integration of Naloxone education into AHA BLS
• Web-based Training module to aid expansion and
sustainability
15
Acknowledgements
•Inspiration: Dova Marder MD
•Training Help: Andrew Hallett MS3, Ben Suwing,
and the NYU Department of Emergency Medicine
•Statistical Assistance: Keith Goldfeld DrPH
•Consultation: Joshua Lee MD MS
•Thanks: Lisa Wang MS3 and Patrick Malecha MS3
•Funding: SARET Program, NIDA-R25 DA022461
16
Questions?
17