Evaluation of a comprehensive overdose prevention and response training program for injection drug users in the Skid Row area of Los Angeles, California

Fatal opiate overdose is a significant cause of mortality among injection drug users (IDUs). We present data from the evaluation of a one-hour overdose prevention and response training program for IDUs implemented by a community-based organization in the Skid Row area of Los Angeles, California. Participants learned skills to prevent, recognize, and respond to opiate overdoses, including calling 911, rescue breathing, and administering an opiate antagonist (i.e., naloxone). Ninety-three IDUs were trained from September 2006 to January 2008. Of those, 69 (74%) enrolled in the prospective evaluation study. Participants were 21% female, 42% White, 29% African American, and 19% Latino. Most (74%) were homeless. In total, 44 (64%) participants provided follow-up data, either through an incident report conducted when they refilled their naloxone prescription, or in a follow-up interview 3 months post-intervention. Detailed data were collected about 32 overdoses witnessed during the 3-month follow-up period. Participants reported responding to the witnessed overdoses by administering naloxone (84%), providing rescue breathing (69%), and calling 911 (66%). All but three overdose victims recovered. In addition to paramedics, police responded to the 911 calls in 41% of cases. Significant increases in knowledge from baseline to follow-up were found for general overdose knowledge (p=0.03) and naloxone knowledge (p<0.0001). Almost half of program participants reported that their drug use decreased at follow-up. Comprehensive overdose prevention and response training programs fulfill a critical role in reducing mortality among IDUs, with few adverse consequences and some unforeseen benefits, such as reductions in drug use.