Comparing Overdose Response Behaviors Between Trained and Untrained Injection Drug Users: The Impact of Overdose Prevention Programs

Introduction: Overdose prevention training programs (ODPT) for injection drug users (IDUs) have the potential to reduce incidence of fatal overdose, a leading cause of mortality in this population. Programs teach IDUs how to recognize and respond to overdose, and many include training in administering naloxone (an opioid antagonist) to overdose victims. Though agencies usually offer training to all clients, not all clients participate. A study was devised to determine how response to drug overdose varied between trained and untrained IDUs.

Methods: Trained (n=29) and untrained (n=77) IDUs who recently witnessed an overdose were recruited from two Los Angeles needle exchanges that provide ODPT (2010-11). During semi-structured interviews, participants described how they responded to a recently witnessed overdose. Qualitative and quantitative data were compared.

Findings: Several differences were observed. Trained participants were more typically: female; heroin injectors; and had overdosed themselves in the past 12 months. Regarding the most recently witnessed overdose, trained participants were more adept at recognizing overdose symptoms, more commonly performed recommended response techniques, such as rescue breathing and administering naloxone, and less commonly “did nothing.” Most significantly, none of the trained respondents reported that the overdose victim died compared to 14% of untrained participants. In contrast, both “called 911” in response to the overdose about 25% of the time.

Conclusions: Findings highlight the need to better understand factors that inhibit some IDUs from accessing training in order to increase program uptake. Additionally, efforts are needed to reduce barriers to calling 911 in the event of an overdose.