Opioid overdose is now the most prevalent cause of injury in the U.S. Due to the rapid response time required in an overdose, evidence-based practice guidelines (EBPG) issued by all the preeminent professional and governmental organizations endorse Opioid Overdose Education and Naloxone Distribution Training (OEND) of bystanders. However, these services have developed for inner city adults who inject drugs, or police or other public safety authorities, which are not easily accessible or likely to be used, by youth. They may not even be available to most youth who live in suburban or rural communities. The U.S. Department of Education recently endorsed OEND in high schools, but staff report not being prepared to respond to an overdose
Methods:
A synthesis of all peer-reviewed studies published between 2009 and 2018 on opioid prevention and opioid overdose in adolescents, and the effectiveness and feasibility of OEND programs for laypersons and first responders using Melynk and Fine-Overholt's Hierachy of Evidence.
Results:
This synthesis revealed 88 studies published between 2009 and 2018. This synthesis found 11 evidence based practice guidelines, seven level of evidence II, three level III, 41 level IV, four level V, 20 level VI and two level VII studies. The research suggests that adolescents are at increased risk for overdose, because they are inexperienced with opioids, engage in polypharmacy, are still developing executive cognitive function, and are particularly susceptible to modeling by friends. Moreover, adolescent opioid misuse is strongly linked with adult heroin misuse. This analysis also found that OEND has been very effective in training laypersons and first responders, reducing mortality by 27% to 46% ,and that OEND is feasible within the school setting.
Conclusion:
This synthesis supports the implementation of pilots for OEND with adult high school staff, and other adults in other low threshold organizations who work with adolescents, to become trusted first responders for adolescents experiencing opioid overdose, creating a safety net for this vulnerable population.