Development of a Brief Prescription Opioid Overdose Prevention Intervention
The purpose of this study was to develop a brief intervention for individuals at risk of unintentional prescription opioid overdose. The goal of the intervention is to promote change in participants’ behavior to reduce their own overdose risk, as well as to improve the probability of participants’ engaging in helpful behavior if witnessing an overdose.
Unintentional poisoning is a significant and growing public health problem in the U.S. The number of unintentional poisoning (or “overdose”) deaths among adults increased162% between 1999 and 2009. Overdoses due to prescription opioids have accounted for much of the increase in overdoses. Overdose death rarely occurs immediately after the first symptoms of overdose. The actions taken by the witnesses of an overdose are important to survival, and prior research has found that witnesses often take action to prevent fatality. This research also indicates that there are misconceptions about helpful actions and barriers to helping, such as fear of legal consequences. Prior studies of overdose prevention have largely focused on injectionheroin use, but numerous differences exist between heroin and prescription opioid users (e.g., demographic characteristics, common methods of ingestion), and it is unclear how the phenomenology of prescription opioid overdoses differ from heroin overdoses. Additionally, these programs have focused on naloxone (an opiate overdose antidote) distribution to potential overdose bystanders, but several barriers to widespread naloxone distribution exist. The purpose of this study was to develop a brief intervention for individuals at risk of unintentional prescription opioid overdose. The goal of the intervention is to promote change in participants’ behavior to reduce their own overdose risk, as well as to improve the probability of participants’ engaging in helpful behavior if witnessing an overdose. The study simultaneously conducted formative research in two settings: (a) an urban emergency department, the Hurley Medical Center Emergency Department in Flint, MI, and (b) a residential addictions treatment program, Community Programs, Inc. in Waterford, MI. In order to sample individuals at risk for prescription opioid overdose, we screened individuals and restricted study participation to individuals who reported a lifetime history of a non-fatal unintentional overdose and past month non-medical use of prescription opioids. Qualitative interviews and quantitative surveys were used to develop a brief intervention, which was then piloted at both study locations.While the pilot study was not powered to detect intervention effects, we conducted analysis of changes from pre-test to post-test in key outcomes for combined pilot intervention data from the two settings (n = 35). For a checklist of knowledge on twelve risk factors, the estimated effect of the intervention on total score was 0.42 (p = 0.07). For three measures of self-efficacy (where higher score means greater self-efficacy) the effect of the intervention was as follows: avoiding substance use – Beta of 0.29 (p = 0.13); reducingsubstance use – Beta of -0.03 (p = 0.86); avoiding combining substances – Beta of 0.43 (p = 0.02). These effects did not differ by site. This study provides preliminary evidence of an effect of a prescription opioid overdose prevention intervention on improving self-efficacy to avoid substance use and self-efficacy to avoid combining substances as overdose risk reduction strategies. The pilot will lead to a larger trial of the intervention.