Evaluation of Prevention Point Philadelphia's overdose prevention program

Background: Since the 1990's, overdose prevention programs have trained individuals how to identify and respond to a drug overdose as well as teach how to administer naloxone, an opioid antagonist. Between July 2006 and March 2011, Prevention Point Philadelphia (PPP) has trained 505 injection drug users (IDUs) in overdose prevention and there have been 142 overdose reversals reported. Objectives: The current study describes IDU's perceptions of witnessing and/or experiencing an overdose and the reasons for administering or not administering naloxone in response to an opioid overdose. Methods: Eleven IDUs were interviewed at PPP's syringe exchange sites. Data from eight interviews was useable and added to the existing participant database. For the purpose of this study, quantitative data from 48 trained and untrained participants was analyzed. A total of ten transcripts were coded and analyzed using Atlas.ti software. Results: Participants were mainly male, white and in their late 30's. They reported witnessing an average of 20 overdoses in their lifetime. Of the 48 participants, 35 reported having experienced at least one overdose in their lifetime. Participants reported being aware of the risk of overdose and how it is a part of a lifestyle associated with drug use. Some participants reported changing their drug use, including who they use with and where they purchase drugs. Only two participants reported administering naloxone at the most recent overdose. Barriers to administration included: not being trained at the time of the overdose; not having the naloxone kit; and not wanting to make the victim feel sick or angry. Motivating factors for participating in the training included past overdose history and wanting to save a life. Conclusion: For IDUs, witnessing and/or experiencing an overdose may not serve as a motivating factor towards seeking treatment or changing drug use. Future studies should examine the implications of viewing overdose as a normal occurrence in the lives of IDUs. Findings from this study demonstrate that various factors influence an individual's decision to administer naloxone. Future harm reduction services should consider incorporating incentives and peer-education to reach this at-risk population more effectively.