1. Gerald Cochran, MSW, PhD; 1 Bethany Brodie, MSW; 1 Alice Bell, MSW, LCSW; 2 Alex Bennett, PhD 3 1 University of Pittsburgh, Pittsburgh PA; 2 Prevention Point Pittsburgh, Pittsburgh PA; 3 National Development and Research Institute, New York PATIENT CHARACTERISTICS AND FACTORS ASSOCIATED OPIOID OVERDOSE AND RESUSCITATION

2. Background  In 2011, overdose deaths surpassed motor vehicle deaths to become the number one cause of injury death in the U.S. Of the 41,340 overdose deaths, the majority involved some type of opioid.  In the decade from 2002 to 2011, the annual number of drug poisoning deaths involving heroin doubled, from 2,089 deaths in 2002 to 4,397 deaths in 2011.  Deaths in 2010 involving prescription opioid painkillers (N=16,651) accounted for 45% of all illicit and prescription drug overdose deaths combined.

3. Background  Overdose prevention and response trainings have been established in cities nationwide in order to address the rising toll of opioid-related overdoses.  Naloxone is an opioid antagonist that has been shown to safely reverse the sedative and respiratory depressing effects of a drug overdose involving opiates.  Little research is available regarding the patient characteristics and administration factors associated with naloxone.

4. Purpose  This exploratory retrospective data analysis examined factors associated with: Naloxone administration for an opioid overdose Factors associated with auxiliary life-saving efforts (rescue breathing/calling 911) in connection with naloxone administration

5. Methods  Program and Participants Naloxone resuscitation incident information data collected by a community-based overdose prevention program in southwestern Pennsylvania This program provides naloxone training, prescribing, and dispensing to community members who use opioids and are interested in having naloxone available for opioid overdose resuscitation  Ethics These data were shared by program administrators with the research team from the University of Pittsburgh. The current research project and the analyses conducted herein were reviewed by the University of Pittsburgh Institutional Review Board and granted exempt status

6. Methods  Data sources Two program questionnaires ○ Medical history form (cross-sectional at program entry) ○ Naloxone use form (multiple observations per participant)  Analyses Two logistic regression models ○ Forward stepwise procedure ○ Predictors of naloxone administration using cross- sectional data with longitudinal outcome ○ Predictors of rescue breathing or calling 9-1-1 using clustered SEs for multiple observations All analyses conducted in Stata/SE 13.1

7. Results Univariate description of program participants Demographics%/ Meann / SD White88.5822 Age*4012.6 Male65.7633 Subsequently used naloxone from PPP for OD reversal26.9260 Previous OD experience Previous OD41.3395 Previous OD taken to hospital53.6192 Called 911 for previously witnessed OD59.5435 Previously witness OP taken to hospital55.1400 Witness previous OD death20.7147 Baseline substance use Age first opioid use*19.76.8 Age first needle use*23.68.3 Uses heroin92.6888 Daily heroin use80.8665 Rx opioid use84.1668 Stimulant use last 6 months51.7465 Occasional ETOH use last 6 months39.6331 Daily ETOH use last 6 months9.176 Benzodiazepine use last 6 months51.4447 Baseline health status Had a previous abscess32.9302 Taking other medications29.7280 Previous HIV testing86.9616 Previous HEP-C testing84.8563 Went to ER in previous 2 years50.4463 Admitted to hospital in previous 2 years31.7289 *Mean, SD

8. Results Univariate description of program participants Victim had blue lips77.5654 Victim had depressed respiration58.1490 Victim appeared to be unconscious41.5350 Used >2mg of naloxone18.9159 Used on another person91.4793 2-4 miles from a hospital18.5161 >4 miles from a hospital45.5397 Opioids involved in current OD87.8766 Other drugs involved in current OD62.7547

9. Results Bivariate and multivariate associations with use of naloxone Bivariate associations Final multivariate model CharacteristicsORSEp 95% CI ORSEp 95% CI White1.220.290.408(0.8-2.0) Age1.030.010.000(1.0- ) 1.040.01 0.000 (1.02-1.1) Male1.260.200.136(0.9-1.7) 1.030.290.919(0.6-1.8) Substance use Stimulant use last 6 months1.350.200.047(1.0-1.8) Occasional ETOH use last 6 months0.760.130.104(0.5-1.1) Daily ETOH use last 6 months1.060.290.843(0.6-1.8) Benzodiazepine use last 6 months1.520.230.006(1.1-2.1) 1.810.51 0.035 (1.0-3.1) OD experience Previously experienced an OD1.610.240.001(1.2-2.1) 0.630.580.613(0.1-3.8) Taken to hospital for OD1.630.380.037(1.0-2.6) 2.000.55 0.012 (1.2-3.4) Previously witnessed OD1.820.340.001(1.3-2.6) 1.050.640.930(0.3-3.4) Called 911 for previously witnessed OD1.270.210.152(0.9-1.8) 0.740.220.310(0.4-1.3) Witness previous OD death1.080.220.707(0.7-1.6) Health Status Had a previous abscess1.460.230.014(1.1-2.0) Taking other medications2.070.320.000(1.5-2.8) 1.520.420.128(0.9-2.6) Previous HIV/HepC screening0.920.200.721(0.6-1.4) Went to ER in previous 2 years1.310.200.075(1.0-1.8)

10. Results Bivariate and multivariate associations with rescue breathing and/or calling 911 Bivariate associationsFinal multivariate model CharacteristicORSEp95%OR ORSEp95%OR White2.380.69 0.003 (1.3-4.2) 1.170.680.785(0.4-3.7) Age0.980.01 0.005 (1.0- ) Male0.540.15 0.032 (0.3-0.9) 1.230.650.688(0.4-3.5) Current OD Victim had blue lips2.370.52 0.000 (1.5-3.7) 1.990.760.070(0.9-4.2) Victim had depressed respiration2.120.54 0.003 (1.3-3.5) 3.451.33 0.001 (1.6-7.4) Victim appeared to be unconscious1.140.310.612(0.7-1.9) 0.810.330.603(0.4-1.8) Amount of naloxone used1.850.49 0.019 (1.1-3.1) Used on another person1.550.620.270(0.7-3.4) 0.300.320.263(0.0-2.4) 2-4 miles from a hospital1.270.340.377(0.7-2.1) 1.890.840.153(0.8-4.5) >4 miles from a hospital1.190.310.509(0.7-2.0) 1.540.620.289(0.7-3.4) Opioids involved in current OD1.160.270.532(0.7-1.8) 1.890.970.211(0.7-5.2) Other drugs involved in current OD1.220.270.373(0.8-1.9) OD Experience Previously experienced an OD1.260.340.392(0.7-2.1) Taken to hospital for OD0.930.330.850(0.5-1.9) 0.940.890.950(0.1-6.0) Previously witnessed OD1.930.62 0.040 (1.0-3.6) Called 911 for previously witnessed OD1.500.410.145(0.9-2.6) 1.320.650.570(0.5-3.5) Witness previous OD death0.630.190.122(0.3-1.1) 1.090.630.883(0.4-3.4) Substance use Stimulant use last 6 months1.360.380.273(0.8-2.3) 3.752.14 0.021 (1.2-11.5) Occasional ETOH use last 6 months1.040.410.926(0.5-2.2) 0.720.330.477(0.3-1.8) Daily ETOH use last 6 months0.980.270.938(0.6-1.7) 0.290.370.327(0.0-3.4) Benzodiazepine use last 6 months1.310.390.364(0.7-2.3) 1.380.650.494(0.5-3.5) Health status Had a previous abscess0.990.270.983(0.6-1.7) 0.540.320.300(0.2-1.7) Taking other medications1.200.330.500(0.7-2.0) 1.730.810.244(0.7-4.3) Previous HIV/HepC screening4.032.22 0.012 (1.4-11.9) 4.333.01 0.035 (1.1-16. 9) Went to ER in previous 2 years2.130.53 0.002 (1.3-3.5) 1.820.820.183(0.8-4.4)

11. Discussion  Increased odds for naloxone administration: Those with a history of concomitant benzodiazepine use ○ Somewhat consistent with OD literature ○ Should additional screening take place to find out more about possible medication (ie, benzos) abuse at baseline? ○ Should those who abuse medications (ie, benzos) receive added training or prevention education? When personal ODs have been serious enough to merit a trip to the hospital ○ Should additional screening take place to find out more of the seriousness of previous OD experience? ○ Should those who have previously gone to hospital for OD receive some added training or prevention education? ○ What is it about having gone to the hospital previously for an OD is driving increased naloxone administration?

12. Discussion  Increased odds for auxiliary lifesaving efforts Victim appeared to have depressed respiration ○ Should other signs and symptoms be emphasized in training as indicators to initiate additional lifesaving efforts? ○ Why not blue lips or unconsciousness? HIV or HepC screening previous to receiving naloxone Rx ○ Does self-care explain this relationship? ○ Does length of time involved in drug use explain this relationship? Stimulants use in 6 months previous to receiving naloxone Rx ○ Possible mediators to this relationship?

13. Thank you gcochran@pitt.edu