Layperson reversal of opioid overdose supported by smartphone alert: A prospective observational cohort study

David G Schwartz, Janna Ataiants, Alexis Roth, Gabriela Marcu, Inbal Yahav, Benjamin Cocchiaro, Michael Khalemsky, Stephen Lankenau, David G Schwartz, Janna Ataiants, Alexis Roth, Gabriela Marcu, Inbal Yahav, Benjamin Cocchiaro, Michael Khalemsky, Stephen Lankenau

Abstract

Background: Rapid naloxone administration is crucial in reversing an opioid overdose. We investigated whether equipping community members, including people who use opioids (PWUO), with a smartphone application enabling them to signal and respond to suspected overdose would support naloxone administration in advance of Emrgency Medical Services (EMS).

Methods: This observational cohort study of opioid overdose intervention used a dedicated smartphone app, UnityPhilly, activated by volunteers witnessing an overdose to signal other nearby volunteers in Philadelphia (March 2019 - February 2020). Alerted volunteers chose to respond, or declined to respond, or ignored/missed the alert. Witnessing volunteer was connected to 9-1-1 through a semi-automated telephone call. The primary outcome was layperson-initiated overdose reversal before EMS arrival, and a secondary outcome was hospital transfer. This study is registered with ClinicalTrials.gov, NCT03305497.

Findings: 112 volunteers, including 57 PWUO and 55 community members, signaled 291 suspected opioid overdose alerts. 89 (30⸱6%) were false alarms. For 202 true alerts, the rate of layperson initiated naloxone use was 36⸱6% (74/202 cases). Most naloxone-use cases occurred in the street (58⸱11% (43/74)) and some in home settings (22⸱98% (17/74)). The first naloxone dose was provided by a nearby volunteer responding to the alert in 29⸱73% (22/74) of cases and by the signaling volunteer in 70⸱27% (52/74) of cases. Successful reversal was reported in 95⸱9% (71/74) of cases. Layperson intervention preceded EMS by 5 min or more in 59⸱5% of cases. Recovery without hospital transport was reported in 52⸱7% (39/74) of cases.

Interpretation: Our findings support the benefits of equipping community members, potentially witnessing suspected opioid overdose, with naloxone and an emergency response community smartphone app, alerting EMS and nearby laypersons to provide additional naloxone.

Funding: Funding provided by NIH through NIDA, grant number: 5R34DA044758.

Conflict of interest statement

All authors report grants from NIH/NIDA during the course of this study.

© 2020 The Author(s).

Figures

Fig. 1
Fig. 1
UnityPhilly Smartphone App Interface Screens. (a) SOS alert (b) Responder dispatch (c) Responder support (d) Signaler updates.
Fig. 2
Fig. 2
(a) Naloxone provision rates (b) Volunteer response rates.
Fig. 3
Fig. 3
Map of Study Area Indicating Overdose Alert Locations. Signaled opioid overdose cases with naloxone-provision (n = 74), March 2019-February 2020. Inset: geographic outliers beyond core study area.

References

    1. Murthy V.H. Ending the opioid epidemic - a call to action. N Engl J Med. 2016;375:2413–2415.
    1. Blanco C., Volkow N.D. Management of opioid use disorder in the USA: present status and future directions. Lancet. 2019;393:1760–1772.
    1. Drug Overdose Deaths | Drug Overdose | CDC Injury Center. 2020; Published online March 19. . (accessed March 21, 2020).
    1. Whelan A.Philly's overdose deaths rose again in 2019, especially in black and Latino communities2020; published online May 13. . (accessed June 14, 2020).
    1. Chou R., Korthuis P.T., McCarty D. Management of suspected opioid overdose with naloxone in out-of-hospital settings: a systematic review. Ann Intern Med. 2017;167:867–875.
    1. Csete J., Kamarulzaman A., Kazatchkine M. Public health and international drug policy. Lancet. 2016;387:1427–1480.
    1. Lankenau S.E., Wagner K.D., Silva K. Injection drug users trained by overdose prevention programs: responses to witnessed overdoses. J Community Health. 2012;38:133–141.
    1. American Medical Association. National roadmap on state-level efforts to end the opioid epidemic. 2019. . (accessed April 12, 2020).
    1. World Health Organization. Community management of opioid overdose. 2015. . (accessed March 21, 2020).
    1. Walley A.Y., Xuan Z., Hackman H.H. Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis. BMJ. 2013;346:f174.
    1. Gov.Wolf announces naloxone standing order. Gov. Wolf announces naloxone standing order. . (accessed Dec 2, 2015).
    1. The Lancet Out-of-hospital cardiac arrest: a unique medical emergency. Lancet. 2018;391:911.
    1. Hazinski M.F., Nolan J.P., Aickin R. Part 1: executive summary: 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2015;132:S2–39.
    1. Weisfeldt M.L., Sitlani C.M., Ornato J.P. Survival after application of automatic external defibrillators before arrival of the emergency medical system: evaluation in the resuscitation outcomes consortium population of 21 million. J Am Coll Cardiol. 2010;55:1713–1720.
    1. Ong M.E.H., Perkins G.D., Cariou A. Out-of-hospital cardiac arrest: prehospital management. Lancet. 2018;391:980–988.
    1. Ringh M., Rosenqvist M., Hollenberg J. Mobile-phone dispatch of laypersons for CPR in out-of-hospital cardiac arrest. N Engl J Med. 2015;372:2316–2325.
    1. Brooks S.C., Simmons G., Worthington H., Bobrow B.J., Morrison L.J. The PulsePoint respond mobile device application to crowdsource basic life support for patients with out-of-hospital cardiac arrest: challenges for optimal implementation. Resuscitation. 2016;98:20–26.
    1. Berglund E., Claesson A., Nordberg P. A smartphone application for dispatch of lay responders to out-of-hospital cardiac arrests. Resuscitation. 2018;126:160–165.
    1. Hatakeyama T., Nishiyama C., Shimamoto T. A smartphone application to reduce the time to automated external defibrillator delivery after a witnessed out-of-hospital cardiac arrest: a randomized simulation-based study. Simul Healthc. 2018;13:387–393.
    1. von Elm E., Altman D.G., Egger M. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370:1453–1457.
    1. Schmidt W.-.P. Randomised and non-randomised studies to estimate the effect of community-level public health interventions: definitions and methodological considerations. Emerg Themes Epidemiol. 2017;14:9.
    1. Eichel L, Pharis M, Poll shows impact of opioid crisis on philadelphians and their neighborhoods. . (accessed March 21, 2020).
    1. Ruiz M.S., OʼRourke A., Allen S.T. Using interrupted time series analysis to measure the impact of legalized syringe exchange on HIV diagnoses in Baltimore and Philadelphia. J Acquir Immune Defic Syndr. 2019;82(Suppl 2):S148–S154.
    1. Schwartz D.G., Bellou A., Garcia-Castrillo L., Muraro A., Papadopoulos N. Exploring mHealth participation for emergency response communities. Australas J Inf Syst. 2017;21 doi: 10.3127/ajis.v21i0.1378.
    1. Marcu G., Aizen R., Roth A.M., Lankenau S., Schwartz D.G. Acceptability of smartphone applications for facilitating layperson naloxone administration during opioid overdoses. Jamia Open. 2019 doi: 10.1093/jamiaopen/ooz068.
    1. Mechem C.C., Yates C.A., Rush M.S., Alleyne A., Singleton H.J., Boyle T.L. Deployment of alternative response units in a high-volume, urban EMS system. Prehosp Emerg Care. 2020;24:378–384.
    1. Sporer K.A., Wilson K.G. How well do emergency medical dispatch codes predict prehospital medication administration in a diverse urban community? J Emerg Med. 2013;44 413–22.e3.
    1. Clark A.K., Wilder C.M., Winstanley E.L. A Systematic review of community opioid overdose prevention and naloxone distribution programs. J Addict Med. 2014;8:153–163.
    1. Neumar R.W., Shuster M., Callaway C.W. Part 1: executive summary: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132:S315–S367.
    1. Billingham S.A.M., Whitehead A.L., Julious S.A. An audit of sample sizes for pilot and feasibility trials being undertaken in the United Kingdom registered in the United Kingdom clinical research network database. BMC Med Res Methodol. 2013;13:104.
    1. Arain M., Campbell M.J., Cooper C.L., Lancaster G.A. What is a pilot or feasibility study? A review of current practice and editorial policy. BMC Med Res Methodol. 2010;10:67.
    1. Saver J.L. Time is brain–quantified. Stroke. 2006;37:263–266.
    1. Larney S., Tran L.T., Leung J. All-cause and cause-specific mortality among people using extramedical opioids: a systematic review and meta-analysis. JAMA Psychiatry. 2019 doi: 10.1001/jamapsychiatry.2019.4170. published online Dec 26.
    1. Lim J.K., Forman L.S., Ruiz S. Factors associated with help seeking by community responders trained in overdose prevention and naloxone administration in Massachusetts. Drug Alcohol Depend. 2019;204
    1. Bowles J.M., Lankenau S.E. I gotta go with modern technology, so I'm Gonna give'em the narcan’: the diffusion of innovations and an opioid overdose prevention program. Qual Health Res. 2019;29:345–356.
    1. Ataiants J., Roth A.M., Mazzella S., Lankenau S.E. Circumstances of overdose among street-involved, opioid-injecting women: drug, set, and setting. Int J Drug Policy. 2020;78
    1. Get Naloxone. Pennsylvania department of drug and alcohol programs. . (accessed June 7, 2020).
    1. Khalemsky M., Schwartz D.G., Herbst R., Jaffe E. Motivation of emergency medical services volunteers: a study of organized Good Samaritans. Isr J Health Policy Res. 2020;9:11.
    1. U.S. Census Bureau. American community survey 5-year population estimates. 2017. . (accessed March 26, 2020).

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