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      Hospital admissions among people who inject opioids following syringe services program implementation

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          Abstract

          Background

          Syringe services programs (SSPs) are an evidence-based harm reduction strategy that reduces dangerous sequelae of injection drug use among people who inject drugs (PWID) such as overdose. SSP services include safer injection education and community-based naloxone distribution programs. This study evaluates differences in overdose-associated hospital admissions following the implementation of the first legal SSP in Florida, based in Miami-Dade County.

          Methods

          We performed a retrospective analysis of hospitalizations for injection drug-related sequelae at a county hospital before and after the implementation of the SSP. An algorithm utilizing ICD-10 codes for opioid use and sequelae was used to identify people who inject opioids (PWIO). Florida Department of Law Enforcement Medical Examiners Commission Report data was used to analyze concurrent overdose death trends in Florida counties.

          Results

          Over the 25-month study period, 302 PWIO admissions were identified: 146 in the pre-index period vs. 156 in the post-index period. A total of 26 admissions with PWIO overdose were found: 20 pre-index and 6 post-index ( p = 0.0034).

          Conclusions

          Declining overdose-associated admissions among PWIO suggests early impacts following SSP implementation. These results indicate a potential early benefit of SSP that should be further explored for its effects on future hospital admission and mortality.

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          Most cited references10

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          Are take‐home naloxone programmes effective? Systematic review utilizing application of the Bradford Hill criteria

          Abstract Background and Aims Fatal outcome of opioid overdose, once detected, is preventable through timely administration of the antidote naloxone. Take‐home naloxone provision directly to opioid users for emergency use has been implemented recently in more than 15 countries worldwide, albeit mainly as pilot schemes and without formal evaluation. This systematic review assesses the effectiveness of take‐home naloxone, with two specific aims: (1) to study the impact of take‐home naloxone distribution on overdose‐related mortality; and (2) to assess the safety of take‐home naloxone in terms of adverse events. Methods PubMed, MEDLINE and PsychINFO were searched for English‐language peer‐reviewed publications (randomized or observational trials) using the Boolean search query: (opioid OR opiate) AND overdose AND prevention. Evidence was evaluated using the nine Bradford Hill criteria for causation, devised to assess a potential causal relationship between public health interventions and clinical outcomes when only observational data are available. Results A total of 1397 records (1164 after removal of duplicates) were retrieved, with 22 observational studies meeting eligibility criteria. Due to variability in size and quality of the included studies, meta‐analysis was dismissed in favour of narrative synthesis. From eligible studies, we found take‐home naloxone met all nine Bradford Hill criteria. The additional five World Health Organization criteria were all either met partially (two) or fully (three). Even with take‐home naloxone administration, fatal outcome was reported in one in 123 overdose cases (0.8%; 95% confidence interval = 0.4, 1.2). Conclusions Take‐home naloxone programmes are found to reduce overdose mortality among programme participants and in the community and have a low rate of adverse events.
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            Effect of Florida's Prescription Drug Monitoring Program and Pill Mill Laws on Opioid Prescribing and Use.

            Prescription Drug Monitoring Program (PDMP) and pill mill laws are among the principal means states use to reduce prescription drug abuse and diversion, yet little high-quality evidence exists regarding their effect.
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              Effectiveness of bystander naloxone administration and overdose education programs: a meta-analysis

              The objective of this review was to assess the effectiveness of bystander naloxone administration and overdose education programs by synthesizing quantitative results reported in the research literature. Studies meeting predefined criteria were identified and reviewed, and their results were synthesized through meta-analysis. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for overdose recoveries for individuals who received naloxone dispensed by non-medical community members, and the standardized mean difference was calculated for test scores of non-medical volunteers who received training in overdose management versus the scores of untrained volunteers. Pooled data from four studies showed that naloxone administration by bystanders was associated with a significantly increased odds of recovery compared with no naloxone administration (OR = 8.58, 95% CI = 3.90 to 13.25). Data from five studies of overdose education indicated that average scores were significantly higher for trained participants than untrained participants for tests on naloxone administration, overdose recognition, and overdose response (standardized mean difference = 1.35, 95% CI = 0.92 to 1.77). Empirical evidence in the research literature suggests that bystander naloxone administration and overdose education programs are associated with increased odds of recovery and with improved knowledge of overdose recognition and management in non-clinical settings. Electronic supplementary material The online version of this article (doi:10.1186/s40621-015-0041-8) contains supplementary material, which is available to authorized users.
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                Author and article information

                Contributors
                kashabornstein@med.miami.edu
                Journal
                Harm Reduct J
                Harm Reduct J
                Harm Reduction Journal
                BioMed Central (London )
                1477-7517
                12 May 2020
                12 May 2020
                2020
                : 17
                : 30
                Affiliations
                [1 ]GRID grid.26790.3a, ISNI 0000 0004 1936 8606, University of Miami Miller School of Medicine, ; Miami, USA
                [2 ]GRID grid.26790.3a, ISNI 0000 0004 1936 8606, Department of Medicine, , University of Miami Miller School of Medicine, ; Miami, USA
                [3 ]GRID grid.26790.3a, ISNI 0000 0004 1936 8606, Department of Public Health Sciences, , University of Miami Miller School of Medicine, ; Miami, USA
                [4 ]GRID grid.421468.d, ISNI 0000 0000 9766 4575, Florida Department of Children and Families Office of Substance Abuse and Mental Health, ; Tallahassee, USA
                Author information
                http://orcid.org/0000-0002-1779-9184
                Article
                376
                10.1186/s12954-020-00376-1
                7216361
                32398059
                fb9ba65d-6da5-42cf-bc1e-2a524aa3fee7
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 21 February 2020
                : 28 April 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100007700, Miami Center for AIDS Research;
                Award ID: P30AI073961
                Funded by: FundRef http://dx.doi.org/10.13039/100000009, Foundation for the National Institutes of Health;
                Award ID: P30CA240139
                Funded by: FundRef http://dx.doi.org/10.13039/100006292, Infectious Diseases Society of America;
                Award ID: Medical Scholars Program
                Award ID: Medical Scholars Program
                Categories
                Brief Report
                Custom metadata
                © The Author(s) 2020

                Health & Social care
                syringe services program,take-home naloxone,overdose,opioid epidemic
                Health & Social care
                syringe services program, take-home naloxone, overdose, opioid epidemic

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