The Overdose Response with Take Home Naloxone (ORTHN) project: Evaluation of health worker training, attitudes and perceptions

Lauren A Monds; Maria Bravo; Llewellyn Mills; Annie Malcolm; Rosie Gilliver; William Wood; Mary Ellen Harrod; Phillip Read; Suzanne Nielsen; Paul M Dietze; Simon Lenton; Anne M Bleeker; Nicholas Lintzeris

doi:10.1111/dar.13474

The Overdose Response with Take Home Naloxone (ORTHN) project: Evaluation of health worker training, attitudes and perceptions

Drug Alcohol Rev. 2022 Jul;41(5):1085-1094. doi: 10.1111/dar.13474. Epub 2022 Apr 20.

Authors

Lauren A Monds^{1

2

3}, Maria Bravo^{1

2

3}, Llewellyn Mills^{1

2

3}, Annie Malcolm^{1

3}, Rosie Gilliver⁴, William Wood⁵, Mary Ellen Harrod⁶, Phillip Read^{4

7}, Suzanne Nielsen⁸, Paul M Dietze^{9

10}, Simon Lenton¹¹, Anne M Bleeker¹², Nicholas Lintzeris^{1

2

3}

Affiliations

¹ Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia.
² Discipline of Addiction Medicine, Central Clinical School, The University of Sydney, Sydney, Australia.
³ NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia.
⁴ Kirketon Road Centre, South Eastern Sydney Local Health District, Sydney, Australia.
⁵ Medically Supervised Injecting Centre, Sydney, Australia.
⁶ NSW Users and AIDS Association, Sydney, Australia.
⁷ The Kirby Institute, UNSW Sydney, Sydney, Australia.
⁸ Monash Addiction Research Centre, Monash University, Melbourne, Australia.
⁹ National Drug Research Institute, Melbourne, Australia.
¹⁰ Behaviours and Health Risks Program, Burnet Institute, Melbourne, Australia.
¹¹ National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia.
¹² Alcohol, Tobacco and Other Drug Association, Canberra, Australia.

PMID: 35442514
DOI: 10.1111/dar.13474

Abstract

Introduction: Naloxone is a life-saving medication that reverses opioid overdose; naloxone can be provided on a 'take-home' basis so naloxone can be administered outside of the health-care setting. The Overdose Response and Take Home Naloxone (ORTHN) project established a model of care for take-home naloxone (THN) interventions across alcohol and other drug and harm reduction services in NSW, Australia. This paper evaluates the staff training and credentialing program, and examines staff attitudes and perspectives regarding the provision of THN interventions in these settings.

Methods: Staff across seven services were trained through a 'train-the-trainer' credentialing model to deliver ORTHN, including naloxone supply. Staff were surveyed regarding their experience, attitudes and knowledge on THN prior to and after training, and after 6 months. At the 6 months follow up, staff were asked about the interventions they provided, barriers and enablers to uptake, and opinions regarding future rollout.

Results: A total of 204 staff were trained and credentialed to provide the ORTHN intervention. Most (60%) were nurses, followed by needle syringe program workers and allied health/counsellors (32%). Linear and logistic regression analyses indicated that the training program was associated with significant improvements in staff knowledge and attitudes towards overdose and THN; however, only attitudinal improvements were maintained over time. There were high rates of staff satisfaction with the ORTHN intervention and training.

Discussion/conclusions: The ORTHN program is 'fit for purpose' for broad implementation in these settings. A number of potential barriers (e.g. time, medication and staffing costs) and enablers (e.g. peer engagement, regulatory framework for naloxone supply) in implementing THN interventions were identified.

Keywords: health worker; naloxone; opioid; overdose; train the trainer.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Drug Overdose* / drug therapy
Harm Reduction
Health Knowledge, Attitudes, Practice
Humans
Naloxone / therapeutic use
Narcotic Antagonists / therapeutic use
Opioid-Related Disorders* / drug therapy

Substances

Narcotic Antagonists
Naloxone