Evaluation of Prevention Point Philadelphia’s Overdose Prevention Program: Applying the Health Belief Model to Overdose Prevention Practices among Injection Drug Users

Objectives: Accidental opioid overdose is a significant cause of death in Philadelphia and the U.S. as a whole. Programs such as Prevention Point Philadelphia (PPP) have created overdose prevention programs to train injection drug users (IDUs) to respond to overdoses using tactics such as rescue breathing and naloxone administration. Trained IDUs have saved hundreds of lives in Philadelphia alone, but most IDUs remain untrained. Using the Health Belief Model, this study compared the behaviors and health beliefs around accidental overdose of trained IDUs to untrained IDUs in order to make recommendations to PPP on how to design an effective outreach campaign to recruit more IDUs for the overdose prevention program. Methods: 20 injection drug users between the ages of 18 and 65 were recruited at PPP’s six weekly syringe exchange sites, and interviewed using a quantitative/qualitative instrument. Interviews were recorded, transcribed, and analyzed in the qualitative analysis software program, ATLAS.ti. Participants trained in the overdose prevention program were compared to untrained participants in their behaviors and health beliefs about accidental overdose, and their responses were analyzed using the Health Belief Model. Results: Trained participants perceived fewer barriers and more benefits to receiving overdose prevention training, as well as a higher perceived susceptibility to accidental overdose. However, untrained participants were as likely to have helped someone who was overdosing within the past year as trained participants, and displayed similar levels of self-efficacy around helping an overdose victim as trained participants. Conclusions: Since most untrained participants are willing to assist someone who is overdosing and have high levels of self-efficacy related to responding to overdoses, eliminating the untrained participants’ perceived barriers to participating in the overdose prevention training may effectively increase the participation rate at PPP’s program. Some strategies include: prominently advertising the program at the syringe exchange sites, emphasizing the ability to save a loved one’s life, offering a small cash or gift card incentive for participating, or providing tokens to cover the cost of public transportation to and from the training session.M.P.H., Public Health -- Drexel University, 201

Denial of Prescription Opioids Among Young Adults with Histories of Opioid Misuse

OBJECTIVES: An exploratory study was undertaken to examine how being denied prescription opioids to treat pain impacted the drug-using careers of young adults with a history of misuse of prescription drugs. DESIGN: Ethno-epidemiological methodology utilizing a cross-sectional design, semi-structured interviews, and qualitative/quantitative data analysis. Settings.  Non-clinical participants were recruited from natural settings, such as streets, parks, beaches, and college campuses, in New York City and Los Angeles during 2008 and 2009. PARTICIPANTS: One hundred fifty participants aged 16 to 25 who had misused a prescription opioid, tranquilizer, or stimulant in the past 90 days. Outcome Measures.  Analyses focused on denial of opioids and associated consequences, including self-medication with prescription opioids and heroin. RESULTS: Thirty-four participants (22.7%) described being denied prescription opioids for the treatment of a painful condition. Current opioid misuse and current pain problems were higher in this group compared to those who had never been denied prescription opioids. Reasons for denial included being identified as a drug user by a physician, lack of health insurance, and having medication withheld by a parent or authority figure. Approximately half reported self-medicating pain with either illegally obtained prescription opioids or heroin. Self-medication often coincided with initiation of new risk behaviors and more intensive drug use. CONCLUSION: Being denied prescription opioids was an important moment in the drug using careers of many study participants. Results suggest that effective pain management techniques are needed to prevent high-risk young adults with pain problems from engaging in escalated opioid misuse and risk behaviors