| Objective To assess the prevalence of and risk factors for nonfatal overdose among injecting drug users(IDUs) and to investigate and analyze the present status of naloxone first-aid on spot conducted by out-reaching wokers in Yunnan Province, southwestern China.Methods Qualitative research and quantitative research were combined to analyze the problems.In cross-sectional study, 340 IDUs were recruited from four MMT clinics and two compulsory isolated detoxification centers in four cities of Honghe prefecture and Dehong prefecture, Yunnan Province, during July and August of 2015. Data on IDUs,including demographic information and drug use history, overdose and witness overdose experiences in the past 12 months and their lifetime, rescue measures and other details about the most recently overdose and witness overdose were collected through face to face interviews with questionnaires. Factors hypothesized to be associated with overdose were evaluated with logistic regression models. Descriptive statistics was adopted to analyze the first-aid measures and the outcomes in last witnessed overdose in the past 12 months.In the qualitative study, 11 out-reaching workers were interviewed to understand the present status of naloxone first-aid. The recording was transferred into text, and analyzed by software of ATLAS.ti.5.0.Results1. Qualitative Research The qualitative interview included 11 outreach-workers, whose average age was(42.6±5.3); 10 were male,1 was female; 1 had a primary school education level, 5had a junior high school education level, 5 had a senior high school education level or above; the average time of being an outreach-worker was 3 years. Dosage increase,herion tolerance decrease and poly-drug use were the main causes of IDUs’ overdose there. Without naloxone, IDUs usually take measures like injecting salt water, pain stimulation and pouring cold water when face overdose.Here is the mode of naloxone first-aid on spot conducted by out-reaching workers:when overdose occur, people at the scene call out-reaching workers. And out-reaching workers rush to overdose spots with naloxone to save those who overdosed. In the case of out-reaching workers arrived, only a few IDUs died. All of the out-reaching workers showd their supports to that program, even it is an illegal practice of medication as the law in China, which is the biggest obstacle that program is facing.2.Quantitative research1.Prevalence and risk factors of nonfatal overdose Of the 340 participants, 46.8%( 159) were recruited from methadone maintenance treatment clinics,53.2%(181)were recruited from compulsory isolated detoxification centers, the mean age was(37.7±8.7) years, 85.3% were male, 65.6% were Han ethnicity, and 49.4% were HIV positive, 22.6% reported have used club-related drugs( such as ephedrine, methamphetamine, benzodiazepines and ketamine) in the previous 12 months.Of those, 41.8%(142)had experienced at least one non-fatal overdose their lifetime(median: 3 overdoses)and 53(15.6%)had experienced at least one non-fatal overdose(median: 1 overdose)in the previous 12 months. Of the 53 IDUs, the mean age was(36.7±8.4)years, 83.0% were male, with an average period of drug abuse of(16.5±7.6)years. Dosage increase(37.7%, 14/53)and poly-drug use(32.1%, 15/53)were the main causes of participants’ own most recently overdose. Multiple logistic regression indicated that having participated in methadone maintenance treatment during the past year(OR=0.534, 95%CI=0.290~0.980)was independently associated with decreased risk of nonfatal heroin overdose, having shared of needles in the past 6months( OR=2.735, 95%CI=1.383~5.407) and having been forced to compulsory isolated detoxification center in the previous 12 months( OR=2.881,95%CI=1.226~6.767)were independently associated with increased risk of nonfatal heroin overdose.2.Present status of naloxone first-aid on spot conducted by out-reaching wokers Of the 340 participants, 217(63.8%) knew naloxone. Of those, 196(90.3%)knew naloxone first-aid program.164 IDUs had witnessed at least one overdose in the past 12 months. During the most recently witnessed overdose, an ambulance was called in 5.5%(9)of overdose events,while attempts to revive the overdose victim through physical stimulation, including applying ice and causing pain, were made in 50.0%(82)of incidents. Out-reaching wokers were called in 31.1%(51)of cases, while those present left in 6.7%(11)of events. In 11 cases, those present had naloxone or they asked peers who had naloxone for help.Of the 9 cases called emergency medical services, overdose victims were revived in 6cases, 1 died and 1 was unclear. Of the 82 cases, overdose victims were revived in 62 cases, 17 died and 3 were unclear. Of the 51 cases called out-reaching wokers,out-reaching wokers arrived at spot in 49 cases and the using time( M±Q) was(10±5)minutes. Overdose victims were revived in 47 cases and 4 died. Of the 11 cases the witness left, overdose victims survived in 1 case, 5 died and 5 were unclear.Of the 11 cases witness had naloxone or they asked peers who had naloxone for help,overdose victims were revived in 10 cases, 1 died.Conclusions1. Nonfatal heroin overdoses are common among Yunnan’s IDUs. IDUs should be encouraged to participate and remain in methadone maintenance treatment to prevent accidental overdose and be educated about proper response to overdose to reduce risk of overdose death, especially to those who are about to be released from compulsory isolated detoxification centers. Our study supports the need for establishing a referral system that matches drug users in compulsory isolated detoxification centers to methadone maintenance treatment programs.2. Naloxone first-aid on spot conducted by out-reaching wokers program in Yunnan has acceptable feasibility and in most cases out-reaching workers have the ability to use naloxone and give first aid correctly. To improve the rescue coverage, IDUs should be educated about naloxone and out-reaching workers rescue program,especially to those who don’t participate in MMT and needle exchange program. |
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