TY - JOUR
KW - Adolescent
KW - Adult
KW - Aged
KW - Drug Overdose/prevention & control
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Narcotic Antagonists/administration & dosage
KW - Opioid-Related Disorders/prevention & control
KW - Pilot Projects
KW - Risk Factors
KW - Single-Blind Method
KW - Treatment Outcome
KW - Young Adult
AU - Phillip Oliver Coffin
AU - Glenn-Milo Santos
AU - Tim Matheson
AU - Emily Behar
AU - Chris Rowe
AU - Talia Rubin
AU - Janelle Silvis
AU - Eric Vittinghoff
A1 - 
AB - OBJECTIVE: The United States is amidst an opioid epidemic, including synthetic opioids that may result in rapid death, leaving minimal opportunity for bystander rescue. We pilot tested a behavioral intervention to reduce the occurrence of opioid overdose among opioid dependent persons at high-risk for subsequent overdose. MATERIALS AND METHODS: We conducted a single-blinded randomized-controlled trial of a repeated dose motivational interviewing intervention (REBOOT) to reduce overdose versus treatment as usual, defined as information and referrals, over 16 months at the San Francisco Department of Public Health from 2014-2016. Participants were 18-65 years of age, had opioid use disorder by Structured Clinical Interview, active opioid use, opioid overdose within 5 years, and prior receipt of naloxone kits. The intervention was administered at months 0, 4, 8, and 12, preceded by the assessment which was also administered at month 16. Dual primary outcomes were any overdose event and number of events, collected by computer-assisted personal interview, as well as any fatal overdose events per vital records. RESULTS: A total of 78 persons were screened and 63 enrolled. Mean age was 43 years, 67% were born male, 65% White, 17% African-American, and 14% Latino. Ninety-two percent of visits and 93% of counseling sessions were completed. At baseline, 33.3% of participants had experienced an overdose in the past four months, with a similar mean number of overdoses in both arms (p = 0.95); 29% overdosed during follow-up. By intention-to-treat, participants assigned to REBOOT were less likely to experience any overdose (incidence rate ratio [IRR] 0.62 [95%CI 0.41-0.92, p = 0.019) and experienced fewer overdose events (IRR 0.46, 95%CI 0.24-0.90, p = 0.023), findings that were robust to sensitivity analyses. There were no differences between arms in days of opioid use, substance use treatment, or naloxone carriage. CONCLUSIONS: REBOOT reduced the occurrence of any opioid overdose and the number of overdoses. TRIAL REGISTRATION: clinicaltrials.gov NCT02093559.
AD - San Francisco Department of Public Health, San Francisco, California, United States of America.; University of California San Francisco, San Francisco, California, United States of America.; San Francisco Department of Public Health, San Francisco, California, United States of America.; University of California San Francisco, San Francisco, California, United States of America.; San Francisco Department of Public Health, San Francisco, California, United States of America.; San Francisco Department of Public Health, San Francisco, California, United States of America.; University of California San Francisco, San Francisco, California, United States of America.; San Francisco Department of Public Health, San Francisco, California, United States of America.; San Francisco Department of Public Health, San Francisco, California, United States of America.; San Francisco Department of Public Health, San Francisco, California, United States of America.; University of California San Francisco, San Francisco, California, United States of America.
BT - PloS one
C5 - Healthcare Disparities; Measures; Opioids & Substance Use
CP - 10
CY - United States
DO - 10.1371/journal.pone.0183354
IS - 10
JF - PloS one
LA - eng
M1 - Journal Article
N2 - OBJECTIVE: The United States is amidst an opioid epidemic, including synthetic opioids that may result in rapid death, leaving minimal opportunity for bystander rescue. We pilot tested a behavioral intervention to reduce the occurrence of opioid overdose among opioid dependent persons at high-risk for subsequent overdose. MATERIALS AND METHODS: We conducted a single-blinded randomized-controlled trial of a repeated dose motivational interviewing intervention (REBOOT) to reduce overdose versus treatment as usual, defined as information and referrals, over 16 months at the San Francisco Department of Public Health from 2014-2016. Participants were 18-65 years of age, had opioid use disorder by Structured Clinical Interview, active opioid use, opioid overdose within 5 years, and prior receipt of naloxone kits. The intervention was administered at months 0, 4, 8, and 12, preceded by the assessment which was also administered at month 16. Dual primary outcomes were any overdose event and number of events, collected by computer-assisted personal interview, as well as any fatal overdose events per vital records. RESULTS: A total of 78 persons were screened and 63 enrolled. Mean age was 43 years, 67% were born male, 65% White, 17% African-American, and 14% Latino. Ninety-two percent of visits and 93% of counseling sessions were completed. At baseline, 33.3% of participants had experienced an overdose in the past four months, with a similar mean number of overdoses in both arms (p = 0.95); 29% overdosed during follow-up. By intention-to-treat, participants assigned to REBOOT were less likely to experience any overdose (incidence rate ratio [IRR] 0.62 [95%CI 0.41-0.92, p = 0.019) and experienced fewer overdose events (IRR 0.46, 95%CI 0.24-0.90, p = 0.023), findings that were robust to sensitivity analyses. There were no differences between arms in days of opioid use, substance use treatment, or naloxone carriage. CONCLUSIONS: REBOOT reduced the occurrence of any opioid overdose and the number of overdoses. TRIAL REGISTRATION: clinicaltrials.gov NCT02093559.
PP - United States
PY - 2017
SN - 1932-6203; 1932-6203
SP - e0183354
T1 - Behavioral intervention to reduce opioid overdose among high-risk persons with opioid use disorder: A pilot randomized controlled trial
T2 - PloS one
TI - Behavioral intervention to reduce opioid overdose among high-risk persons with opioid use disorder: A pilot randomized controlled trial
U1 - Healthcare Disparities; Measures; Opioids & Substance Use
U2 - 29049282
U3 - 10.1371/journal.pone.0183354
VL - 12
VO - 1932-6203; 1932-6203
Y1 - 2017
Y2 - Oct 19
ER -