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Opioid overdose response education

Question Type:
Intervention
Full Question:
Adults and children at risk of suspected cardio/respiratory arrest due to opioids in the prehospital setting (P), does opioid overdose response education with or without naloxone distribution (I), compared with no overdose response education or overdose prevention education only (C), change Survival with Favorable neurological/functional outcome at discharge, 30 days, 60 days, 180 days AND/OR 1 year, Survival with Favorable neurological/functional outcome at discharge, 30 days, 60 days, 180 days AND/OR 1 year, Survival only at discharge, 30 days, 60 days, 180 days AND/OR 1 year, Survival only at discharge, 30 days, 60 days, 180 days AND/OR 1 year (O)?
Consensus on Science:
For the critical outcome of survival to hospital discharge, we have identified very-low-quality evidence (downgraded for risk of bias, inconsistency, indirectness, and imprecision) from 3 observational before-after studies.(Maxwell 2006, 89; Walley 2013, f174) Only 1 of 3 studies(Walley 2013, 241) attempted to correct for any confounding factors expected in interventional studies by using historic controls. This study did observe a dose-response effect with 0.73 (95% CI, 0.57–0.91) and 0.54 (95% CI, 0.39–0.76) adjusted-rate ratios for lethal overdose in communities with low and high implementation, respectively.(Walley 2013, 241) The remaining 2 observational studies reported reductions in rate ratios for lethal overdose in communities, 0.62 (95% CI, 0.54–0.72)(Albert 2011, S77) and 0.70 (95% CI, 0.65–0.74).(Maxwell 2006, 89)
Treatment Recommendation:
We suggest offering opioid overdose response education, with or without naloxone distribution, to persons at risk for opioid overdose in any setting (weak recommendation, very-low-quality evidence).Values, Preferences, and Task Force Insights In making these recommendations, we place greater value on the potential for lives saved by recommending overdose response education, with or without naloxone, and lesser value on the costs associated with naloxone administration, distribution, or education.
CoSTR Attachments:
GRADE_table_evidence_naloxone_n.docx    
GRADE_table_recommendation_naloxone_n.docx    
Summary Of Bias Assessment - BLS 891_n.xlsx    

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