Best practices for community-based overdose education and naloxone distribution programs: results from using the Delphi approach

Table 1 Final compilation of SSP-based OEND best practices with accompanying definitions

Staff training and support
1. Proactive engagement
SSP staff /volunteers proactively ask participants if they would like naloxone and overdose prevention education
2. Needs-based training
OEND trainings can be completed in as little as 5 min and follows the participant’s needs
3. Follow-up support for vicarious trauma^¥
SSPs provide support for overdose prevention educators to address experiences of vicarious trauma
4. Follow-up support for burnout^‖
SSPs provide support for overdose prevention educators to address burnout
5. Onsite overdose protocol established
SSP has an onsite overdose protocol, and staff/volunteers are trained to respond to an overdose during service provision
6. Training of trainers
Overdose prevention educators are trained in:
• Engagement, counseling, and listening skills
• Delivering health education for safer drug use, overdose prevention/response, and naloxone administration
• Working with participants to develop personal overdose prevention plans
• Supporting participants with experiences of witnessing overdoses and administering naloxone
• Providing referrals to health, substance use, and social services

Naloxone saturation and supply
7. Needs-based naloxone distribution
Naloxone distribution is based on participant’s needs and the needs of their community. *
8. Naloxone is accessible
Overdose prevention trainings and naloxone distribution is provided at all syringe access service sites and during community-based outreach
9. Sufficient naloxone supply
Naloxone inventory is accessible to SSP staff/volunteers, and the program has enough naloxone to not run out or need to ration to participants for the next 3 months
10. Naloxone saturation
Annually, SSPs distribute 20 times or more the number of naloxone doses as the number of opioid overdose death in the previous year (or for the most recent year overdosed death data are available)
11. Option to choose naloxone administration modality
Participants can choose intranasal or intramuscular naloxone, based on their preferences

Culturally appropriate service
12. Involvement of people who use drugs^†
People who use drugs deliver overdose prevention education, distribute naloxone, contribute to naloxone programming, and provide oversight of program activities
13. Lay Person Naloxone Team
SSPs utilize non-medical staff/volunteers to provide overdose prevention education and naloxone distribution
14. Overdose response information and education materials offered
Educational materials regarding overdose risk and response, such as pamphlets, posters, palm cards, and/or Web-based resources, are available to SSP participants
15. Outreach and marketing conducted
SSP publicizes naloxone programming by distributing information through flyers, pamphlets, posters, and social media; building community partnerships; and conducting outreach in the community

Grounded in harm reduction
16. OEND program is grounded in harm reduction principles^‡
SSP staff/volunteers are trained and supported to offer services grounded in harm reduction principles
17. Low threshold services
SSP offers walk-in services without the need to make appointments
18. Naloxone at no cost
Naloxone is distributed by the SSP and is free
19. Anonymous Service Delivery
Participants are not required to provide personal information or identification to receive naloxone
20. Only essential data are collected
SSP only collects essential information from participants for program improvement, reporting, or advocacy

^¥Vicarious trauma—the negative changes that happen to people over time as they witness and engage with other people’s suffering and need that can leave them feeling numb, disconnected, isolated, overwhelmed, and depressed. Over time, this process can lead to changes in your psychological, physical, and spiritual well-being
^‖Burnout—the feeling of physical and emotional exhaustion due to stress from working with people under difficult or demanding conditions
^*Includes secondary naloxone distribution (peer-to-peer distribution)
^†These are active program participants
^‡According to Harm Reduction International, harm reduction is a set of evidence-based practices that minimize the negative impacts of drug use and drug policies. Harm reduction is fundamentally grounded in principles that protect human rights and improve public health and incorporates a wide array of approaches designed to meet people where they are and offer opportunities for people to improve their health and well-being. Harm Reduction Coalition has designated a set of eight principles central to harm reduction practice which can be found here: https://harmreduction.org/about-us/principles-of-harm-reduction/

ISSN: 1477-7517