Preventing avoidable deaths: Essentials and recommendations on overdose

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1 Preventing avoidable deaths: Essentials and recommendations on overdose Teles S., Carvalho H., Pinto M., Oliveira M. J., Rodrigues C., & Queiroz J. (2014).

2 Final report: Report's launch in EMCDDA event: 'Take home naloxone to reduce fatalities: scaling up a participatory intervention across Europe, 13 and 14 October 2014, Lisbon. Recommendations on overdose prevention: draft available at APDES facebook. des.pt%2fv1%2fuploads%2fnews_files%2f278.pdf&h=qaq Fkovzk&s=1&enc=AZPcL9HvOtbK4hBZ8pXlDCPhDGAYcz23aJ 9y65nZgV0jnDczZm5mZIN3eKBic04W4qLrac0qBoxamgsFraN lhinyq80isflkwq-szayokdzmag

3 Recommendations: base ideas Figure 1: Framework for multi-level strategic overdoses prevention: baseline for literature review and recommendations creation. Inspired by Bronfenbrenner Human Environmental Framework (1979).

4 Recommendations: base ideas Preventing overdose ocurrence Research Practice Actions following fatal overdose Preventing overdose deaths Policy Preventing overdose reoccurrence after nonfatal episode Overdose prevention strategies Figure 2: Overdose prevention cycle. Figure 3: Actors

5 Recommendations: domains and topics Drug-induced deaths definition Transversal Nationally-adapted guidelines Environmental Prevention Overdose Prevention campaigns Drug Policy Models Overdose Risk assessment Preventing Overdose occurrence Drug Treatment Drug Comsumption Rooms Practice Research Policy Information on heroin purity and composition Naloxone provision Preventing Overdose deaths Training PUD, families/social network After non-fatal overdoses Training professionals Family and social network Actions following fatal overdose Drug-related and drug-induced deaths registry systems EuroHarm Reduction Network Conference; Amsterdam, October

6 Recommendations on overdose prevention: some highlights Transversal recommendations: Drug-induced death definition 1) Artificial and imprecise distinction between illegal/legal substances involved on overdose; 2) Vagueness occur after the consumption of the substance - and exclusion of slow onset episodes.

7 Current definition people who die directly due to use of illegal substances, although these often occur in combination with other substances, such as alcohol or psychoactive medicines. These deaths occur generally shortly after the consumption of the substance (EMCDDA, 2009a,p.6)

8 Recommendations on overdose prevention: some highlights Environmental prevention 1) Insufficient consideration, in prevention programs, of data about social inequalities, unemployment rates, line of poverty rates and homeless rates at different levels: local, regional and national. 2) Insufficient research about socioeconomic determinants of drug overdose.

9 Recommendations on overdose prevention: some highlights Preventing overdose occurrence: overdose risk assessment 1) Individual overdose risk assessment: almost half of European countries don t have or have rare to limited coverage (27 reporting); 1) PUD unawareness/ underestimation of their overdose risk (Darke etal.,2011); 1) Insufficient liaison between services- misleading overdose risk assessment and inadvertently contribution to risk.

10 Recommendations on overdose prevention: some highlights Preventing overdose occurrence: Drug treatment 1) Supervision practices as both a risk and protective factor; 2) Insufficient access to the different substances used in OST in some European countries;

11 Recommendations on overdose prevention: some highlights Training PUD and families/social network 1) Several resistances or lack of commitment in offering training to PUD and their families/social network.

12 Recommendations on overdose prevention: some highlights Preventing overdose re-occurrence after non-fatal episode(s) 1) Lack of opportunistic interventions provided by emergency and hospital personnel;

13 Recommendations on overdose prevention: some highlights Actions following fatal overdose: drug-related and drug induced deaths registry systems 1) Insufficient standardization of data collection and report proceedings across European countries; 2) Constrained capacity for developing toxicological analysis and/or implement toxicological studies; 3) Wasted opportunities for collect information on overdose risk factors.

14 Discussion Non-fatal overdose: opportunistic interventions Drug-induced death definition Training PUD and families/social network Environmental prevention Overdose risk assessment Registy systems Drug treatment

15 Acknowledgments To all peer educators and technicians who offered their feedback To the European group of experts: Xavier Majó, Mika Mickonen and his colleagues James Boyd and Margareeta Hakkinen, John Strang, Paolo Pani, Dagmar Hedrich, Kerstin Dettmer and Rui Rangel. To all Euro HRN partners and Workstream partner Contacts:

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