Given that overdoses often occur in the presence of a witness (Lagu et al., 2006 Sporer, 2003 Strang et al., 2000 Tracy et al., 2005 Wagner et al., 2015), programs have been implemented where laypersons are given brief education in recognizing the signs of opioid overdose. Many opioid overdose deaths are preventable, using a comprehensive approach that includes prevention, treatment of opioid use disorder, and raising public awareness (Levine & Fraser, 2018). In 2019, nearly 50,000 opioid-related overdose deaths were reported in the United States (US) (Mattson et al., 2021). While the European Monitoring Center for Drugs and Drug Addiction has noted an increase in drug-related deaths since 2014 (European Monitoring Centre for Drugs & Drug Addiction, 2019, 2020a), the opioid epidemic has mainly affected North America. Drug overdose continues to be one of the main causes of death among people who use substances, and opioids are present in most overdose cases (Mattson et al., 2021).
Reducing fatal opioid overdoses remains a major challenge for public health. Opioid-Related Overdose Deaths and Targeted Response Specifically, our findings indicate that fidelity should be measured from an independent perspective (i.e., an individual who is experienced with fidelity rating but not directly involved in the intervention). OEND implementation outcomes and their relationship with intervention outcomes differed depending on the role of the fidelity rater in relation to the intervention.
However, fidelity measures from the perspective of trainees or trainers and acceptability of OEND were not associated with changes in trainees’ overdose knowledge or attitudes. Stepwise multiple regression models indicated that adherence of the trainer rated from the observer perspective added significantly to the prediction of changes in overdose knowledge, F(1, 67) = 9.81, p = 0.003, and explained 13% of the variance in outcome. Implementation outcomes were fidelity (competence and adherence of the trainer, N = 10 modified Fidelity Checklist) and acceptability of OEND (Acceptability of Intervention Measure), assessed from multiple perspectives (trainees, trainers, and an independent observer). Trainees ( N = 75) completed the Opioid Overdose Knowledge and Attitude Scales before and after training (intervention outcomes). This study evaluated 16 OEND trainings conducted at different Opioid Overdose Prevention Programs in New York City. However, we know little about OEND implementation outcomes (i.e., indicators of implementation success), specifically the fidelity of training delivery, and how these may relate to intervention outcomes (i.e., indicators of the success or effectiveness of an intervention), such as overdose knowledge and attitudes. Overdose Education and Naloxone Distribution (OEND) is an effective public health intervention to reduce opioid overdose fatalities (McDonald and Strang, Addiction 111:1177–1187, 2016).
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