Overdose
Conditions
Keywords
Brief overdose prevention, Naloxone, Youth parents, Health care providers, Primary care
Brief summary
Between 2015 and 2019, overdose deaths translated to 1.25 million years of life lost among adolescents and young adults (youth) aged 12 to 24 years, and the percent change in fatal overdose rates among adolescents ages 14 to 18 was higher than adults between 2019 and 2020.3-5 Primary care providers are uniquely positioned to provide evidence-based information to youth to both improve awareness of overdose risk (individual benefit) and simultaneously ensure that youth are prepared to recognize and respond to an overdose (public health benefit). However, currently there is no evidence-based intervention for pediatric primary care to reduce youth overdose risk and ensure youth can recognize and respond to an overdose. To address the gap in evidence-based overdose prevention interventions for youth, we propose a randomized controlled trial (RCT) to evaluate the efficacy of a brief universal overdose prevention intervention in pediatric primary care. We will enroll 24 providers and 624 youth patient participants randomized (at the provider level) to receive either the brief overdose prevention intervention or usual care.
Interventions
Providers in the intervention group will inform youth participants about: the risk factors for overdose, how to stay safe and prevent overdose, how to recognize an overdose, and how to respond to an overdose. Providers in the intervention group will also inform youth participants how to use naloxone and facilitate access if youth would like to have it.
Youth participants will be provided usual care by providers in the control group. As part of usual care, providers may facilitate access to naloxone for youth control participants if they would like to have it.
Sponsors
Boston Medical Center
National Institute on Drug Abuse (NIDA)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
A two-arm cluster RCT will be conducted. Randomization will occur at the provider level. After enrollment, a 2-block randomization will be done to ensure that randomization to the intervention is balanced across provider types (e.g., family medicine vs. pediatrics). .
Eligibility
Sex/Gender
ALL
Age
13 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Providers: * Physicians and advance practice providers (nurse practitioners and physician assistants) within Pediatric Primary Care and Family Medicine at Boston Medical Center, NeighborHealth, and South Boston Community Health Center * ≥ 1 clinic session per week Youth: * Ages 13 - 26 * Scheduled for a CPE or follow-up clinical appointment with a provider who is participating in the trial * English speaking
Exclusion criteria
Providers: * Participated as an intervention provider in the R61 pilot RCT (H-45731) * Participated in the Community Advisory Board that assisted in the development of the intervention (H-45388) Youth: * Caregivers of youth ages 13-17 unable to provide informed consent or are not English speaking * Cognitive limitation or intellectual disability that in the opinion of their provider would not be able to complete the requirements of the research * Young adults ages 18-26 with a legal guardian * Any medical/psychiatric condition that causes acute distress and requires emergency evaluation * Under legal custody of the Department of Children and Families (DCF) * Participated in the intervention arm of the R61 pilot RCT (H-45731)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Provider Fidelity to the Intervention | 12 months | Providers in the intervention arm will complete a checklist after all CPEs and follow-up clinical appointments with youth ages 13 to 26 years. The checklist will assess provider consistency in delivery of the intervention including adherence to intervention topics and the provision of naloxone. |
| Youth Fidelity to the Intervention | 12 months | Youth in the intervention arm will complete a checklist after their CPEs and follow-up clinical appointments. The checklist will assess consistency in intervention delivery including adherence to intervention topics and whether naloxone was offered to the youth. |
| Youth knowledge of risk associated with exposure to fentanyl and other emerging drugs | Baseline, 3 months, 6 months, 9 months, and 12 months. | Assessed using a 4-point Likert-scale question measuring perceived risk of harm from taking prescription medication that was not prescribed or taking medication other than prescribed. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Youth knowledge of strategies to reduce overdose risk | Baseline, 3 months, 6 months, 9 months, and 12 months. | Assessed using 4-point Likert-scale questions measuring perceived risk associated with using more than one substance at a time and using substances while alone. |
| Youth's ability to recognize and respond to an overdose | Baseline, 3 months, 6 months, 9 months, and 12 months. | Assessed using investigator-developed knowledge assessment questions evaluating recognition of overdose signs, appropriate overdose response, and knowledge of naloxone. |
Countries
United States
Contacts
CONTACTSarah Bagley, MD, MSc
CONTACTSarah N Kosakowski, MPH
PRINCIPAL_INVESTIGATORSarah Bagley, MD
Boston Medical Center, Internal Medicine, Addiction Medicine
PRINCIPAL_INVESTIGATORAmy Yule, MD
Boston Medical Center, Psychiatry
Outcome results
None listed