Training the trainers? Does it work with opioid overdose management and naloxone administration?

Dr Soraya Mayet

Consultant Psychiatrist in Substance Misuse

Dr Soraya Mayet graduated in London with a BSc: Physiology and Pharmacology First Class Honours and MBBS. Followed by academic psychiatry training at the Maudsley Hospital where she completed Membership of the Royal College of Psychiatry. During her training, she worked as a Clinical Research Worker in Addictions at the Institute of Psychiatry, Kings College London developing and teaching the clinical skills module on the MSc in ‘public health and clinical aspects of addictions’. She was also seconded to the Department of Health for two years working on contingency plans. She completed a Post Graduate Certificate in Academic Practice at Kings College London and is a fellow of the higher education academy. She is honorary lecturer for the Institute of Psychiatry. Following gaining a CCT in general psychiatry and addictions she moved to the North East of England taking up a post as Consultant Psychiatrist in Substance Misuse covering three community drug services, prison substance misuse and Principle Investigator for the Randomised Injectable Opiate Treatment Trial (RIOTT) Darlington. Her work includes book chapters on addictions, Cochrane reviews and published research papers on perinatal addictions, ‘take home’ naloxone, psychosocial interventions, prescribing, groin injecting and contributed to the DH 2007 clinical guidelines for drug misuse. She is hoping to complete her Doctor of Medicine (MD) on QT and opioid maintenance treatment at Kings College London soon. 

Address where work carried out: Kings College London

Acknowledgements: Funding support was provided by the NTA (National Treatment Agency for Substance Misuse). We are grateful to all clinicians from the addiction services who accepted taking part on this study.

No Conflict of Interest

Aims: To assess change in clinicians’ knowledge for managing an opioid overdose and administering naloxone following training, evaluate whether the ‘cascade method’ is efficient for disseminating training, and evaluate the barriers to implementing training.

Design: Repeated measures design evaluated knowledge pre-and-post training. Follow-up for one year to assess the cascade method. Sample of clinicians followed up to assess barriers to implementing training.

Setting: Initial training in London cascaded to 6 addictions services across England.

Participants: Healthcare professionals in Addictions services.

Intervention: Two-hour interactive training session on overdose management and naloxone administration. Trained clinicians were expected to train other clinicians/clients.

Measurements: Self administered structured questionnaire recording overdose knowledge and confidence pre-and-post training and barriers to implementation of training.

Findings: 219 clinicians trained with a mean composite score of 18.3 (±3.8) for opioid overdose risks, signs and actions to be taken following an overdose out of a possible 26 and after training demonstrated a significant increase in knowledge increasing to 21.2 (±4.1) (Z=9.2, P<0.001). Confidence and willingness to administer naloxone improved (p<0.05). One hundred clinicians trained a further 119 clinicians (n=219) and ‘trained’ clinicians (N=219) trained a further 239 drug users. Motivation, resources, treatment philosophy and confidence, were barriers to implementing training.

Conclusions: Training healthcare workers in addictions on how to manage an opioid overdose and administer naloxone improved knowledge and was considered effective. The ‘cascade method’ was not successful for disseminating the training to large numbers of clinicians or drug users which may be related to clinician and service related barriers.