JMIR Publications

ABSTRACT

Background:

Use of naloxone, an opioid antagonist, is a critical component of the US response to fatal opioid-involved overdoses. The importance and utility of naloxone in preventing fatal overdose has been widely declaimed by medical associations and government officials and is supported by strong research evidence. Still, there are one or more gaps in our current national strategy as many opioid-involved overdose fatalities have no evidence of naloxone administration.

Objective:

Improving the likelihood that naloxone will be used to prevent fatal overdose is predicated on facilitating an environment wherein naloxone exists near each overdose and is accessible by someone who is willing and able to use it. How to accomplish this on a national scale has been unclear. However, there exists a national network of more than one million cardiopulmonary resuscitation (CPR) layperson responders and 4,800 emergency response agencies linked through a phone app called PulsePoint Respond. PulsePoint responders certify that they are trained to administer CPR and willing to respond to possible cardiac events in public. When such an event occurs near their phone’s location, they receive an alert to respond. These motivated citizens are ideally positioned to carry naloxone and reverse overdoses that occur in public. This randomized, controlled trial will examine the feasibility of recruiting first-responder agencies and layperson CPR responders who already use PulsePoint to obtain overdose education and carry naloxone.

Methods:

This will be a 3-arm, parallel group, randomized, controlled trial. We will randomly select 180 first response agencies from the population of agencies contracting with the PulsePoint Foundation. The 3 study arms will include a standard recruitment arm, a misperception-correction recruitment arm, and a control arm (1:1:1 allocation, with random allocation stratified by rural/non-rural zip code designation). We will study agency recruitment and, among agencies we successfully recruit, responder certification of receiving overdose and naloxone education and/or carrying naloxone. Hypothesis 1 contrasts agency recruitment success between Arms 1 and 2; hypothesis 2 contrasts ratios of layperson certification across all three Arms. The primary analyses will be logistic regression comparing the recruitment rates between arms, adjusting for rural/non-rural zip code designation.

Results:

This study has been reviewed by the Indiana University Institutional Review Board (reference #20218 and #20219). Funding for this project was provided by the National Institute on Drug Abuse (R34DA058162).

Conclusions:

The hypotheses in this study will test whether a specific type of messaging is particularly effective in recruiting agencies and layperson responders. Although we hypothesize that Arm 2 will outperform the other arms, our intention is to use the best-performing approach in the next phase of this study if any of our approaches demonstrates feasibility. Clinical Trial: OSF Registries (https://osf.io/egn3z).