Physician UCSD/Rady Children's Hospital San Diego, California, United States
Background: In San Diego alone, over 1/3rd of incarcerated youth surveyed in 2021 reported illegal use of prescription or over the counter drugs, amongst which tranquilizers (29%), Percocet (16%) and fentanyl (7%) are the most common, followed by oxycontin (6%) and Vicodin (4%). In response to the opioid epidemic, Opioid Education and Naloxone Distribution (OEND) programs are gaining traction in the U.S. Still, access to programs remains limited for incarcerated youth. Objective: Adolescents at the Youth Transition Campus (YTC) in San Diego voluntarily participated in a pilot OEND program. A multidisciplinary group used Ishikawa diagrams to establish barriers to implementation in clinic workflow and design training sessions. The primary aim was to increase the percentage of minors with opioid usage history who participate in the OEND program prior to release. The secondary aim was to assess the impact of OEND training with surveys and simulation. The project balancing measure was defined as maintaining clinic workflow and efficiency by survey of staff. Design/Methods: Using a generalized mixed effects regression model, pre- and post-training validated surveys were compared to evaluate for change in opioid-use knowledge and attitudes. Each training session consisted of a naloxone administration video and a simulation activity. By utilizing PDSA cycles, improvements were made to the training survey, notation of individuals who participated in training, and transition of individuals between training sessions. Results: The primary aim was met in implementation of OEND program for minors with 49 individuals completing the program. Of all 49 individuals who participated, there was a statistically significant increase in the number who, after training, correctly identified heroin, oxycontin and fentanyl as opioids (p < 0.010), correctly identified trouble breathing as a sign of opioid overdose (p < 0.004), wanted to help someone who overdosed (p < 0.017), felt they would know how to help someone who overdosed (p < 0.001), and reported not needing additional training in order to feel confident helping someone who overdosed (p < 0.007). All participants successfully completed simulation of nasal injection. There was no disruption to clinic workflow.
Conclusion(s): The implementation of OEND program amongst detained youth in San Diego has shown improvement on opioid use knowledge and attitude, as well as successful simulation training. Training of incarcerated youth shows promising application, warranting future research and follow-up of real-life application.
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