Effects of Peer-to-Peer Opioid Overdose and Naloxone Training in Adolescents

Adolescent overdose deaths have increased significantly, with an average of 22 American teens dying weekly in 2022. Despite evidence-based interventions to mitigate these deaths, few preventive interventions have been investigated and widely adopted for this age group.

A population-based sample of high school students in Los Angeles County participated in peer-delivered training between November 2023 and March 2024. Topics covered included trends in overdose deaths particularly in adolescents, defining opioids including fentanyl, recognizing overdose, and responding with naloxone. Participants completed an anonymous online pre-post survey which evaluated knowledge, attitudes and confidence regarding opioids, overdose and naloxone.

206 students (mean age 16.0 years; 50.0% male, 47.6% female) participated in 15 training sessions and completed both pre- and post-training surveys. Students' knowledge, measured as percentage of correct responses, increased from a mean of 34.0% to 78.9% (95% CI -6% to 5%; p < 0.0001). Students' attitudes, scored on a scale of 1-4 (1 = strongly disagree, 2 = disagree, 3 = agree, 4 = strongly agree), improved from a mean score of 2.98 to 3.52 (95% CI -0.09 to 0.10; p < 0.0001). Confidence, rated on a scale of 1-4 (1 = very low, 2 = low, 3 = high, 4 = very high), improved from a mean score of 1.97 to 3.17 (95% CI -0.11 to 0.11; p < 0.0001).

Peer-to-peer overdose and naloxone training significantly increases knowledge, improves attitudes, and raises confidence in adolescents. There is a clear need to increase overdose awareness in adolescents and peers should be incorporated into prevention efforts.