Witnessed overdose history and response among overdose survivors who use non-prescribed opioids in an overdose...

The REpeated-dose Behavioral intervention to reduce Opioid Overdose Trial (REBOOT) evaluated motivational interviewing for overdose prevention, focusing partly on witnessed overdose response. We assessed participants' witnessed overdose history and REBOOT's impact on overdose response among opioid overdose survivors using non-prescribed opioids in Boston and San Francisco.

We described participants' witnessed overdose and naloxone administration history over the four months preceding enrollment and the number and characteristics of witnessed overdoses reported during the study. We then used generalized estimating equations to test if the intervention affected if participants responded "me" to who, if anyone, responded to a witnessed overdose by assessing responsiveness, calling 911, performing rescue breathing, doing chest compressions, or administering naloxone during 16-month follow-up.

Of 265 participants, most (83 %) witnessed at least one overdose in the four months preceding enrollment; 68 % of these participants had administered naloxone. In the 16-month post-enrollment follow-up, 250 (94 %) participants witnessed 597 overdoses. In 94 % of these, participants reported that somebody (themselves or others) responded. REBOOT had no significant impact on whether participants personally responded to overdoses: 67 % of control and 72 % of intervention participants personally responded pre-enrollment (p = 0.39), versus 63 % and 62 % post-enrollment (p = 0.97).

Most REBOOT participants witnessed a recent opioid overdose preceding enrollment. After enrollment, nearly all witnessed overdoses were responded to; the intervention had no effect on whether the participant personally responded. Given near-universal response, there was little room for improving overdose response. Future research should test similar interventions in communities with less prior overdose prevention exposure.