Overdose Rescues by Trained and Untrained Participants, Overdose Education & Naloxone Distribution Programs

A Retrospective Cohort Study

Drug overdose is the leading cause of premature, preventable mortality in the United States. In Massachusetts, opioid related overdose exceeds motor vehicle crashes as the leading cause of injury death.

Naloxone is an opioid antagonist that has no misuse potential and reverses the effects of respiratory depression and decreased consciousness during an opioid overdose.

Naloxone can be distributed either through a prescription or through community-based “overdose education with naloxone distribution” (OEND) programs. These programs target people at high risk of opioid overdose and/or likely to be bystanders during an overdose.

Doe-Simkins and colleagues wanted to measure whether “untrained” overdose bystanders can successfully respond to overdoses and how heroin use changes before and after training. An “untrained” bystander is an individual who has not been formally trained how to administer naloxone and who had obtained naloxone through social networks.

The authors utilized program data from the Massachusetts Opioid Overdose Prevention Pilot program and focused on individuals who had reported any substance use in the 30 days prior to enrollment (n=4,926). Between September 18, 2006 and December 31, 2010, there were 8,664 participants who were trained to prevent, recognize and respond to an overdose. There were 4, 926 participants who reported any substance use over the past 30 days among both the untrained and trained individuals included in the study. Among the 4,926 substance-using participants, 295 trained and 78 untrained individuals reported one or more rescues.

The study did not find any statistical significance between how trained and untrained participants reported help-seeking, rescue breathing (e.g. CPR), staying with the victim or in the success of naloxone administration.

The authors identified 325 OEND participants who had reported their substance use twice and when examining those individuals, they did not find an overall change in the number of days using heroin over the past 30 days.

These findings provide initial reassurance that training active substance users in overdose management and distributing naloxone rescue kits does not lead opioid users to increase their overall opioid use. Overall, the authors found few differences in behaviors between trained and untrained overdose rescuers.

This suggests the kits can be used with little if any formal training and can still save lives, although training may boost confidence in its use and is associated with a higher number of rescues.


Overdose deaths have increased rapidly in the past 10 years in the United States. OEND programs are expanding around the country. These programs empower individuals to use naloxone to save lives and prevent opiate overdose death.

This study highlights the fact that administering the naloxone anti-overdose medication may be straightforward and fairly intuitive, increasing the chances that bystanders will be able to administer the medication successfully and save lives.


Doe-Simkins, M., Quinn, E., Xuan, Z., Sorensen-Alawad, A., Hackman, H., Ozonoff, A., & Walley, A. Y. (2014). Overdose rescues by trained and untrained participants and change in opioid use among substance-using participants in overdose education and naloxone distribution programs: a retrospective cohort study. BMC Public Health, 14(1), 297.