Tuesday, June 21, 2011

Program report: Overdose response in Yunnan, China

By: Nicholas Bartlett, Deming Xin, Hong Zhang, Bamian Huang

his month, an article that we researched and wrote last year, "A Qualitative Evaluation of a Peer-Implemented Overdose Response Pilot Project in Gejiu, China," has become available online in the International Journal of Drug Policy. The article reports on the experiences from Huyangshu, a harm reduction NGO based in Yunnan that has been offering naloxone in China through an emergency overdose response hotline service since 2008.

We conducted qualitative interviews with 30 clients, including 15 individuals who received naloxone injections to reverse an overdose and 15 individuals who called the hotline in response to the overdose of a peer. Clients pointed to a number of local structural shifts, including the aging of the opiate using population and drug mixing practices, that contribute to the city’s overdose toll. The article offers reflections on the program's implementation to date and considerations about how to improve in the future.

Nearly a year after the research was conducted, Huyangshu staff continues to operate the hotline. To date, the six staff members have successfully reversed a total of 121 using naloxone in responding to 136 different overdoses (in 15 cases, clients were revived without requiring naloxone injections).

Though the program has still managed to reverse every overdose where they have used naloxone, they have encountered three different clients who needed three naloxone injections each before their overdoses were reversed. Staff were surprised to find that each of these individuals had not injected diazepam or antihistamines (commonly used in combination with heroin this part of China) before overdosing. All three clients were tall, heavy-set men.

Despite the continuing success of the intervention, the program continues to encounter some of the difficulties discussed in the article. In the last two months, five people in the city that staff members are aware of died of heroin overdoses, including a former employee of Huyangshu. Each of these individuals were injecting alone when they died.

Effectively utilizing hospitals' emergency rescue services has also continued to be an issue. Drug users generally refuse emergency medical services out of fear of both the cost and worries that hospital staff might report them to the police. Huyangshu staff have called ambulances on four different occasions to help with what appeared to be complicated overdose cases. In each case, ambulances arrived quickly and offered courteous service, in one instance specifically complimenting Huyangshu staff on the work that they were doing. However, in each case, the client, after regaining consciousness, refused to accept ambulance transportation to the hospital for further medical services. In the article, we discuss this issue in more detail and consider possible ways of encouraging overdose victims to accept comprehensive medical services when needed.

Finally, Huyangshu staff report that they are increasingly comfortable in responding to overdoses. The compact nature of the city means that they are generally able to arrive at the site of an overdose within several minutes of receiving a call to the hotline. As mentioned in the article, Huyangshu is hoping later this year to begin distributing vials of naloxone directly to clients.

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