P2.A008: Peer-to-Peer Opioid Overdose and Naloxone Training in Adolescents

Background: After holding steady for many years, adolescent overdose deaths increased from a rate of 2.40 per 100,000 in 2010 to 4.57 in 2020 and 5.49 in 2021. In 2022, an average of 22 adolescent overdose deaths weekly were reported, the equivalent of one classroom of students per week in the U.S. Given that non-cannabis drug use by this age group is at an all-time low, this increase is likely driven by contamination of the counterfeit drug supply with fentanyl.

Studies evaluating overdose education and naloxone distribution consistently demonstrate increased knowledge about overdose, improved attitudes on naloxone, and reduced overdose deaths; however, none have involved adolescents. Adolescents may prefer to seek help, particularly for health-related issues, from peers rather than parents, teachers or pediatricians. Peer education, regarding sex education, HIV prevention, alcohol and smoking, among other topics, has been successful in promoting awareness, increasing knowledge, and changing behavior.

Methods: A before-after survey study was conducted at a private co-educational Catholic high school in Los Angeles County between November 2023 and March 2024. Twenty-minute training sessions were delivered by peers, covering trends in overdose deaths particularly in adolescents, defining opioids including fentanyl, recognizing overdose risk factors as well as signs and symptoms, and responding with naloxone. Participants completed an anonymous brief online survey just before and just after training. Primary outcome measures included changes in knowledge, attitudes and confidence regarding opioids, overdose and naloxone. Means with 95% confidence intervals and paired samples t-tests comparing difference between pre- and post-survey results were estimated using IBM SPSS Statistics, version 29.0.1.0. With a power of 85% and alpha = .05, the sample size required to detect an effect size of 0.2 in paired t-tests comparing differences was n = 199. Statistical significance was set at a two-tailed P< 0.05.

Results: Of 486 eligible, 206 (42.4%) 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).

Conclusion: Peer-to-peer overdose and naloxone training significantly increases knowledge, improves attitudes, and raises confidence in adolescents. Given the recent alarming increase in overdose deaths, adolescents should be encouraged and supported in their efforts to educate peers.