Recent research conducted in 2014 by the National Advisory Committee on Drugs and Alcohol suggests that there are 18,988 opiate users in the Republic of Ireland (rate 6.18 per 1,000 population), indicating that Ireland has one of the highest estimated rates of problem opiate use across 17 countries in the European Union.1 Opiate use disorder is an increasingly common condition in healthcare systems in Ireland, with over 200 opiate overdose deaths occurring annually.2

Naloxone is an antidote for opioid overdose that reverses the depressant effects of opiates such as heroin. Naloxone has been shown to reduce mortality among people who use opioids and its distribution to trained lay users is effective for reducing fatal overdose.3 The Naloxone Demonstration Project was initiated in the Republic of Ireland in 2015, and in that year 600 individuals were trained in how to use naloxone.4 To date, more than 400 drug users have been prescribed naloxone5 and there have been five recorded ‘overdose reversals’ that may have contributed to lives being saved.

Evidence suggests that there is support among general practitioners (GPs) in Ireland for wider naloxone availability.6 Nevertheless, medical students’ exposure to patients with substance use disorders is limited and usually only occurs during general practice and psychiatry placements. In addition, there is a lack of formal substance use education at undergraduate level in Ireland, along with information regarding effective treatments such as naloxone. A recent study examined final-year medical students’ learning experiences and attitudes towards opioid use disorder, overdose, and community naloxone provision as an emerging overdose treatment.

In this research,7 published in the journal Addictive Behaviors, an anonymous paper-based survey was administered to 243 undergraduate medical students undertaking their final professional completion module prior to graduation from University College Dublin. The results were compared with parallel surveys of GPs and GP trainees. A total of 197 medical students completed the survey (response rate: 81%), with just under one-half being male (45%), most being of Irish nationality (77%), and aged less than 25 years (63%).

Results

The respondents reported feeling reasonably prepared to recognise key markers of opioid use disorder but felt less prepared for other aspects of opioid use disorder management, consultation with a patient about their opioid use disorder, assessing addiction severity, formulating a treatment plan or managing an opioid overdose. Most had taken a history from a patient with an opioid use disorder (83%) and one-third had witnessed at least one opioid overdose. Nevertheless, only a small proportion (10%) had seen naloxone administered, and only three had themselves administered naloxone in overdose. In comparison, 35% of GPs and 63% of GP trainees in parallel surveys had administered naloxone.

Just over one-half (52%) of student respondents saw a need for wider naloxone availability. For those students who were in opposition to wider availability, concerns included potential use of naloxone, lack of evidence for the benefit of wider availability, and that it might encourage greater opioid use. A similar proportion of respondents (54%) supported wider naloxone availability among laypeople.

Conclusions

The study authors noted that while recognition of opioid use disorder was reasonably well reported, management competencies were, in general, less positive. Few had seen naloxone administered or administered it themselves. In addition, despite evidence of the effectiveness of lay administration of naloxone in preventing fatal overdose, 46% of respondents did not support wider naloxone distribution among laypeople. The authors suggest that these results may reflect students’ lack of exposure to patients with substance use disorder and overdose and to gaps in education in undergraduate levels.

1    Hay G, Jaddoa A, Oyston J, Webster J, Van Hout MC, and Rael dos Santos A (2017) Estimating the prevalence of problematic opiate use in Ireland using indirect statistical methods. Dublin: National Advisory Committee on Drugs and Alcohol. http://www.drugsandalcohol.ie/27233/

2    Irish Medical Organisation (IMO) (2015) IMO position paper on addiction and dependency. Dublin: IMO. https://www.drugsandalcohol.ie/24092/

3    European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (2015) Preventing fatal overdoses: a systematic review of the effectiveness of take-home naloxone. EMCDDA Papers. Luxembourg: Publications Office of the European Union. https://www.drugsandalcohol.ie/23289/

4    Merchants Quay Ireland (2016) Merchants Quay Ireland: annual review 2015. Dublin: Merchants Quay Ireland. http://www.drugsandalcohol.ie/26106/

5    Merchants Quay Ireland (2017) Merchants Quay Ireland: annual review 2016. Dublin: Merchants Quay Ireland. http://www.drugsandalcohol.ie/27910/

6    Klimas J, Egan M, Tobin H, Coleman N and Bury G (2015) Development and process evaluation of an educational intervention for overdose prevention and naloxone distribution by general practice trainees. BMC Medical Education, 15: 206.

7    Tobin H, Klimas J, Barry T, Egan M, Bury G (2018) Opiate use disorders and overdose: medical students’ experiences, satisfaction with learning, and attitudes toward community naloxone provision. Addictive Behaviors. Early online . https://www.drugsandalcohol.ie/28290/