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Opioid OverdosePhase 4OOPENNCT01788306

Project OOPEN: Opioid Overdose Prevention, Education and Intervention

A Phase 4 study testing OOPEN+BBCC in people with Opioid Overdose, run by University of Washington at 3 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This prospective, randomized emergency department trial will study the effectiveness of an intervention that combines opioid overdose prevention, education and intervention that includes take home naloxone with brief behavioral change counseling. Read more about this study

Who is it for?
Ages 18 to 70 years
Conditions the study is for
Opioid Overdose
What is being tested?
OOPEN+BBCC
Could I receive a placebo?
No, everyone receives an active treatment
How many people
256 participants
Where
3 sitesUnited States
Study dates
Jan 2013to Oct 2018
Phase
Phase 4
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 70 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Meets study definition of elevated risk of future opioid overdose
  • Reason for visit is opioid overdose (regardless of frequency of use), or
  • Use of pharmaceutical opioids not prescribed to the patient 2 or more times in the prior month, or
  • Use of other opioids, alcohol, benzodiazepines or stimulants within two hours of using opioids 2 or more times in the prior month, or
  • Average daily dose of prescribed opioids consumed is greater than10 mg morphine equivalent analgesic dose or higher for 15 or more days in the last 30.
  • Enrolled in opioid substitution program (e.g. methadone or suboxone) and receiving doses.
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  • Use of heroin through any route of administration at least 2 times in the last 30 days (or if institutionalized recently, in the most recent month they were not institutionalized) with or without other risks being present.
  • Use of pharmaceutical opioids at least 2 times in the last 30 days (or if institutionalized recently, in the most recent month they were not institutionalized) with other risks being present.
  • Average daily dose of prescribed opioids consumed is 30 mg morphine equivalent analgesic dose or higher without other risks being present.(For adult medicine clinic patients only.)

Who cannot join

  • Unwilling to allow further access to medical or drug treatment records.
  • Inability to communicate in English.
  • Current active suicidal ideation.
  • Significant cognitive or psychiatric impairment (per judgment of clinical staff)
  • Inability to provide adequate contact information to assist with follow-up.
  • Under age 18 or over age 70 at time of recruitment.
Show all 9Show fewer
  • Not currently living in Washington State or planning to move from Washington State within the following year.
  • Receiving treatment for sexual assault.
  • Have non-expired take-home naloxone at home, on their person, or in their possessions.

Trial locations and contacts

3 sites in 1 country.

United States3 sites
  • Harborview Medical Center

    Seattle, Washington, 98104

  • Evergreen Treatment Services

    Seattle, Washington, 98134

  • University of Washington Medical Center

    Seattle, Washington, 98195

Other trials in United States

About this study

Official title: A Trial to Prevent Opioid Overdose: E.D. Based Intervention & Take-home Naloxone

This prospective, randomized emergency department trial will study the effectiveness of an intervention that combines opioid overdose prevention, education and intervention that includes take home naloxone with brief behavioral change counseling. The study will recruit both heroin users (n=500) and pharmaceutical opioid users at elevated risk for overdose (n=500). Outcomes of interest include subsequent opioid overdoses and overdose risk behaviors.

Primary Aims

Read more

The primary aims are to test whether those who receive the intervention compared to standard care have: 1) Lower rates of opioid non-fatal and fatal overdose; 2) Reduce drug use, inappropriate medication use, and other overdose risk behaviors.

Secondary Aims

The secondary aims are to test whether those who receive the intervention compared to standard care have: 3) More appropriate health care utilization (e.g. fewer emergency department visits and admissions to inpatient care); 4) Lower total health care costs; 5) Determine the prevalence of HIV risk behaviors among heroin and pharmaceutical opioid users at risk for overdose and whether the intervention impacts these behaviors.

Read the detailed description

Fatal overdoses involving pharmaceutical opioids have increased dramatically over the past decade, surpassing those related to heroin, and are the leading cause of drug overdose in much of the U.S. In Seattle-King County, 75% of drug overdoses involved pharmaceutical opioids and/or heroin in 2009. Opioid overdoses, heroin and pharmaceutical, are preventable and reversible. Research indicates that drug users and their partners can be successfully trained to recognize and reverse overdoses with naloxone (an opioid antagonist medicine or "antidote").

Despite active heroin overdose prevention, education and intervention programs with naloxone (OOPEN) in 15 states with thousands of overdose reversals and no serious adverse events, rigorous studies of these programs on rates of subsequent heroin overdoses have not been conducted. No OOPEN programs or studies have yet been implemented for pharmaceutical opioid users at elevated risk for overdose. The Emergency Department (ED) setting holds great promise for identifying and recruiting those at elevated risk of both heroin and pharmaceutical opioid overdose: 1) the ED study site for this proposal provides most services to those needing care for acute opioid related medical problems in Seattle, and 2) patients' need for urgent medical attention may heighten their concern about potential harms from opioids.

Unique to this setting is the potential to identify high risk pharmaceutical opioid users, a population that is difficult to locate and engage. ED interventions using brief behavior change counseling (BBCC) have been shown to significantly improve health behaviors such as alcohol use and injury, to increase entry into drug treatment as well as to reduce costs. Evidence is promising, but limited, regarding the impact of BBCC on opioid related risk behaviors.

This prospective, randomized ED trial will study the effectiveness of an intervention that combines OOPEN with BBCC for both heroin users (n=500) and pharmaceutical opioid users at elevated risk for overdose (n=500). The primary outcome is subsequent opioid overdoses, ascertained by follow up interviews conducted at 3, 6 and 12 months as well as via administrative records for up to 24 months (i.e. medical records, ambulance responses, and death certificates).

Primary Aims

The primary aims are to test whether those who receive the intervention compared to standard care have: 1) Lower rates of opioid non-fatal and fatal overdose; 2) Reduce drug use, inappropriate medication use, and other overdose risk behaviors.

Secondary Aims

The secondary aims are to test whether those who receive the intervention compared to standard care have: 3) More appropriate health care utilization (e.g. fewer emergency department visits and admissions to inpatient care); 4) Lower total health care costs; 5) Determine the prevalence of HIV risk behaviors among heroin and pharmaceutical opioid users at risk for overdose and whether the intervention impacts these behaviors.

Conditions
Opioid Overdose
Being tested
OOPEN+BBCC
Keywords
Elevated risk, opioid overdose
Medical subject headings
Opiate Overdose

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • OOPEN+BBCCDrug

    Take-home naloxone is offered as part of a behavioral prevention intervention to reduce the occurrence of future opioid overdose.

Study groups in NCT01788306
Study groupRoleWhat they receive
Intervention (OOPEN+BBCC)Active comparatorStudy intervention, overdose prevention, education, intervention, brief behavioral change counseling, take-home naloxone, referral to local available resources.
Receives: Drug: OOPEN+BBCC
ControlNo interventionStandard of care, referral to local available resources.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Rate of Fatal Opioid Overdose

    Rate of fatal opioid overdose

    Measured: One year

  2. Rate of Non-fatal Opioid Overdose

    Rate of non-fatal opioid overdose

    Measured: One year

  3. Elapsed Time Until Opioid Overdose

    Elapsed time until opioid overdose

    Measured: Up to1064 days

  4. Change in Overdose Risk (Change in Opioid Use - Heroin)

    Determine whether changes in behavior occur that increase or decrease risk of future overdose. Behaviors being measured include the amount of opioids taken, the use of opioids alone, use of opioids with alcohol or other drugs or medications, possessing naloxone, use of opioids in an environment that supports continued opioid use.(Data table includes proportions at 3 month follow-up.)

    Measured: 3 months

  5. Change in Overdose Risk (Change in Opioid Use - Prescription-Type Opioids)

    Determine whether changes in behavior occur that increase or decrease risk of future overdose. Behaviors being measured include the amount of opioids taken, the use of opioids alone, use of opioids with alcohol or other drugs or medications, possessing naloxone, use of opioids in an environment that supports continued opioid use.(Data table includes proportions at 3 month follow-up.)

    Measured: 3 months

  6. Change in Overdose Risk (Using Alone When Taking Opioids)

    Determine whether changes in behavior occur that increase or decrease risk of future overdose. Behaviors being measured include the amount of opioids taken, the use of opioids alone, use of opioids with alcohol or other drugs or medications, possessing naloxone, use of opioids in an environment that supports continued opioid use. (Data table includes means at 3 month follow-up.)

    Measured: 3 months

  7. Change in Overdose Risk (Use of Sedatives When Taking Opioids)

    Determine whether changes in behavior occur that increase or decrease risk of future overdose. Behaviors being measured include the amount of opioids taken, the use of opioids alone, use of opioids with alcohol or other drugs or medications, possessing naloxone, use of opioids in an environment that supports continued opioid use. (Data table includes proportions at 3 month follow-up.)

    Measured: 3 months

  8. Change in Overdose Risk (Use of Alcohol When Taking Opioids)

    Determine whether changes in behavior occur that increase or decrease risk of future overdose. Behaviors being measured include the amount of opioids taken, the use of opioids alone, use of opioids with alcohol or other drugs or medications, possessing naloxone, use of opioids in an environment that supports continued opioid use.(Data table includes proportions at 3 month follow-up.)

    Measured: 3 months

Secondary outcomes (20)
  1. Health Care Utilization (ED and Inpatient Admissions)

    Appropriate health care utilization (e.g. fewer emergency department visits and admissions to inpatient care)

    Measured: One year (annual rate)

  2. Change in HIV Risk Behaviors (Condom Use)

    Determine whether change occurs in the number of sexual risk behaviors (such as engaging in intercourse without a condom) and/or injection use behaviors (such as sharing syringes) that may increase the risk of contracting HIV.(Data table includes proportions at 3 month follow-up.)

    Measured: 3 months

  3. Change in HIV Risk Behaviors (Shared Syringes)

    Determine whether change occurs in the number of sexual risk behaviors (such as engaging in intercourse without a condom) and/or injection use behaviors (such as sharing syringes) that may increase the risk of contracting HIV. (Data table includes proportions at 3 month follow-up.)

    Measured: 3 months

  4. Change in Overdose Risk Behaviors and Perceptions (Take Home Naloxone)

    Change in overdose response including naloxone availability and change in overdose risk perceptions. (Data table includes proportions at 3 month follow-up.)

    Measured: 3 Months

  5. Change in Overdose Risk Behaviors and Perceptions (Likelihood of Overdose)

    Change in overdose response including naloxone availability and change in overdose risk perceptions. (Data table includes proportions at 3 month follow-up.)

    Measured: 3 Months

  6. Change in Overdose Risk Behaviors and Perceptions (Concerned About Overdose)

    Change in overdose response including naloxone availability and change in overdose risk perceptions. (Data table includes proportions at 3 month follow-up.)

    Measured: 3 Months

  7. Subgroup Analyses - Change in HIV Risk Behaviors (Condom Use)

    Sub-group analyses- primary and secondary outcomes will be examined by homelessness status at baseline.(Data table includes proportions at 3 month follow-up.)

    Measured: 3 months

  8. Subgroup Analyses - Change in HIV Risk Behaviors (Shared Syringes)

    Sub-group analyses- primary and secondary outcomes will be examined by homelessness status at baseline.(Data table includes proportions at 3 month follow-up.)

    Measured: 3 months

  9. Sub-group Analyses - Change in Overdose Risk (Change in Opioid Use - Heroin)

    Sub-group analyses- primary and secondary outcomes will be examined by homelessness status at baseline.(Data table includes proportions at 3 month follow-up.)

    Measured: 3 months

  10. Sub-group Analyses - Change in Overdose Risk (Change in Opioid Use - Prescription Type Opioids)

    Sub-group analyses- primary and secondary outcomes will be examined by homelessness status at baseline.(Data table includes proportions at 3 month follow-up.)

    Measured: 3 months

  11. Sub-group Analyses - Change in Overdose Risk (Using Alone When Taking Opioids)

    Sub-group analyses- primary and secondary outcomes will be examined by homelessness status at baseline.(Data table includes means at 3 month follow-up.)

    Measured: 3 months

  12. Subgroup Analyses- Change in Overdose Risk (Use of Sedatives When Taking Opioids)

    Sub-group analyses- primary and secondary outcomes will be examined by homelessness status at baseline.(Data table includes proportions at 3 month follow-up.)

    Measured: 3 months

  13. Subgroup Analyses- Change in Overdose Risk (Use of Alcohol When Taking Opioids)

    Sub-group analyses- primary and secondary outcomes will be examined by homelessness status at baseline.(Data table includes proportions at 3 month follow-up.)

    Measured: 3 months

  14. Sub-group Analyses - Change in Overdose Risk Behaviors and Perceptions (Take Home Naloxone)

    Sub-group analyses- primary and secondary outcomes will be examined by homelessness status at baseline.(Data table includes proportions at 3 month follow-up.)

    Measured: 3 Months

  15. Sub-group Analyses- Change in Overdose Risk Behaviors and Perceptions (Likelihood of Overdose)

    Sub-group analyses- primary and secondary outcomes will be examined by homelessness status at baseline.(Data table includes proportions at 3 month follow-up.)

    Measured: 3 Months

  16. Sub-group Analyses- Change in Overdose Risk Behaviors and Perceptions (Concerned About Overdose)

    Sub-group analyses- primary and secondary outcomes will be examined by homelessness status at baseline.(Data table includes proportions at 3 month follow-up.)

    Measured: 3 Months

  17. Health Care Costs

    Total health care costs

    Measured: Two years

  18. Health Care Utilization

    Rate and elapsed time until initiation of buprenorphine or methadone maintenance. (for those not on treatment medications)

    Measured: Two years

  19. Health Care Utilization

    Retention time on buprenorphine or methadone (for those on medications at baseline)

    Measured: Two years

  20. Opioid Overdose - Crossover Analysis

    Crossover analysis- Comparison group participants who obtain naloxone during the follow up period will be analyzed with those in the intervention arm and compared with those who did not obtain naloxone in the comparison arm to examine differences in overdose rates and elapsed time to overdose.

    Measured: Two years

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted11 Feb 2013 (estimated)
  2. Study startJan 2013
  3. Primary completionOct 2018
  4. Study completionOct 2018

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
256 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01788306
Sponsor's protocol ID
43874
Other IDs
1R01DA030351
Acronym
OOPEN
Status last verified
Dec 2021
First submitted
1 Feb 2013
Last updated
11 Jan 2022
Data monitoring committee
Yes

Publications

  • Banta-Green CJ, Coffin PO, Merrill JO, Sears JM, Dunn C, Floyd AS, Whiteside LK, Yanez ND, Donovan DM. Impacts of an opioid overdose prevention intervention delivered subsequent to acute care. Inj Prev. 2019 Jun;25(3):191-198. doi: 10.1136/injuryprev-2017-042676. Epub 2018 Feb 7.

    PubMed 29436397

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing OOPEN+BBCC in people with Opioid Overdose, run by University of Washington at 3 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 9 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 11 Jan 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 11 Jan 2022). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Rate of Fatal Opioid Overdose (time frame: One year). The study lists 8 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01788306, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 11 Jan 2022.

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