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Hands-On Naloxone Training is Beneficial for Rural Clinicians and Staff 

January 12, 2022
Meg Brunner, MLIS
Cody SL, et al. An exploratory study of a hands-on naloxone training for rural clinicians and staff. Journal of Nursing Scholarship 2022 (in press). (Need help getting a copy of this article? Contact Meg at [email protected].)
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Addiction Science Made Easy
December 2022
Northwest ATTC


What’s the Question?

Since the COVID-19 pandemic began, an increase in illicit drugs containing fentanyl has led to a surge in opioid overdose deaths in the U.S. Higher overdose death rates are especially a challenge for rural communities, where there are fewer prevention, treatment, and recovery resources for people with opioid use disorder (OUD).

Though naloxone has historically been provided by first responders like police or EMTs, in rural communities, it may take a long time for first responders to arrive on a scene, increasing the risk for deadly overdose. 

In this study, researchers were curious about the potential impact of providing hands-on naloxone training to rural clinicians and staff at behavioral health care centers. They wanted to see what rural clinicians and staff already knew about opioids and overdose, whether training increased their knowledge and confidence, and what their perceptions of that training were. 

How Was This Study Conducted?

Researchers used a few different tools to assess knowledge of opioids and overdose, including the Brief Opioid Overdose Knowledge (BOOK) survey, which uses 12-items to assess general knowledge, and a rubric based on the Substance Abuse and Mental Health Services Administration (SAMHSA) Opioid Overdose Toolkit that used 5 steps to evaluate participants’ ability to recognize opioid overdose and administer intranasal naloxone using a mannequin. They also developed a survey to assess participants’ perceptions of the hands-on training after completion.

For the study, rural clinicians and staff were asked to take the BOOK, then participate in a 30-minute lecture on opioids and overdose. They then performed the SAMHSA rubric, administering naloxone on a mannequin while being monitored by a trainer. Finally, the took the BOOK again to assess how much they had learned, and then completed the survey about the training itself. 

What Did Researchers Find Out?

Participants’ scores on the BOOK increased after the training, specifically in categories of general opioid knowledge and overdose response. Almost all of the participants were able to correctly demonstrate the 5-steps in the SAMHSA rubric and properly administer naloxone intranasally, and they also rated the training positively, reporting that they felt it had improved their understanding of opioids and management of opioid overdose. Importantly, participants also noted that they would be comfortable teaching what they had learned to community members. 

What Are the Implications for the Workforce

There are a few interesting aspects of this study that may be relevant to the workforce. First, not only providers, but also staff participated in the training and improved their knowledge and skills in identifying and reversing an overdose. This suggests that the one-hour, hands-on training could also be useful for lay persons in the general community who have little or no medical experience.

Additionally, the fact participants felt they would be able to go forward and help train others suggests that the hands-on training could be used in a “Training the Trainers” model, making it possible for rural clinicians and staff to teach community members and peers who are likely to witness individuals experiencing overdose how to respond and administer naloxone. This could greatly expand the availability and use of naloxone in rural communities. 

Ultimately, this small study demonstrated that a one-hour, hands-on naloxone training can effectively engage clinicians and staff and increase their comfort in teaching naloxone administration to family and caregivers of those impacted by OUD.