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Engaging peer networks in opioid overdose response in the State of Manipur, India

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BACKGROUND: Anecdotal evidence suggests that Opioid overdose is a major cause of premature death among people who inject drugs (PWID) such as heroin in the State of Manipur, India. Reducing the time between the onset of ODIO symptoms, appropriate assistance, including administration of the antidote naloxone, which is easily available in a public health setting, can quickly and effectively reverse the ODIO and prevent mortality.
DESCRIPTION: To address ODIO, an overdose intervention project was initiated in the Imphal-West and Churachandpur districts of Manipur. As peers of PWID are often the first to witness any ODIO incident, an Overdose Response Unit (ORU) was formed. We trained 268 peer educators and leaders of PWID on ODIO management, including the safe administration of naloxone at the hotspots. Each ORU has up to 6 members, including a coordinator, an outreach worker, and peer educators. They were all encouraged to use 'Helpline Numbers', which is active round the clock. Information on the ORU and helpline was shared through vouchers, interpersonal communication, and social networking sites. An electronic database is maintained for ODIO cases by the project.
LESSONS LEARNED: A total of 1,190 ODIO cases have been reported from April 2019 through Sept 2021 in which ORU was able to avert many deaths. Out of 1,190 cases, 1,166 (93%) were referred for help from the PWID peer network. All death cases were mostly from other districts where ORU does not exist, and reports were mostly from the public. 96% of management was done by administering Naloxone & rest by appropriate non-medical assistance.
CONCLUSIONS: ODIO has a significant risk of death among PWID. Proper engagement of peer networks within the system of overdose management system can bring a significant change in terms of preventing ODIO incidents and likely saving lives.