Funded Projects

Naloxone Training and Kit Distribution

Project Year

2024

City & State

Los Angeles, California

Program Name

CATCH Resident

Topic

Substance Use (LHI)

Program Description

"“The Problem”: Approximately 740,000 Los Angeles County Residents struggle with a substance use disorder (1). With this, accidental opioid-related deaths are rising, with 3,244 reported opioid-related deaths in California in 2019 (2). Despite rising opioid deaths, Naloxone is rarely a part of home first aid kits. Moreover, naloxone (sold under the brand name ""Narcan"") is a readily available and easy to administer opioid-reversal agent that has been shown to save lives when administered promptly. Given the high patient volume of pediatric Emergency Departments, we have a tremendous opportunity to intervene. Adolescents are already routinely screened for substance use, and many pediatricians also screen families for substance use (as a part of the ""adverse childhood experiences [ACEs]"" screening questionnaire). With all of this in mind, we have begun stocking free intranasal Naloxone (Narcan) in the Children’s Hospital Los Angeles (CHLA) Emergency Department for distribution to families with high-risk substance use exposure.   “Primary Setting”: Children’s Hospital Los Angeles Emergency Department and the surrounding Los Angeles community  “Number of Children Affected”: An estimated 4.8% of California adolescents (age 12-17) meet criteria for substance use disorder, with 44% of all California adolescents reporting alcohol or drug use by the 11th grade (2). Given there are ~650,000 adolescents living in Los Angeles County, this equates to an estimated 31,000 adolescents with substance use disorder who reside within a relatively close proximity to the Children’s Hospital Los Angeles Emergency Department.  Project Goal”: Our goal is to increase the accessibility of intranasal Naloxone (Narcan) in the reversal of opioid-induced accidental deaths. Alongside this goal, we hope to 1) introduce this model of intranasal Naloxone (Narcan) distribution in a pediatric emergency department to other pediatric emergency departments in the Los Angeles area. Moreover, we hope to 2) increase provider knowledge and comfort regarding at-home administration of Narcan and 3) help our community partners expand their reach throughout the Los Angeles area.    “Proposed Intervention”: We recently began distributing ‘Narcan Kits’ in the CHLA emergency department with funding through CHLA’s Krieger Resident Advocacy Award (funding expires June 2024) and through support of community partners, including “Team Awareness Combating Overdose” (TACO) and adolescent substance use counselors. We hope to expand this existing project by formally training pediatric residents in the Los Angeles area on how to use Narcan and how to incorporate SBIRT (Screening, Brief Intervention, and Referral to Treatment) into their clinical practice. In addition, we hope to provide an avenue for patients and families to share their perspectives regarding opioid overdose in the Los Angeles community. Our hope is that this will allow us to identify how we can best maximize our impact.   “Anticipated Outcomes”: We are conducting a PDSA, with special attention to the number of patients/families who receive a Narcan Kit (includes intranasal naloxone [2], fentanyl test strips [2], and education materials) prior to ED discharge. Since implementation of this project in October 2023, we have distributed approximately 8 kits per month. We anticipate that staff SBIRT training will directly increase Narcan Kit distribution. We also anticipate that providing an avenue for patients and families to share their experiences with substance use disorder will help providers open a conversation on the utility of at-home intranasal naloxone. Our hope is that all of this together will eventually lead to a decrease in adolescent opioid-related deaths.      References: 1. National Survey on Drug Use and Health 2012-2016 2. Substance Use in California: Prevalence and Treatment. California Health Care Almanac 2022."

Project Goal

To increase the accessibility of intranasal Naloxone (Narcan) in the reversal of opioid-induced accidental deaths

Project Objective 1

By June of 2025, CHLA ED physicians and pediatric residents will demonstrate efficacy in the use of intranasal naloxone and in educating families on the use of intranasal naloxone (measured through direct observation of this skill during a skill workshop).

Project Objective 2

By June of 2025, CHLA ED physicians and pediatric residents will improve self-efficacy in incorporating SBIRT (Screening, Brief Intervention, and Referral to Treatment) into their clinical practice (measured through participant surveys). 

Project Objective 3

By June of 2025, program participants will establish a working partnership with Team Awareness Combatting Overdose as a resource for adolescents and families at risk for substance use. (measured by practice and training site report).

AAP District

District IX

Institutional Name

Children's Hospital Los Angeles

Contact 1

Jake Lehman, MD