1
|
Ferguson N, Farrugia A, Moore D, Fraser S. Remaking the 'angry Narcanned subject': Affording new subject positions through take-home naloxone training. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 123:104253. [PMID: 37995551 DOI: 10.1016/j.drugpo.2023.104253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/25/2023]
Abstract
Naloxone is a medication used to reverse opioid overdose. Alongside its lifesaving effects, it also has a reputation for producing distress, aggression and occasionally violence upon administration. This article analyses how take-home naloxone (THN) training initiatives address naloxone's reputation for producing aggression and conflict, and how new subject positions emerge in the context of this training. While the role of naloxone in producing aggression has been discussed in a range of research, this work emphasises that such conflict is neither inevitable nor even likely because it is contingent on several other issues such as administration practices. Building on this scholarship, we work with Bruno Latour's theorisation of technological 'affordances' to analyse THN as a socially co-produced technology that, rather than either determining or neutrally communicating actions and effects, 'affords' possibilities, capacities and subjects. Analysing data drawn from observations of THN training in Victoria, Australia, and in-depth interviews with training participants, we argue that the issue of conflict upon revival affords a subject position we term the 'angry Narcanned subject'. This subject, we note, has come to hold a powerful position in understandings of naloxone, not least because it tends to accord with stereotypes of antisocial drug users. From here, we argue that a much of THN training is focused on challenging and reframing naloxone's reputation for conflict and questioning related subject positions, especially that of the angry Narcanned subject. We argue that this process of challenging and reframing affords two new subject positions for consumers: the 'capable administrator' and the 'calmer revivee'. We conclude that while THN training affords multiple, potentially positive, subject positions, unless these initiatives are accompanied by broader interventions such as decriminalisation campaigns, they may inadvertently responsibilise people who consume opioids for addressing overdose and erase the role of prohibition, criminalisation and stigmatisation in producing overdose events.
Collapse
Affiliation(s)
- Nyssa Ferguson
- Department of Public Health, La Trobe University, Australia.
| | - Adrian Farrugia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia
| | - David Moore
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia
| | - Suzanne Fraser
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia; Centre for Social Research in Health, University of New South Wales, Australia
| |
Collapse
|
2
|
Freestone J, Ezard N, Bourne A, Brett J, Roberts DM, Hammoud M, Nedanoski A, Prestage G, Siefried KJ. Understandings, attitudes, practices and responses to GHB overdose among GHB consumers. Harm Reduct J 2023; 20:121. [PMID: 37660058 PMCID: PMC10475182 DOI: 10.1186/s12954-023-00857-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 08/23/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND Gamma-hydroxybutyrate (GHB) is used at disproportionately high rates within sexuality and gender diverse communities and carries a high risk of overdose. GHB overdose can result in death. Internationally, recent increases in GHB overdoses have been observed. Coronial reviews of GHB-related death highlight the pivotal roles that bystanders to GHB overdose play in preventing fatality. No research has examined, in detail, how bystanders respond to GHB overdose. This qualitative study was conducted among people who use GHB and explored how they responded upon witnessing a GHB overdose experienced by someone else. METHODS Interviews were conducted with 31 sexuality and gender diverse Australian residents reporting three or more occasions of GHB use in the previous 12 months. Participants were asked questions about witnessed GHB overdose, their actions and decision-making processes throughout overdose. Data were analysed thematically. RESULTS Participants described witnessing GHB overdose, commonly in private settings involving sexualized GHB use. Variable definitions of GHB overdose were reported, ranging from GHB-induced symptoms of distress to comatose intoxication. Drastic actions to keep someone alert and responsive post-GHB ingestion were reported; these included the administration of stimulant substances and citrus. Decisions to call or not call for emergency medical services (EMS) were influenced by many circumstantial variables. In most instances, an EMS call was resisted and response practices deviated from established first aid protocols. CONCLUSIONS GHB overdose prevention and response training programs targeting people who use GHB are urgently required. These education interventions ought to address inaccuracies that inform street remedies for GHB overdose, teach people how to safely check breathing and response, promote basic first aid principles and address barriers to contacting EMS.
Collapse
Affiliation(s)
- Jack Freestone
- The Kirby Institute, University of New South Wales Sydney, Wallace Wurth Building, High St, Kensington, NSW, 2052, Australia.
- ACON, 414 Elizabeth Street, Surry Hills, NSW, 2010, Australia.
| | - Nadine Ezard
- National Centre for Clinical Research on Emerging Drugs, c/o the University of New South Wales, Sydney, 2052, Australia
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Darlinghurst, 2010, Australia
- The National Drug and Alcohol Research Centre (NDARC), The University of New South Wales, Sydney, 2052, Australia
| | - Adam Bourne
- The Kirby Institute, University of New South Wales Sydney, Wallace Wurth Building, High St, Kensington, NSW, 2052, Australia
- Australian Research Centre for Sex Health and Society, La Trobe University, Building NR6., Bundoora, VIC, 3086, Australia
| | - Jonathan Brett
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Darlinghurst, 2010, Australia
| | - Darren M Roberts
- Edith Collins Centre, Drug Health Services, Royal Prince Alfred Hospital, Sydney, NSW, 2050, Australia
| | - Mohamed Hammoud
- The Kirby Institute, University of New South Wales Sydney, Wallace Wurth Building, High St, Kensington, NSW, 2052, Australia
| | | | - Garrett Prestage
- The Kirby Institute, University of New South Wales Sydney, Wallace Wurth Building, High St, Kensington, NSW, 2052, Australia
| | - Krista J Siefried
- National Centre for Clinical Research on Emerging Drugs, c/o the University of New South Wales, Sydney, 2052, Australia
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Darlinghurst, 2010, Australia
- The National Drug and Alcohol Research Centre (NDARC), The University of New South Wales, Sydney, 2052, Australia
| |
Collapse
|
3
|
Khan MR, Hoff L, Elliott L, Scheidell JD, Pamplin JR, Townsend TN, Irvine NM, Bennett AS. Racial/ethnic disparities in opioid overdose prevention: comparison of the naloxone care cascade in White, Latinx, and Black people who use opioids in New York City. Harm Reduct J 2023; 20:24. [PMID: 36841763 PMCID: PMC9959933 DOI: 10.1186/s12954-023-00736-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 01/12/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND Drug overdose mortality is rising precipitously among Black people who use drugs. In NYC, the overdose mortality rate is now highest in Black (38.2 per 100,000) followed by the Latinx (33.6 per 100,000) and white (32.7 per 100,000) residents. Improved understanding of access to harm reduction including naloxone across racial/ethnic groups is warranted. METHODS Using data from an ongoing study of people who use illicit opioids in NYC (N = 575), we quantified racial/ethnic differences in the naloxone care cascade. RESULTS We observed gaps across the cascade overall in the cohort, including in naloxone training (66%), current possession (53%) daily access during using and non-using days (21%), 100% access during opioid use (20%), and complete protection (having naloxone and someone who could administer it present during 100% of opioid use events; 12%). Naloxone coverage was greater in white (training: 79%, possession: 62%, daily access: 33%, access during use: 27%, and complete protection: 13%, respectively) and Latinx (training: 67%, possession: 54%, daily access: 22%, access during use: 24%, and complete protection: 16%, respectively) versus Black (training: 59%, possession: 48%, daily access:13%, access during use: 12%, and complete protection: 8%, respectively) participants. Black participants, versus white participants, had disproportionately low odds of naloxone training (OR 0.40, 95% CI 0.22-0.72). Among participants aged 51 years or older, Black race (versus white, the referent) was strongly associated with lower levels of being trained in naloxone use (OR 0.20, 95% CI 0.07-0.63) and having 100% naloxone access during use (OR 0.34, 95% CI 0.13-0.91). Compared to white women, Black women had 0.27 times the odds of being trained in naloxone use (95% CI 0.10-0.72). CONCLUSIONS There is insufficient protection by naloxone during opioid use, with disproportionately low access among Black people who use drugs, and a heightened disparity among older Black people and Black women.
Collapse
Affiliation(s)
- Maria R. Khan
- grid.137628.90000 0004 1936 8753Department of Population Health, New York University Grossman School of Medicine, New York, NY USA ,grid.137628.90000 0004 1936 8753Center for Drug Use and HIV/HCV Research, New York University School of Global Public Health, New York, NY USA ,grid.137628.90000 0004 1936 8753Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY USA
| | - Lee Hoff
- grid.137628.90000 0004 1936 8753Department of Population Health, New York University Grossman School of Medicine, New York, NY USA
| | - Luther Elliott
- grid.137628.90000 0004 1936 8753Center for Drug Use and HIV/HCV Research, New York University School of Global Public Health, New York, NY USA ,grid.137628.90000 0004 1936 8753Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY USA ,grid.137628.90000 0004 1936 8753Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY USA
| | - Joy D. Scheidell
- grid.137628.90000 0004 1936 8753Department of Population Health, New York University Grossman School of Medicine, New York, NY USA ,grid.137628.90000 0004 1936 8753Center for Drug Use and HIV/HCV Research, New York University School of Global Public Health, New York, NY USA ,grid.137628.90000 0004 1936 8753Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY USA
| | - John R. Pamplin
- grid.137628.90000 0004 1936 8753Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY USA ,grid.21729.3f0000000419368729Columbia University Mailman School of Public Health, Department of Epidemiology, New York, NY USA
| | - Tarlise N. Townsend
- grid.137628.90000 0004 1936 8753Department of Population Health, New York University Grossman School of Medicine, New York, NY USA ,grid.137628.90000 0004 1936 8753Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY USA
| | - Natalia M. Irvine
- grid.137628.90000 0004 1936 8753Department of Population Health, New York University Grossman School of Medicine, New York, NY USA
| | - Alex S. Bennett
- grid.137628.90000 0004 1936 8753Center for Drug Use and HIV/HCV Research, New York University School of Global Public Health, New York, NY USA ,grid.137628.90000 0004 1936 8753Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY USA ,grid.137628.90000 0004 1936 8753Center for Anti-Racism, Social Justice, and Public Health, New York University School of Global Public Health, New York, NY USA
| |
Collapse
|
4
|
Perreault M, Ferlatte MA, Lachapelle É, Tremblay G, Milton D. Implementation facilitators and barriers to the expansion of a peer-led overdose prevention program. DRUGS: EDUCATION, PREVENTION AND POLICY 2023. [DOI: 10.1080/09687637.2023.2178880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- Michel Perreault
- Douglas Mental Health University Institute, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
| | | | | | | | - Diana Milton
- Douglas Mental Health University Institute, Montreal, Canada
| |
Collapse
|
5
|
Williams SH, McFarlane MD, Giammarino M, Oleksa J. The problem is obtaining knowledge: a qualitative analysis of provider barriers and accelerators to rapid adoption of new treatment in a public health emergency. BMC Public Health 2023; 23:183. [PMID: 36707792 PMCID: PMC9881294 DOI: 10.1186/s12889-022-14890-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/19/2022] [Indexed: 01/29/2023] Open
Abstract
Granted by the U.S. Food and Drug Administration, an Emergency Use Authorization (EUA) can only be utilized upon declaration that a specialized set of circumstances exist which justify the authorization. In 2020, the COVID-19 pandemic demanded rapid communication strategies to promote treatment options available through EUA. Despite the authorizations of available monoclonal antibody (mAb) treatments in November 2020, their rate of adoption among health care providers in the U.S. remained low well into 2021. This study examines the accelerators and barriers to provider adoption of COVID-19 treatment so that future adoption of treatments in emerging public health emergencies may be better communicated and hastened. We established a framework informed by adoption accelerators and barriers identified by Diffusion of Innovations (DoI) Theory and conducted a study during the rapidly evolving COVID-19 public health emergency. Most DoI public health research focuses on chronic health issues and has yet to be applied to provider adoption of new treatment under EUA. Through a series of guided interviews with health care providers, primarily physicians or nurse practitioners that were responsible for referring COVID-19 patients, we extracted tools, processes, or other mechanisms (accelerators) and barriers to validate against our DoI framework and fill the gap regarding emergency situations. Our research found that providers supported by large health systems were more inclined to adoption, due to many contributing factors such as the availability of collaborative support and availability of information. Further, communicating evidence-based summaries of treatment options and related processes was also critical to adoption.
Collapse
Affiliation(s)
- Stuart H. Williams
- grid.420015.20000 0004 0493 5049MITRE Health, The MITRE Corporation, 7525, Colshire, DR, McLean, VA 22102 USA
| | - Megan D. McFarlane
- grid.420015.20000 0004 0493 5049MITRE Health, The MITRE Corporation, 7525, Colshire, DR, McLean, VA 22102 USA
| | - Mary Giammarino
- grid.420015.20000 0004 0493 5049MITRE Health, The MITRE Corporation, 7525, Colshire, DR, McLean, VA 22102 USA
| | - Jamie Oleksa
- grid.476870.aU.S. Department of Health and Human Services, BARDA, 200 Independence Ave SW, Washington, DC 20201 USA
| |
Collapse
|
6
|
Wagner KD, Marks C, Felsher M, Latkin C, Pearson JL, Falade-Nwulia OO. Individual and social network correlates of responding to multiple overdoses among a cohort of people who use drugs. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 5:100107. [PMID: 36688935 PMCID: PMC9854250 DOI: 10.1016/j.dadr.2022.100107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background The purpose of this study was to identify characteristics of people who respond to two or more overdoses (i.e., multiple overdose responders; MOR) compared to those who respond to zero or one, and the association between MOR status and changes in network size. Methods Secondary analysis of data from a randomized trial among 199 PWUD in Baltimore, MD (2016-2019). We used cross-tabulation, 𝜒 2 , and ANOVA models to identify cross-sectional associations between overdose response and demographic, drug use, and network size; and ANCOVA models to examine the relationship between baseline MOR status and change in network size. Results From the cohort of 199, 185 people provided data on overdose response at baseline; 197 provided data at 6-month follow-up. At baseline, 27.6% of participants were classified as MORs (ever). Correlates of MOR status included homelessness; age; injecting drug use; quality of interactions with police (respectful vs. not); and use of powder cocaine, prescription opioids, and heroin. MORs had larger networks and their network size decreased more over time, but the association was not statistically significant. At follow-up, 16% were classified as MORs (past 6 months); correlates of follow-up MOR status were similar to those at baseline. Conclusions Overdose prevention interventions rely on PWUD to respond to overdoses. Identifying factors associated with MOR status could increase intervention efficiency and providing MORs with support could increase sustainability. Our findings suggest that PWUD experiencing homelessness, using cocaine and heroin, and demonstrating increased salience of overdose in their lives would benefit from targeted programs.
Collapse
Affiliation(s)
- Karla D. Wagner
- School of Public Health, University of Nevada, Reno; Reno, Nevada, USA,Corresponding Author: 1664 N. Virginia St. MC 0274; Reno, NV 89557, (K.D. Wagner)
| | - Charles Marks
- School of Public Health, University of Nevada, Reno; Reno, Nevada, USA
| | - Marisa Felsher
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine; Baltimore, MD, USA
| | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins School of Medicine; Baltimore, MD, USA
| | | | - Oluwaseun O Falade-Nwulia
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine; Baltimore, MD, USA
| |
Collapse
|
7
|
Bennett AS, Scheidell J, Bowles JM, Khan M, Roth A, Hoff L, Marini C, Elliott L. Naloxone protection, social support, network characteristics, and overdose experiences among a cohort of people who use illicit opioids in New York City. Harm Reduct J 2022; 19:20. [PMID: 35246165 PMCID: PMC8894821 DOI: 10.1186/s12954-022-00604-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/17/2022] [Indexed: 12/02/2022] Open
Abstract
Background Despite increased availability of take-home naloxone, many people who use opioids do so in unprotected contexts, with no other person who might administer naloxone present, increasing the likelihood that an overdose will result in death. Thus, there is a social nature to being “protected” from overdose mortality, which highlights the importance of identifying background factors that promote access to protective social networks among people who use opioids. Methods We used respondent-driven sampling to recruit adults residing in New York City who reported recent (past 3-day) nonmedical opioid use (n = 575). Participants completed a baseline assessment that included past 30-day measures of substance use, overdose experiences, and number of “protected” opioid use events, defined as involving naloxone and the presence of another person who could administer it, as well as measures of network characteristics and social support. We used modified Poisson regression with robust variance to estimate unadjusted and adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs). Results 66% of participants had ever been trained to administer naloxone, 18% had used it in the past three months, and 32% had experienced a recent overdose (past 30 days). During recent opioid use events, 64% reported never having naloxone and a person to administer present. This was more common among those: aged ≥ 50 years (PR: 1.18 (CI 1.03, 1.34); who identified as non-Hispanic Black (PR: 1.27 (CI 1.05, 1.53); experienced higher levels of stigma consciousness (PR: 1.13 (CI 1.00, 1.28); and with small social networks (< 5 persons) (APR: 1.14 (CI 0.98, 1.31). Having a recent overdose experience was associated with severe opioid use disorder (PR: 2.45 (CI 1.49, 4.04), suicidality (PR: 1.72 (CI 1.19, 2.49), depression (PR: 1.54 (CI 1.20, 1.98) and positive urinalysis result for benzodiazepines (PR: 1.56 (CI 1.23, 1.96), but not with network size. Conclusions Results show considerable gaps in naloxone protection among people who use opioids, with more vulnerable and historically disadvantaged subpopulations less likely to be protected. Larger social networks of people who use opioids may be an important resource to curtail overdose mortality, but more effort is needed to harness the protective aspects of social networks.
Collapse
Affiliation(s)
- Alex S Bennett
- School of Global Public Health, New York University, New York, USA. .,Center for Drug Use and HIV/HCV Research, New York University, New York, USA.
| | - Joy Scheidell
- Center for Drug Use and HIV/HCV Research, New York University, New York, USA.,Center for Opioid Epidemiology and Policy, Grossman School of Medicine, New York University, New York, USA
| | - Jeanette M Bowles
- Centre for Drug Policy and Evaluation, Unity Health Toronto, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
| | - Maria Khan
- Center for Drug Use and HIV/HCV Research, New York University, New York, USA.,Center for Opioid Epidemiology and Policy, Grossman School of Medicine, New York University, New York, USA
| | - Alexis Roth
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Lee Hoff
- Center for Opioid Epidemiology and Policy, Grossman School of Medicine, New York University, New York, USA
| | - Christina Marini
- School of Global Public Health, New York University, New York, USA
| | - Luther Elliott
- School of Global Public Health, New York University, New York, USA.,Center for Drug Use and HIV/HCV Research, New York University, New York, USA
| |
Collapse
|
8
|
Miller NM, Waterhouse-Bradley B, Campbell C, Shorter GW. How do naloxone-based interventions work to reduce overdose deaths: a realist review. Harm Reduct J 2022; 19:18. [PMID: 35197057 PMCID: PMC8867850 DOI: 10.1186/s12954-022-00599-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 02/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Naloxone-based interventions as part of health systems can reverse an opioid overdose. Previous systematic reviews have identified the effectiveness of naloxone; however, the role of context and mechanisms for its use has not been explored. This realist systematic review aims to identify a theory of how naloxone works based on the contexts and mechanisms that contribute to the success of the intervention for improved outcomes. METHODS Pre-registered at PROSPERO, this realist review followed RAMESES standards of reporting. Keywords included 'naloxone' and ' opioid overdose'. All study designs were included. Data extraction using 55 relevant outputs based on realist logic produced evidence of two middle-range theories: Naloxone Bystander Intervention Theory and Skills Transfer Theory. RESULTS Harm reduction and/or low threshold contexts provide a non-judgemental approach which support in-group norms of helping and empower the social identity of the trained and untrained bystander. This context also creates the conditions necessary for skills transfer and diffusion of the intervention into social networks. Stigma and negative attitudes held by first responders and stakeholders involved in the implementation process, such as police or GPs, can prohibit the bystander response by inducing fear in responding. This interferes with skills transfer, naloxone use and carriage of naloxone kits. CONCLUSIONS The findings provide theoretically informed guidance regarding the harm reduction contexts that are essential for the successful implementation of naloxone-based interventions. Peer-to-peer models of training are helpful as it reinforces social identity and successful skills transfer between bystanders. Health systems may want to assess the prevalence of, and take steps to reduce opioid-related stigma with key stakeholders in contexts using a low threshold training approach to build an environment to support positive naloxone outcomes. TRIAL REGISTRATION PROSPERO 2019 CRD42019141003.
Collapse
Affiliation(s)
- Nicole M Miller
- Institute of Mental Health Sciences, School of Psychology, Ulster University, Coleraine, UK
| | | | | | - Gillian W Shorter
- Drug and Alcohol Research Network & Centre for Improving Health Related Quality of Life, School of Psychology, Queen's University Belfast, Belfast, UK.
| |
Collapse
|
9
|
Martignetti L, Sun W. Perspectives of Stakeholders of Equitable Access to Community Naloxone Programs: A Literature Review. Cureus 2022; 14:e21461. [PMID: 35223245 PMCID: PMC8858082 DOI: 10.7759/cureus.21461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 12/02/2022] Open
Abstract
The purpose of this review is to examine the existing literature about facilitators and barriers influencing equitable access to naloxone programs by individuals who use opioids. A total of 49 published articles were examined, which generated four overarching themes:(1) Stigma as a barrier to access; (2) Lack of a wide range of stakeholder perspectives; (3) Need for a comprehensive understanding of factors affecting equitable access to naloxone programs; (4) Facilitators to increase the access of community naloxone programs. Our review highlighted the importance of advocacy in practice, education, administration, and policy to address the health inequities that exist in naloxone distribution programs. Advocacy activities involve the need for health care professionals to engage in social justice practice through evidence-based informed research about the facts of opioid use; challenging the stigma toward victim-blaming against naloxone users; as well as promoting program development and health policy to bring about equitable access to naloxone programs by marginalized and socially disadvantaged populations.
Collapse
|
10
|
Parkes T, Foster R, McAuley A, Steven D, Matheson C, Baldacchino A. Chronic pain, prescribed opioids and overdose risk: a qualitative exploration of the views of affected individuals and family members. DRUGS: EDUCATION, PREVENTION AND POLICY 2022. [DOI: 10.1080/09687637.2021.2022100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Tessa Parkes
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Rebecca Foster
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Andrew McAuley
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - Catriona Matheson
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Alex Baldacchino
- Population and Behavioural Science Division, School of Medicine, University of St Andrews, St Andrews, UK
- NHS Addiction Services, NHS Fife, Kirkcaldy, UK
| |
Collapse
|
11
|
Lay knowledge and practices of methamphetamine use to manage opioid-related overdose risks. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 99:103463. [PMID: 34619443 DOI: 10.1016/j.drugpo.2021.103463] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/08/2021] [Accepted: 09/12/2021] [Indexed: 12/21/2022]
Abstract
AIM Methamphetamine use has increased among individuals with opioid use disorder. The key aims of this study are to detail and contextualise lay knowledge, attitudes, and behaviours related to methamphetamine use in relation to opioid overdose risks in an area dominated by non-pharmaceutical fentanyl-type drugs (NPF). METHODS The study recruited 41 individuals in Dayton, Ohio, who reported past 30-day use of methamphetamine and heroin/fentanyl. Interviews included structured and qualitative questions. Urine toxicology analysis was conducted to identify NPFs and other drugs. Open-ended interview sections were audio-recorded, transcribed, and analysed qualitatively using NVivo. RESULTS The mean age was 38.3 years, 51% were female, and 100% non-Hispanic white. Participants described an exceedingly unpredictable local opioid market that became saturated with NPFs. The sample tested positive for 10 NPFs, including fentanyl (100%), acetyl fentanyl (61%), tetrahydrofuran fentanyl (29%), and carfentanil (12%). Most participants believed that methamphetamine could help prevent and/or reverse an opioid-related overdose. Nearly half had personally used it to help manage overdose risks related to NPF. These beliefs were embedded in a lay understanding of how methamphetamine works to stimulate the cardiovascular system. They were acted upon in the context of last resort situations that were determined by a lack of immediate access to naloxone, ambiguities surrounding overdose symptomatology, and easy access to plentiful and inexpensive methamphetamine. CONCLUSION Lay efforts to rely on methamphetamine to manage NPF-related overdose risks highlight the need for a continuing expansion of take-home-naloxone programs and implementation of other novel harm reduction approaches in communities affected by NPFs.
Collapse
|
12
|
Investigating a bidirectional relationship between overdose and provision of injection initiation assistance among persons who inject drugs in Vancouver, Canada and Tijuana, Mexico. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 95:103398. [PMID: 34390966 DOI: 10.1016/j.drugpo.2021.103398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/13/2021] [Accepted: 07/17/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Individuals who initiate injection drug use often receive assistance from an injection-knowledgeable peer. Persons who assist peers in injection initiation events often inject frequently, which heightens overdose risk. As such, overdose and injection initiation events may be correlated. To explore a potential relationship, we assessed temporal associations between experiencing a non-fatal overdose and assisting others in initiating injection drug use among persons who inject drugs in two North American cities - Vancouver, Canada and Tijuana, Mexico. METHODS From 2014 to 2018, this retrospective cohort study included people who inject drugs from Vancouver (n=1332) and Tijuana (n=666) who completed a baseline and six-month follow-up interview. Within each site, we assessed bidirectional temporal associations using two separate multivariable logistic regression models: for model 1, recent provision of injection initiation assistance (at six months) was the outcome and recent overdose (at baseline) was the exposure; for model 2, recent overdose (at six months) was the outcome and recent provision of injection initiation assistance (at baseline) was the exposure. Both models adjusted for potential confounders. RESULTS Vancouver-based participants reporting overdose at baseline had 163% greater odds of reporting provision of injection initiation assistance at follow-up (adjusted Odds Ratio [aOR] 2.63; 95% Confidence Interval [CI] 1.41-4.90); while participants reporting provision of injection initiation assistance at baseline had 89% greater odds of reporting a non-fatal overdose at follow-up (aOR 1.89; 95% CI 1.00-3.57). Among Tijuana-based participants, we did not observe a statistically significant association in either direction. CONCLUSION Findings in Vancouver suggest that injection initiation assistance and overdose are bidirectionally-associated phenomena. The present findings highlight the need for interventions that ensure that persons who provide injection initiation assistance are given overdose prevention support, both for themselves and for those they assist to initiate injection drug use. While our Tijuana-based results did not suggest a bidirectional relationship, preventative approaches should nonetheless be undertaken.
Collapse
|
13
|
Bowles JM, Smith LR, Mittal ML, Harding RW, Copulsky E, Hennessey G, Dunkle A, Davidson PJ, Wagner KD. "I wanted to close the chapter completely … and I feel like that [carrying naloxone] would keep it open a little bit": Refusal to carry naloxone among newly-abstinent opioid users and 12-step identity. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 94:103200. [PMID: 33765517 PMCID: PMC10155624 DOI: 10.1016/j.drugpo.2021.103200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND 12-step programs aim to address drug-related harms, like opioid overdose, via abstinence. However, abstaining from opioids can diminish tolerance, which increases risk for overdose death upon resumption. A recent study found that desire to abstain from drugs inhibited willingness to participate in take-home naloxone programming, which was linked to perceptions of harm reduction strategies being tied to drug use. In the present study, we uncovered a similar phenomenon occurring among newly-abstinent participants who were refusing to carry naloxone. METHODS This study is an analysis of broader qualitative data collected throughout Southern California among persons who use opioids, including those recently abstinent. Preliminary analysis revealed that those newly abstinent refused to accept naloxone at the end of interviews, and so we began probing about this (N=44). We used thematic analysis and author positionality to explicate the emergent phenomenon and applied social identity theory to conceptualize findings. RESULTS Mechanisms underlying naloxone refusal included its tie to a drug-using identity that newly-abstinent participants were attempting to retire. Carrying naloxone was also viewed as pointless due to doubt of witnessing an overdose again. Furthermore, the thought of being equipped with naloxone was not believed to be congruent with an abstinent identity, e.g. "me carrying it [naloxone] is making me feel like I'm going to be hanging out with people that are doing it [using drugs]." CONCLUSION Recent detoxification heightens vulnerability to overdose, which other newly-abstinent peers might be positioned to respond to as bonds are formed through 12-step identity formation. However, naloxone is often refused by this group due to perceived 12-step identity clash. While some treatment spaces distribute naloxone, 12-step identity associated behavioral expectations appear to conflict with this strategy. Reframing these disconnects is essential for expanding the lifesaving naloxone community safety net.
Collapse
Affiliation(s)
- J. M. Bowles
- University of California San Diego, Division of Infectious Diseases and Global Public Health, La Jolla, CA, United States
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael’s Hospital: Toronto, ON, Canada
- Correspondence: Corresponding author for refereeing submission process, | 215-260-8510
| | - L. R. Smith
- University of California San Diego, Division of Infectious Diseases and Global Public Health, La Jolla, CA, United States
| | - M. L. Mittal
- University of California San Diego, Division of Infectious Diseases and Global Public Health, La Jolla, CA, United States
| | - R. W. Harding
- School of Community Health Sciences, University of Nevada, Reno, United States
| | - E. Copulsky
- University of California San Diego, Division of Infectious Diseases and Global Public Health, La Jolla, CA, United States
| | - G. Hennessey
- University of California San Diego, Division of Infectious Diseases and Global Public Health, La Jolla, CA, United States
| | - A. Dunkle
- Solace Foundation, California, United States
| | - P. J. Davidson
- University of California San Diego, Division of Infectious Diseases and Global Public Health, La Jolla, CA, United States
- Joint last and corresponding authors if published: |
| | - K. D. Wagner
- School of Community Health Sciences, University of Nevada, Reno, United States
- Joint last and corresponding authors if published: |
| |
Collapse
|
14
|
Bennett AS, Freeman R, Des Jarlais DC, Aronson ID. Reasons People Who Use Opioids Do Not Accept or Carry No-Cost Naloxone: Qualitative Interview Study. JMIR Form Res 2020; 4:e22411. [PMID: 33355094 PMCID: PMC7787889 DOI: 10.2196/22411] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/25/2020] [Accepted: 12/03/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Many people use opioids and are at risk of overdose. Naloxone is an opioid antagonist used to counter the effects of opioid overdose. There is an increased availability of naloxone in New York City; however, many who use opioids decline no-cost naloxone even when offered. Others may have the medication but opt not to carry it and report that they would be reluctant to administer it if they were to witness an overdose. OBJECTIVE We aim to better understand why people who use opioids may be reluctant to accept, carry, and administer naloxone, and to inform the development of messaging content that addresses barriers to its acceptance and use. METHODS We conducted formative qualitative interviews with 20 people who use opioids who are 18 years and older in New York City. Participants were recruited via key informants and chain referral. RESULTS Participants cited 4 main barriers that may impede rates of naloxone acceptance, possession, and use: (1) stigma related to substance use, (2) indifference toward overdose, (3) fear of negative consequences of carrying naloxone, and (4) fear of misrecognizing the need for naloxone. Participants also offered suggestions about messaging content to tackle the identified barriers, including messages designed to normalize naloxone possession and use, encourage shared responsibility for community health, and elicit empathy for people who use drugs. Taken together, participants' narratives hold implications for the following potential messaging content: (1) naloxone is short-acting, and withdrawal sickness does not have to be long-lasting; (2) it is critical to accurately identify an opioid-involved overdose; (3) anyone can overdose; (4) naloxone cannot do harm; and (5) the prompt administration of the medication can help ensure that someone can enjoy another day. Finally, participants suggested that messaging should also debunk myths and stereotypes about people who use drugs more generally; people who use opioids who reverse overdoses should be framed as lay public health advocates and not just "others" to be managed with stigmatizing practices and language. CONCLUSIONS It must be made a public health priority to get naloxone to people who use opioids who are best positioned to reverse an overdose, and to increase the likelihood that they will carry naloxone and use it when needed. Developing, tailoring, and deploying messages to address stigma, indifference toward overdose, fear and trepidation about reversing an overdose, and fear of police involvement may help alleviate fears among some people who are reluctant to obtain naloxone and use the medication on someone in an overdose situation.
Collapse
Affiliation(s)
- Alex S Bennett
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
- Center for Drug Use and HIV Research, School of Global Public Health, New York University, New York, NY, United States
| | - Robert Freeman
- School of Social Work, New York University, New York, NY, United States
| | - Don C Des Jarlais
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
- Center for Drug Use and HIV Research, School of Global Public Health, New York University, New York, NY, United States
- Department of Epidemiology, School of Global Public Health, New York University, New York City, NY, United States
| | - Ian David Aronson
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
- Center for Drug Use and HIV Research, School of Global Public Health, New York University, New York, NY, United States
| |
Collapse
|
15
|
Ataiants J, Mazzella S, Roth AM, Sell RL, Robinson LF, Lankenau SE. Overdose response among trained and untrained women with a history of illicit drug use: a mixed-methods examination. DRUGS-EDUCATION PREVENTION AND POLICY 2020; 28:328-339. [PMID: 34321719 DOI: 10.1080/09687637.2020.1818691] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Little is known about differences in bystander behavior among people who use drugs, trained and untrained in opioid overdose prevention. We examined three types of recommended overdose response - a 911 call, rescue breathing/CPR, and naloxone administration-among Philadelphia-based, predominantly street-involved women with a history of illicit drug use. The study utilized a convergent mixed methods approach integrating data from 186 quantitative survey responses and 38 semi-structured qualitative interviews. Quantitative findings revealed that compared to untrained women, trained women were more likely to administer naloxone (32.9% vs. 5.2%) and use two recommended responses (20.0% vs. 9.5%). No significant differences were found between the two groups in calling 911 or using rescue breathing/CPR. Qualitative findings indicated that barriers to enacting recommended overdose response were either structural or situational and included the avoidance of police, inability to carry naloxone or phone due to unstable housing, and perceived lack of safety on the streets and when interacting with strangers. Our study demonstrated that overdose training improved the frequency of naloxone administration among this sample of predominantly street-involved women. Future efforts need to focus on avoiding intrusive policing, scaling-up naloxone refill sites, and providing secondary naloxone distribution via drug user networks.
Collapse
Affiliation(s)
- Janna Ataiants
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | | | - Alexis M Roth
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Randall L Sell
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Lucy F Robinson
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Stephen E Lankenau
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| |
Collapse
|
16
|
Schwartz DG, Ataiants J, Roth A, Marcu G, Yahav I, Cocchiaro B, Khalemsky M, Lankenau S. Layperson reversal of opioid overdose supported by smartphone alert: A prospective observational cohort study. EClinicalMedicine 2020; 25:100474. [PMID: 32954238 PMCID: PMC7486335 DOI: 10.1016/j.eclinm.2020.100474] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Rapid naloxone administration is crucial in reversing an opioid overdose. We investigated whether equipping community members, including people who use opioids (PWUO), with a smartphone application enabling them to signal and respond to suspected overdose would support naloxone administration in advance of Emrgency Medical Services (EMS). METHODS This observational cohort study of opioid overdose intervention used a dedicated smartphone app, UnityPhilly, activated by volunteers witnessing an overdose to signal other nearby volunteers in Philadelphia (March 2019 - February 2020). Alerted volunteers chose to respond, or declined to respond, or ignored/missed the alert. Witnessing volunteer was connected to 9-1-1 through a semi-automated telephone call. The primary outcome was layperson-initiated overdose reversal before EMS arrival, and a secondary outcome was hospital transfer. This study is registered with ClinicalTrials.gov, NCT03305497. FINDINGS 112 volunteers, including 57 PWUO and 55 community members, signaled 291 suspected opioid overdose alerts. 89 (30⸱6%) were false alarms. For 202 true alerts, the rate of layperson initiated naloxone use was 36⸱6% (74/202 cases). Most naloxone-use cases occurred in the street (58⸱11% (43/74)) and some in home settings (22⸱98% (17/74)). The first naloxone dose was provided by a nearby volunteer responding to the alert in 29⸱73% (22/74) of cases and by the signaling volunteer in 70⸱27% (52/74) of cases. Successful reversal was reported in 95⸱9% (71/74) of cases. Layperson intervention preceded EMS by 5 min or more in 59⸱5% of cases. Recovery without hospital transport was reported in 52⸱7% (39/74) of cases. INTERPRETATION Our findings support the benefits of equipping community members, potentially witnessing suspected opioid overdose, with naloxone and an emergency response community smartphone app, alerting EMS and nearby laypersons to provide additional naloxone. FUNDING Funding provided by NIH through NIDA, grant number: 5R34DA044758.
Collapse
Affiliation(s)
- David G. Schwartz
- Information Systems Division, Graduate School of Business, Bar-Ilan University, Ramat-Gan, Israel
- Corresponding author.
| | - Janna Ataiants
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Alexis Roth
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Gabriela Marcu
- School of Information, University of Michigan, Ann Arbor, MI, USA
| | - Inbal Yahav
- Coller School of Management, Tel-Aviv University, Tel-Aviv, Israel
| | - Benjamin Cocchiaro
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael Khalemsky
- Information Systems Division, Graduate School of Business, Bar-Ilan University, Ramat-Gan, Israel
| | - Stephen Lankenau
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| |
Collapse
|
17
|
Bowles JM, Smith LR, Verdugo SR, Wagner KD, Davidson PJ. "Generally, you get 86'ed because you're a liability": An application of Integrated Threat Theory to frequently witnessed overdoses and social distancing responses. Soc Sci Med 2020; 260:113190. [PMID: 32673794 DOI: 10.1016/j.socscimed.2020.113190] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/24/2020] [Accepted: 07/01/2020] [Indexed: 12/16/2022]
Abstract
While rates of opioid overdose deaths in North American have increased exponentially in recent years, most overdoses are not fatal, especially when witnesses are present and can intervene. Previous research has found that some people who use drugs [PWUDs] trained in overdose response might cut social ties with frequent overdosers, leading to more solitary opioid use and risk of death if someone overdoses alone. To examine the phenomenon of social distancing of people who overdose frequently, we used data from fifty-two in-depth qualitative interviews collected in Southern California with PWUDs who had recently witnessed an opioid overdose. Transcripts were reviewed and coded thematically, using the Integrated Threat Theory (ITT) to conceptualize the observed phenomenon. ITT outlines how realistic and symbolic threats are experienced by a group. We found that while some participants acknowledged the role of adulterated street drugs in overdoses, individualized blame was nonetheless imposed. Accusations of careless drug use practices fostered negative stereotyping towards frequent overdosers. This was attributed to the need to summon 911 for rescue, which often resulted in police dispatch. The intergroup relationship between police and PWUDs is precarious as police pose realistic threats onto PWUDs - such as incarceration, eviction, and manslaughter charges - leading to intragroup anxiety among PWUDs about future overdose events, and labelled frequent overdosers as liabilities. These threats, and inter/intra-group conflict, explained one reason how and why non-fatal overdoses led to social distancing events. People who overdose frequently were also accused of breaking the norm of drug user surreptitiousness; a symbolic threat that endangered the group due to police exposure. Social distancing might dampen exposure to the protective effect of peer-led interventions such as take-home naloxone programs, increasing risk of overdose death. This phenomenon highlights how intergroup dynamics are driving intragroup processes. Suggestions for tailoring public health interventions are discussed.
Collapse
Affiliation(s)
- J M Bowles
- University of California San Diego, Department of Medicine, Division of Infectious Diseases and Global Public Health, USA; Centre on Drug Policy Evaluation, St. Michael's Hospital, Li Ka Shing Knowledge Institute, Canada
| | - L R Smith
- University of California San Diego, Department of Medicine, Division of Infectious Diseases and Global Public Health, USA
| | - S R Verdugo
- University of California San Diego, Department of Medicine, Division of Infectious Diseases and Global Public Health, USA; First Watch San Diego, USA
| | - K D Wagner
- University of Nevada, Reno, School of Community Health Sciences, USA.
| | - P J Davidson
- University of California San Diego, Department of Medicine, Division of Infectious Diseases and Global Public Health, USA.
| |
Collapse
|
18
|
Bagley B, Bright CF. "Those People Count": Naloxone Media Coverage in Mississippi. QUALITATIVE HEALTH RESEARCH 2020; 30:1237-1248. [PMID: 32208912 PMCID: PMC7305992 DOI: 10.1177/1049732320911952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
There is a movement to promote naloxone adoption by law enforcement and other stakeholders in the state of Mississippi. The purpose of this study is to understand how local media are framing the conversation about naloxone products, and to better understand how it might affect naloxone adoption among law enforcement. We searched for news articles published in Mississippi from January 2012 to July 2018 mentioning the words Narcan® and/or naloxone. Four main themes emerged from 25 articles: (a) positive and informative discussion of naloxone, (b) full articles persuading readers to use and/or advocate the use of naloxone, (c) government or organizational effort to increase the availability and use of naloxone products, and (d) negative or misleading information about naloxone. Better efforts to disseminate correct and persuasive information about the drug will have a profound and positive effect on the opioid epidemic in Mississippi and in the United States.
Collapse
|
19
|
"You've got to care to carry this stuff" Community implications from take-home naloxone use: A qualitative study. J Subst Abuse Treat 2020; 115:108030. [PMID: 32600618 DOI: 10.1016/j.jsat.2020.108030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 04/09/2020] [Accepted: 05/06/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND In New Mexico, drug overdose rates have been among the highest in the nation for the past two decades, with 332 overdose deaths involving opioids in 2017. While interventions aimed at enhancing distribution and uptake of take-home naloxone (THN) have identified people who use opioids as viable candidates, there exists a gap in applying these findings to underserved, ethnic minority women. METHODS We conducted qualitative interviews with participants recruited from a parent study which recruited 395 women diagnosed with OUD who participated in a two year study (April 2016-May 2018) during which they received opioid overdose education and two free THN kits for their use. RESULTS Findings characterize the social dynamics of persistent opioid exposure, accidental overdose, and take home naloxone use to reverse overdose, and we identified three overarching themes: 1) Crisis management and community responsibility; 2) Complex social networks as informal channels for family to family and peer to peer naloxone distribution and education; and 3) Participant preferences and strategies for THN distribution and education. CONCLUSIONS Participants in the ASAP program demonstrated an unquestionable willingness to distribute naloxone when they had access to it, and the ability to replace it. Further research is warranted to apply these findings in interventional contexts to refine strategies toward prioritizing distribution of THN, enhance training tools and optimize community locations for engagement.
Collapse
|
20
|
Ataiants J, Roth AM, Mazzella S, Lankenau SE. Circumstances of overdose among street-involved, opioid-injecting women: Drug, set, and setting. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 78:102691. [PMID: 32086154 PMCID: PMC7302961 DOI: 10.1016/j.drugpo.2020.102691] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Current discourses about the causes of the overdose crisis largely focus on the harmful effects of drugs. Prior research, however, indicates that drug use experience is shaped by complex interactions of drugs with physiological and mental "sets" of people who use drugs and the wider social and physical "setting." Zinberg's "drug, set, and setting" theoretical framework was applied to identify patterns in circumstances leading up to women's overdose. METHODS In-depth semi-structured interviews were conducted with 29 opioid-injecting street-involved women, clients of a Philadelphia harm reduction program. Qualitative analysis with deductive and inductive coding was utilized to examine transcripts for theory-driven and emerging themes. RESULTS Ten out of 29 women attributed their overdose to "drugs," reporting the unpredictable quality of street opioids, concurrent use of benzodiazepines, or chasing the "high." Thirteen women reported "set" as a type of circumstance where their emotional states were affected by a "good" or "bad" day, leading them to unusual drug consumption practices. Six women described "setting" type of circumstances where their overdose was preceded by a recent change in context, such as release from prison, which prompted unsafe drug use to address physiological or psychological dependence on drugs. CONCLUSION While all overdoses result from the pharmacological action of drugs, some overdoses were triggered by circumstances occurring in women's set or setting. Overdose prevention policies should embrace not only individual-level behavioral interventions, but also structural measures to address stress, social isolation, and risky drug use contexts that plague the lives of street-involved women who inject opioids.
Collapse
Affiliation(s)
- Janna Ataiants
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market St, Philadelphia, PA 19104, USA.
| | - Alexis M Roth
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market St, Philadelphia, PA 19104, USA
| | - Silvana Mazzella
- Prevention Point Philadelphia, 2913 Kensington Ave, Philadelphia, PA 19134, USA
| | - Stephen E Lankenau
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market St, Philadelphia, PA 19104, USA
| |
Collapse
|
21
|
Kline A, Mattern D, Cooperman N, Dooley-Budsock P, Williams JM, Borys S. "A Blessing and a Curse:" Opioid Users' Perspectives on Naloxone and the Epidemic of Opioid Overdose. Subst Use Misuse 2020; 55:1280-1287. [PMID: 32182153 DOI: 10.1080/10826084.2020.1735437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background: To address the alarming rise in opioid overdose deaths, states have increased public access to the overdose reversal medication, naloxone. While some studies suggest that increased naloxone accessibility reduces opioid overdose deaths, others raise concerns about unintended consequences, such as increases in risky drug use and opioid re-use post-overdose to counter naloxone-induced withdrawal symptoms. Few studies have examined the impact of expanded naloxone access on the attitudes and behaviors of opioid users. Methods: In this qualitative study, we conducted in-depth, semi-structured interviews with 36 English-speaking opioid users 18+ years of age. Informants were recruited from an urban methadone clinic, a needle exchange program and a residential treatment program. The approximately hour-long interviews focused on users' attitudes and behaviors surrounding naloxone, opioid use and overdose. Transcribed audio-recordings of interviews were analyzed using NVivo. Results: Informants were ambivalent about naloxone, widely acknowledging its life-saving benefits while reporting such negative effects as severe withdrawal symptoms and the promotion of riskier drug use. Naloxone-induced withdrawal, coupled with misperceptions about naloxone's pharmacological effects, prompted overdose survivors to rapidly re-use opioids and refuse hospitalization following an overdose reversal. About half the sample believed naloxone led to greater risk-taking by others, such as fentanyl use or use in higher quantities, but did not endorse riskier drug use themselves. Conclusions: The results suggest the need for targeted education about the pharmacological effects of naloxone and better strategies for managing naloxone-induced withdrawal. Future research should focus on the extent to which naloxone is associated with greater opioid risk-taking.
Collapse
Affiliation(s)
- Anna Kline
- Division of Addiction Psychiatry, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Dina Mattern
- Division of Addiction Psychiatry, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Nina Cooperman
- Division of Addiction Psychiatry, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Patricia Dooley-Budsock
- Division of Addiction Psychiatry, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Jill M Williams
- Division of Addiction Psychiatry, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Suzanne Borys
- Division of Mental Health and Addiction Services, Trenton, New Jersey, USA
| |
Collapse
|