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Karamouzian M, Cui Z, Hayashi K, DeBeck K, Reddon H, Buxton JA, Kerr T. Longitudinal polysubstance use patterns and non-fatal overdose: A repeated measures latent class analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024:104301. [PMID: 38182524 DOI: 10.1016/j.drugpo.2023.104301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 11/06/2023] [Accepted: 12/15/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Polysubstance use (PSU) is common among people who use opioids (PWUO) and has been associated with drug-related harms. We aimed to identify latent longitudinal PSU classes among a cohort of PWUO and characterize non-fatal overdose risks among different sub-classes over time. METHODS We used longitudinal data (2005-2018) from three ongoing prospective cohorts of people who use drugs in Vancouver, Canada. The primary outcome of interest was self-reported non-fatal overdose during the past six months. The primary exposure of interest was longitudinal PSU patterns among PWUO, obtained from repeated measures latent class analysis (RMLCA) of weekly substance use-related outcome indicators. Multivariable generalized estimating equations models were built to assess the association between latent PSU class membership and non-fatal overdose, adjusting for potential sociodemographic, behavioural, and structural confounders. RESULTS 2627 PWUO were included in the analysis, and 1094 (41.6 %) had experienced at least one non-fatal overdose during the study period. RMLCA revealed five distinct latent longitudinal PSU classes, including low/infrequent use (Class 1; 30 %), primarily opioid and methamphetamine use (Class 2; 22 %), primarily cannabis use (Class 3; 15 %), primarily opioid and crack use (Class 4; 29 %), and frequent PSU (Class 5; 4 %). In comparison with Class 1 (low), membership in all latent PSU classes except Class 3 (cannabis) was associated with increased odds of non-fatal overdose: Class 2 (opioids + meth) vs. Class 1 (Adjusted odds ratios [aOR] = 2.20, 95 % confidence intervals [CI]: 1.51-3.22), Class 4 (opioids + crack) vs. Class 1 (aOR = 1.06, 95 % CI: 0.85-1.33), and Class 5 (frequent) vs. Class 1 (aOR = 2.39, 95 % CI: 1.92-2.97). CONCLUSION Our findings highlighted the heterogeneous characteristics of PWUO in terms of patterns of PSU and non-fatal overdose risk. The diverse nature of PWUO and the potential additive or multiplicative impact of using several substances on overdoses should be reflected across the substance use treatment continuum and care provision.
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Affiliation(s)
- Mohammad Karamouzian
- Centre on Drug Policy Evaluation, Saint Michael's Hospital, Toronto, ON M5B 1T8, Canada; British Columbia Centre on Substance Use, Vancouver, BC V6Z 2A9, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada.
| | - Zishan Cui
- British Columbia Centre on Substance Use, Vancouver, BC V6Z 2A9, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, BC V6Z 2A9, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, Vancouver, BC V6Z 2A9, Canada; School of Public Policy, Simon Fraser University, Burnaby, BC V6B 5K3, Canada
| | - Hudson Reddon
- British Columbia Centre on Substance Use, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada
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Zinsli KA, Banta-Green CJ, Whiteside LK, Hood J, Kingston S, Tinsley J, Moreno C, Glick SN. Trends and correlates of naloxone possession and use among people who inject drugs in Seattle, Washington. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023:104272. [PMID: 38057247 DOI: 10.1016/j.drugpo.2023.104272] [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: 01/30/2023] [Revised: 10/27/2023] [Accepted: 11/16/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Naloxone distribution has been implemented as an essential opioid overdose prevention measure for people who inject drugs (PWID), and many jurisdictions in the United States have implemented policy change to increase naloxone access. This project describes temporal trends in and correlates of naloxone possession and use among PWID in the Seattle area of Washington State. METHODS Using a repeat cross-sectional design, we utilized two sets of serial cross-sectional surveys of PWID, which included biennial surveys of Seattle area syringe service program (SSP) clients and community-based National HIV Behavioral Surveillance surveys of PWID (NHBS-PWID) conducted from 2012-2019. Survey participant characteristics were descriptively compared between participants reporting naloxone possession to those not reporting naloxone possession. Multivariable Poisson regression was used to calculate prevalence ratios for naloxone possession comparing later to earlier survey years, adjusting for age, gender, race/ethnicity, primary drug, and experiencing and witnessing an overdose in the past 12 months. RESULTS Naloxone possession and use increased in both survey populations. The prevalence of possessing naloxone was 2.8 times greater [2019 vs. 2013= 95% CI: 2.40-3.33] among SSP participants and 2.8 times greater [2018 vs. 2012=95% CI: 2.41-3.16] among NHBS-PWID participants for the most recent time period. The prevalence of naloxone use was 1.3 times greater [2019 vs. 2017= 95% CI: 1.13-1.58] and 2.1 times greater [2015 vs. 2012=95% CI:1.62-2.73] among SSP and NHBS-PWID participants, respectively, for the most recent time period. CONCLUSION Naloxone possession and use increased in PWID in the Seattle area from 2012-2019, and is, at least in part, likely the result of numerous policy and programmatic efforts to facilitate easier naloxone accessibility in the wake of dramatic increases in overdose mortality. Further research on disparities in naloxone possession are needed to ensure equitable access.
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Affiliation(s)
- Kaitlin A Zinsli
- Department of Epidemiology, University of Washington, Seattle WA, USA.
| | - Caleb J Banta-Green
- Addictions, Drug and Alcohol Institute, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Lauren K Whiteside
- School of Medicine, Department of Emergency Medicine, University of Washington, Seattle, WA, USA
| | - Julia Hood
- HIV/STD Program, Public Health - Seattle and King County, Seattle, WA, USA
| | - Susan Kingston
- Addictions, Drug and Alcohol Institute, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Joe Tinsley
- HIV/STD Program, Public Health - Seattle and King County, Seattle, WA, USA
| | - Courtney Moreno
- HIV/STD Program, Public Health - Seattle and King County, Seattle, WA, USA
| | - Sara N Glick
- HIV/STD Program, Public Health - Seattle and King County, Seattle, WA, USA; Division of Allergy and Infectious Disease, School of Medicine, University of Washington, Seattle, WA, USA
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3
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Spring C, Croxford S, Ward Z, Ayres R, Lord C, Desai M, Vickerman P, Artenie A. Perceived availability and carriage of take-home naloxone and factors associated with carriage among people who inject drugs in England, Wales and Northern Ireland. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 102:103615. [DOI: 10.1016/j.drugpo.2022.103615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/27/2022] [Accepted: 02/05/2022] [Indexed: 11/15/2022]
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4
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Noyes EA, Dunleavy S, Mail V, Plakas I, Keyes S, Gaeta JM, Obando A, Paci E, Lent C, Regis C, Taveras EM, Yule AM, Chatterjee A. Awareness, Utilization, and Preferences of Harm Reduction Interventions among Street-Involved Young Adults in Boston. Subst Use Misuse 2022; 57:827-832. [PMID: 35195488 PMCID: PMC10372698 DOI: 10.1080/10826084.2022.2040031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This study explores knowledge and utilization of, barriers to, and preferences for harm reduction services among street-involved young adults (YA) in Boston, Massachusetts. METHODS This cross-sectional survey of YA encountered between November and December 2019 by a longstanding outreach program for street-involved YA. We report descriptive statistics on participant-reported substance use, knowledge and utilization of harm reduction strategies, barriers to harm reduction services and treatment, and preferences for harm reduction service delivery. RESULTS The 52 YA surveyed were on average 21.4 years old; 63.5% were male, and 44.2% were Black. Participants reported high past-week marijuana (80.8%) and alcohol (51.9%) use, and 15.4% endorsed opioid use and using needles to inject drugs in the past six months. Fifteen (28.8%) YA had heard of "harm reduction", and 17.3% reported participating in harm reduction services. The most common barriers to substance use disorder treatment were waitlists and cost. Participants suggested that harm reduction programs offer peer support (59.6%) and provide a variety of services including pre-exposure prophylaxis (42.3%) and sexually transmitted infection testing (61.5%) at flexible times and in different languages, including Spanish (61.5%) and Portuguese (17.3%). CONCLUSIONS There is need for comprehensive, YA-oriented harm reduction outreach geared toward marginalized YA and developed with YA input to reduce barriers, address gaps in awareness and knowledge of harm reduction, and make programs more relevant and inviting to YA.
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Affiliation(s)
| | | | - Victoria Mail
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Isabel Plakas
- Boston Health Care of the Homeless Program, Boston, MA, USA
| | - Susan Keyes
- Boston Health Care of the Homeless Program, Boston, MA, USA
| | - Jessie M Gaeta
- Boston Health Care of the Homeless Program, Boston, MA, USA.,Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Aura Obando
- Harvard Medical School, Boston, MA, USA.,Boston Health Care of the Homeless Program, Boston, MA, USA.,Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.,Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Elizabeth Paci
- Boston Health Care of the Homeless Program, Boston, MA, USA
| | | | - Craig Regis
- Kraft Center for Community Health, Massachusetts General Hospital, Boston, MA, USA
| | - Elsie M Taveras
- Harvard Medical School, Boston, MA, USA.,Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA.,Kraft Center for Community Health, Massachusetts General Hospital, Boston, MA, USA
| | - Amy M Yule
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.,Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | - Avik Chatterjee
- Harvard Medical School, Boston, MA, USA.,Boston Health Care of the Homeless Program, Boston, MA, USA.,Department of Medicine, Boston University School of Medicine, Boston, MA, USA
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MacNeill L, Doucet S, Luke A. Motives for non-medical prescription opioid (NMPO) use among young people in a semi-rural Canadian Province. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.1941349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Lillian MacNeill
- Centre for Research in Integrated Care (CRIC), University of New Brunswick, Saint John, Canada
- Nursing & Health Sciences, University of New Brunswick, Saint John, Canada
| | - Shelley Doucet
- Centre for Research in Integrated Care (CRIC), University of New Brunswick, Saint John, Canada
- Nursing & Health Sciences, University of New Brunswick, Saint John, Canada
| | - Alison Luke
- Centre for Research in Integrated Care (CRIC), University of New Brunswick, Saint John, Canada
- Nursing & Health Sciences, University of New Brunswick, Saint John, Canada
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6
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Burton G, McAuley A, Schofield J, Yeung A, Matheson C, Parkes T. A systematic review and meta-analysis of the prevalence of take-home naloxone (THN) ownership and carriage. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103298. [PMID: 34078563 DOI: 10.1016/j.drugpo.2021.103298] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 04/29/2021] [Accepted: 05/05/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Drug-related deaths globally are increasing year on year, with the largest proportion of these being opioid-related. The opioid antagonist naloxone distributed for take-home use ('Take-Home Naloxone (THN)') has been championed as one method of tackling this public health crisis, however to be effective it must be available at an opioid overdose. Ownership and carriage are therefore fundamental to THN success. This study aimed to assess the prevalence of ownership and carriage of THN internationally among people who use drugs (PWUD). METHODS NHS Scotland Journals, AMED, EMBASE, HMIC, MEDLINE, PsycINFO, CINAHL Complete, PubMed, Cochrane Library, PROSPERO and grey literature were searched for articles which measured prevalence of THN ownership or carriage between 1996 and 2020. Ownership was defined as report of a personal supply of THN. Carriage was defined as the participant carrying THN on their person at time of data collection or reporting a frequency of how often they carry THN. Risk of bias was evaluated using the Joanna Briggs Checklist for Prevalence Studies. RESULTS Systematic search yielded 6363 papers, with ten eligible papers identified. Eight articles were included in ownership prevalence and five articles included for carriage prevalence, with an overlap of three studies between both measures. Pooled prevalence indicated moderate ownership levels (57%, CI 47-67%) but lower carriage levels (20%, CI 12-31%). Analysis was complicated by the limited number of available studies and lack of standardised terminology and measurement. CONCLUSION Understanding naloxone ownership and carriage globally is hampered by limited evidence and heterogeneity across studies. From the available data, prevalence of THN carriage overall appears low, despite moderate ownership. Given the variation across studies, future research should seek to utilise more standardised terminology and methods of measurement. Furthermore, services distributing THN must ensure the importance of regular carriage of naloxone is consistently emphasised.
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Affiliation(s)
- Gillian Burton
- University of Stirling, Salvation Army Centre for Addiction Services and Research, Colin Bell Building, Stirling, FK9 4LA, Scotland
| | - Andrew McAuley
- Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow, G4 0BA, Scotland.
| | - Joe Schofield
- University of Stirling, Salvation Army Centre for Addiction Services and Research, Colin Bell Building, Stirling, FK9 4LA, Scotland
| | - Alan Yeung
- Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow, G4 0BA, Scotland
| | - Catriona Matheson
- University of Stirling, Salvation Army Centre for Addiction Services and Research, Colin Bell Building, Stirling, FK9 4LA, Scotland
| | - Tessa Parkes
- University of Stirling, Salvation Army Centre for Addiction Services and Research, Colin Bell Building, Stirling, FK9 4LA, Scotland
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7
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Slesnick N, Chavez L, Bunger A, Famelia R, Ford J, Feng X, Higgins S, Holowacz E, Jaderlund S, Luthy E, Mallory A, Martin J, Walsh L, Yilmazer T, Kelleher K. Housing, opportunities, motivation and engagement (HOME) for homeless youth at-risk for opioid use disorder: study protocol for a randomized controlled trial. Addict Sci Clin Pract 2021; 16:30. [PMID: 33980315 PMCID: PMC8115873 DOI: 10.1186/s13722-021-00237-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 04/23/2021] [Indexed: 01/18/2023] Open
Abstract
Background Homeless youth experience high rates of substance use disorders, exposures to violence, mental and physical health conditions, and mortality. They have been particularly affected by the opioid crisis. However, no study to date has used a randomized controlled design to test preventive interventions of opioid and other drug use among this vulnerable population. Resolution of youth homelessness through housing and supportive services including prevention services, often referred to as “Housing First,” has great potential to reduce the likelihood for the development of an opioid use disorder as well as other problem behaviors associated with living on the streets. Housing First has been tested through randomized trials among homeless adults with mental health and substance use disorders, but has not been empirically tested for opioid prevention among homeless youth. Methods Homeless youth will be recruited from a drop-in shelter site frequented by disconnected youth; they will be screened for eligibility, including current homelessness, age 18–24 years, and not currently meeting criteria for opioid use disorder (OUD). In a controlled trial, 240 youth will then be randomized to one of two conditions, (1) housing + opioid and related risk prevention services, or (2) opioid and related risk prevention services alone. This project utilizes existing efficacious models of prevention to address opioid-related risks, including motivational interviewing, strengths-based outreach and advocacy, and an HIV risk preventive intervention. Follow-up will be conducted at 3, 6, 9 and 12-months post-baseline. The economic cost of each intervention will be determined to support implementation decisions with other providers and their funders. Discussion This study will provide essential information for researchers and providers on the efficacy of housing + opioid and related risk prevention services in an RCT for effects on opioid use and mechanisms underlying change. Because youth experiencing homelessness are at increased risk for a variety of adverse outcomes, the proposed intervention may produce substantial health care benefits to the youths and society at large. Trial registration ClinicalTrials.gov, NCT04135703, Registered October 13, 2019, https://clinicaltrials.gov/ct2/show/NCT04135703?term=NCT04135703&draw=2&rank=1#contacts
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Affiliation(s)
- Natasha Slesnick
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA.
| | - Laura Chavez
- Center for Innovation in Pediatric Practice, The Abigail Wexner Research Institute At Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Alicia Bunger
- College of Social Work, The Ohio State University, 1947 N. College Road, Columbus, OH, 43210, USA
| | - Ruri Famelia
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Jodi Ford
- College of Nursing, The Ohio State University, 1585 Neil Avenue, Columbus, OH, 43210, USA
| | - Xin Feng
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Sarah Higgins
- Center for Innovation in Pediatric Practice, The Abigail Wexner Research Institute At Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Eugene Holowacz
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Soren Jaderlund
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Ellison Luthy
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Allen Mallory
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Jared Martin
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Laura Walsh
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Tansel Yilmazer
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Kelly Kelleher
- Center for Innovation in Pediatric Practice, The Abigail Wexner Research Institute At Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
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8
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Collins AB, Ndoye CD, Arene-Morley D, Marshall BDL. Addressing co-occurring public health emergencies: The importance of naloxone distribution in the era of COVID-19. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 83:102872. [PMID: 32713765 PMCID: PMC7373067 DOI: 10.1016/j.drugpo.2020.102872] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/06/2020] [Accepted: 07/20/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Alexandra B Collins
- Department of Epidemiology, School of Public Health, Brown University, 121 South Main Street, Providence, RI 02903, United States.
| | | | - Diego Arene-Morley
- Rhode Island Communities for Addiction Recovery Efforts, 134 Mathewson Street, Providence, RI 02903, United States
| | - Brandon D L Marshall
- Department of Epidemiology, School of Public Health, Brown University, 121 South Main Street, Providence, RI 02903, United States
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Lai JT, Chapman BP, Carreiro SP, Babu KM, Boyer EW, Chai PR. Understanding Naloxone Uptake from an Emergency Department Distribution Program Using a Low-Energy Bluetooth Real-time Location System. J Med Toxicol 2020; 16:405-415. [PMID: 32253630 DOI: 10.1007/s13181-020-00774-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/19/2020] [Accepted: 03/24/2020] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION Emergency department (ED)-based naloxone distribution programs are a widespread harm reduction strategy. However, data describing the community penetrance of naloxone distributed from these programs are lacking. This study gauges acceptance of naloxone use and monitoring technology among people who use drugs (PWUD), and explores the use of real-time location systems (RTLS) in monitoring naloxone movements. METHODS A prospective observational study was conducted on a convenience sample of individuals (N = 30) presenting to a tertiary-care academic medical center ED for an opioid-related complaint. A naloxone kit equipped with a low-energy Bluetooth (BLE) tracking system was employed to detect movement of naloxone off the hospital campus as a proxy for community penetrance, followed by a qualitative interview to gauge participant acceptance of naloxone use and monitoring technology. RESULTS Detection of BLE signals verified transit of 24 distributed naloxone kits off our hospital campus. Three participants whose BLE signals were not captured reported taking their kits with them following discharge, suggesting technological errors occurred; another three participants were lost to follow-up. Qualitative interviews demonstrated that participants accepted ED-based naloxone distribution programs and passive tracking technologies, but revealed concerns regarding hypothetical continuous monitoring systems and problematic interactions with first responders and law enforcement personnel. CONCLUSIONS Based on acquired BLE signals, 80% of dispensed naloxone kits left the hospital campus. Use of RTLS to passively geolocate naloxone rescue kits is feasible, but detection can be adversely affected by technological errors. PWUD are amenable to transient monitoring technologies but identified barriers to implementation.
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Affiliation(s)
- Jeffrey T Lai
- Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Ave North LA-218, Worcester, MA, 01655, USA.
| | - Brittany P Chapman
- Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Ave North LA-218, Worcester, MA, 01655, USA
| | - Stephanie P Carreiro
- Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Ave North LA-218, Worcester, MA, 01655, USA
| | - Kavita M Babu
- Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Ave North LA-218, Worcester, MA, 01655, USA
| | - Edward W Boyer
- Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter R Chai
- Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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10
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Take-Home Naloxone for the Emergency Interim Management of Opioid Overdose: The Public Health Application of an Emergency Medicine. Drugs 2020; 79:1395-1418. [PMID: 31352603 PMCID: PMC6728289 DOI: 10.1007/s40265-019-01154-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Naloxone is a well-established essential medicine for the treatment of life-threatening heroin/opioid overdose in emergency medicine. Over two decades, the concept of 'take-home naloxone' has evolved, comprising pre-provision of an emergency supply to laypersons likely to witness an opioid overdose (e.g. peers and family members of people who use opioids as well as non-medical personnel), with the recommendation to administer the naloxone to the overdose victim as interim care while awaiting an ambulance. There is an urgent need for more widespread naloxone access considering the growing problem of opioid overdose deaths, accounting for more than 100,000 deaths worldwide annually. Rises in mortality are particularly sharp in North America, where the ongoing prescription opioid problem is now overlaid with a rapid growth in overdose deaths from heroin and illicit fentanyl. Using opioids alone is dangerous, and the mortality risk is clustered at certain times and contexts, including on prison release and discharge from hospital and residential care. The provision of take-home naloxone has required the introduction of new legislation and new naloxone products. These include pre-filled syringes and auto-injectors and, crucially, new concentrated nasal sprays (four formulations recently approved in different countries) with speed of onset comparable to intramuscular naloxone and relative bioavailability of approximately 40-50%. Choosing the right naloxone dose in the fentanyl era is a matter of ongoing debate, but the safety margin of the approved nasal sprays is superior to improvised nasal kits. New legislation in different countries permits over-the-counter sales or other prescription-free methods of provision. However, access remains uneven with take-home naloxone still not provided in many countries and communities, and with ongoing barriers contributing to implementation inertia. Take-home naloxone is an important component of the response to the global overdose problem, but greater commitment to implementation will be essential, alongside improved affordable products, if a greater impact is to be achieved.
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11
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Hurt BR, Hussain A, Aledhaim A, Moayedi S, Schenkel SM, Kim HK. Access and Barriers to Take-Home Naloxone Use among Emergency Department Patients with Opioid Misuse in Baltimore, Maryland, USA. Subst Use Misuse 2020; 55:2237-2242. [PMID: 32729772 DOI: 10.1080/10826084.2020.1797811] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The opioid epidemic has prompted the expansion of take-home naloxone (THN) distribution programs. The proportion of emergency department (ED) patients with opioid misuse who have access to a naloxone kit (NK) and barriers to using it are unclear. Objective: Characterizing the access and barrier to NK use among at-risk ED patients. Methods: We enrolled a convenience sample of ED patients with active opioid misuse from May 21-July 31, 2018. We administered a survey to collect patients' demographic data, substance use history, and access to and use of NK. The primary outcome was NK access (prior receipt of a kit or prescription); secondary outcomes were knowledge and use of NK, and barriers to obtaining and using it. Results: Of 165 respondents, 71.5% knew of THN programs and 57.6% (n = 95) had access to THN by either having received a NK (n = 90) or a prescription (n = 5); 34 respondents received both. Among 39 (23.6%) who received a naloxone prescription, 25 (64.1%) filled it. 60.0% (n = 99) reported knowing how to administer naloxone; lack of training was the primary reason (n = 63/66, 96.9%) for their unfamiliarity. Patients who presented after an opioid overdose (25.5%; n = 42) were less likely to have knowledge of THN programs (57.1% vs. 76.4%), and to have received a NK (35.7% vs. 61.0%). Conclusion: Awareness of THN programs was high among our cohort. But approximately 60% the respondents received a NK or knew how to use it. Despite efforts to expand THN access, gaps in knowledge, access, and use exist.
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Affiliation(s)
- Brenten R Hurt
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Atizaz Hussain
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ali Aledhaim
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Siamak Moayedi
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Stephen M Schenkel
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Hong K Kim
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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12
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Moustaqim-Barrette A, Papamihali K, Crabtree A, Graham B, Karamouzian M, Buxton JA. Correlates of take-home naloxone kit possession among people who use drugs in British Columbia: A cross-sectional analysis. Drug Alcohol Depend 2019; 205:107609. [PMID: 31654839 DOI: 10.1016/j.drugalcdep.2019.107609] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 05/27/2019] [Accepted: 10/03/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION In response to North America's opioid crisis, access to naloxone has increased. However, our understanding of the correlates of possessing a naloxone kit is limited. This study seeks to determine the prevalence and correlates of kit possession among people who use drugs (PWUD) in British Columbia (BC) Canada. METHODS This analysis used cross-sectional survey data collected in 2018 from 27 harm reduction sites in BC. Descriptive statistics and Poisson regression with robust error variance were used to examine factors associated with naloxone kit possession. RESULTS Overall, 70.7% (n = 246) of the total sample (n = 348) reported having a naloxone kit. Having a kit was significantly associated with self-reported opioid use in comparison with non-opioid use (Adjusted Prevalence Ratio (APR): 2.39; 95% CI: 1.33-4.32). Those reporting 'injection' as their preferred drug administration method were also more likely to possess a kit compared to those that predominantly preferred inhalation, smoking, or snorting (APR: 2.39; 95% CI: 1.25-4.58). Urbanicity, age, gender, and having regular housing were not significantly associated with possessing a kit. CONCLUSIONS This study is the first to examine naloxone kit possession across geographies, including non-urban areas. Lower kit possession among those that preferred inhaling, smoking or snorting drugs may reflect misconceptions around overdose risk of non-injection drug administration. Our study supports the need for enhanced awareness around the risk of opioid overdose with non-injection administration and suggests a need for comprehensive public health messaging that aims to address overdose risk and response.
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Affiliation(s)
| | - Kristi Papamihali
- British Columbia Centre for Disease Control, 655 W 12th Ave, V5Z 4R4, Vancouver, BC, Canada.
| | - Alexis Crabtree
- British Columbia Centre for Disease Control, 655 W 12th Ave, V5Z 4R4, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, 2206 E Mall, V6T 1Z8, Vancouver, BC, Canada.
| | - Brittany Graham
- British Columbia Centre for Disease Control, 655 W 12th Ave, V5Z 4R4, Vancouver, BC, Canada.
| | - Mohammad Karamouzian
- School of Population and Public Health, University of British Columbia, 2206 E Mall, V6T 1Z8, Vancouver, BC, Canada; British Columbia Centre on Substance Use, 400-1045 Howe St, V6C 1A5, Vancouver, BC, Canada; HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| | - Jane A Buxton
- British Columbia Centre for Disease Control, 655 W 12th Ave, V5Z 4R4, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, 2206 E Mall, V6T 1Z8, Vancouver, BC, Canada.
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13
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Lintzeris N, Monds LA, Bravo M, Read P, Harrod ME, Gilliver R, Wood W, Nielsen S, Dietze PM, Lenton S, Shanahan M, Jauncey M, Jefferies M, Hazelwood S, Dunlop AJ, Greenaway M, Haber P, Ezard N, Malcom A. Designing, implementing and evaluating the overdose response with take-home naloxone model of care: An evaluation of client outcomes and perspectives. Drug Alcohol Rev 2019; 39:55-65. [PMID: 31774221 DOI: 10.1111/dar.13015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND DESIGNS Take-home naloxone (THN) interventions are an effective response to preventing overdose deaths, however uptake across Australia remains limited. This project designed, implemented and evaluated a model of care targeting opioid users attending alcohol and other drug (AOD) treatment, needle and syringe programs (NSP) and related health services targeting people who inject drugs. DESIGN AND METHODS Service providers, consumers and regulators collaboratively designed a THN brief intervention (ORTHN, Overdose Response with Take-Home Naloxone) involving client education and supply of naloxone in pre-filled syringes, delivered by nursing, allied health and NSP workers. ORTHN interventions were implemented in over 15 services across New South Wales, Australia. The evaluation included client knowledge, attitudes, substance use and overdose experiences immediately before and 3 months after ORTHN intervention in a subsample of participants. RESULTS Six hundred and sixteen interventions were delivered, with 145 participants recruited to the research subsample, of whom 95 completed the three-month follow up. Overdose-related attitudes amongst participants improved following ORTHN, with no evidence of increased substance use or failure to implement other 'first responses' (e.g. calling an ambulance). Nine participants (10%) reversed an overdose using THN in the follow-up period. Participants identified a willingness to access THN from a range of services. While a minority (16%) indicated they were unwilling to pay for THN, the median price that participants were willing to pay was $AUD20 (IQR $10.40). DISCUSSION AND CONCLUSIONS The ORTHN model of care for THN appears an effective way to disseminate THN to people who use opioids attending AOD, NSP and related health-care settings.
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Affiliation(s)
- Nicholas Lintzeris
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia.,Discipline of Addiction Medicine, Central Clinical School, The University of Sydney, Sydney, Australia.,NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia
| | - Lauren A Monds
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia.,Discipline of Addiction Medicine, Central Clinical School, The University of Sydney, Sydney, Australia.,NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia
| | - Maria Bravo
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia.,Discipline of Addiction Medicine, Central Clinical School, The University of Sydney, Sydney, Australia.,NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia
| | - Phillip Read
- Kirketon Road Centre, South Eastern Sydney Local Health District, Sydney, Australia.,The Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | - Rosie Gilliver
- Kirketon Road Centre, South Eastern Sydney Local Health District, Sydney, Australia
| | - William Wood
- Medically Supervised Injecting Centre, Sydney, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | - Paul M Dietze
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Australia
| | - Simon Lenton
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Marian Shanahan
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | | | - Meryem Jefferies
- NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia.,Drug Health, Western Sydney Local Health District, Sydney, Australia
| | - Susan Hazelwood
- NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia.,Drug and Alcohol Services, Hunter New England Local Health District, Newcastle, Australia
| | - Adrian J Dunlop
- NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia.,Drug and Alcohol Services, Hunter New England Local Health District, Newcastle, Australia
| | | | - Paul Haber
- Discipline of Addiction Medicine, Central Clinical School, The University of Sydney, Sydney, Australia.,NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia.,Drug Health Services, Sydney Local Health District, Sydney, Australia
| | - Nadine Ezard
- NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia.,Drug and Alcohol Services, St. Vincent's Local Health Network, Sydney, Australia.,National Centre for Clinical Research in Emerging Drugs, Sydney, Australia
| | - Annie Malcom
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia.,NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia
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14
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Bahji A, Cheng B, Gray S, Stuart H. Reduction in mortality risk with opioid agonist therapy: a systematic review and meta-analysis. Acta Psychiatr Scand 2019; 140:313-339. [PMID: 31419306 DOI: 10.1111/acps.13088] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2019] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Opioid agonist therapies are effective medications that can greatly improve the quality of life of individuals with opioid use disorder. However, there is significant uncertainty about the risks of cause-specific mortality in and out of treatment. OBJECTIVE This systematic review and meta-analysis explored the association between methadone and buprenorphine with cause-specific mortality among opioid-dependent persons. METHODS We searched six online databases to identify relevant cohort studies, calculating all-cause and overdose-specific mortality rates during periods in and out of treatment. We pooled mortality estimates using multivariate random effects meta-analysis of the crude mortality rate per 1000 person-years of follow-up as well as relative risks comparing mortality in vs. out of treatment. RESULTS A total of 32 cohort studies (representing 150 235 participants, 805 423.6 person-years, and 9112 deaths) met eligibility criteria. Crude mortality rates were substantially higher among methadone cohorts than buprenorphine cohorts. Relative risk reduction was substantially higher with methadone relative to buprenorphine when time in-treatment was compared to time out-of-treatment. Furthermore, the greatest mortality reduction was conferred during the first 4 weeks of treatment. Mortality estimates were substantially heterogeneous and varied significantly by country, region, and by the nature of the treatment provider. CONCLUSION Precautions are necessary for the safer implementation of opioid agonist therapy, including baseline assessments of opioid tolerance, ongoing monitoring during the induction period, education of patients about the risk of overdose, and coordination within healthcare services.
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Affiliation(s)
- A Bahji
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.,Department of Psychiatry, Queen's University, Kingston, ON, Canada.,Substance Treatment and Recovery Team, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - B Cheng
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - S Gray
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - H Stuart
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
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15
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Abstract
The ventilatory control system is highly vulnerable to exogenous administered opioid analgesics. Particularly respiratory depression is a potentially lethal complication that may occur when opioids are overdosed or consumed in combination with other depressants such as sleep medication or alcohol. Fatalities occur in acute and chronic pain patients on opioid therapy and individuals that abuse prescription or illicit opioids for their hedonistic pleasure. One important strategy to mitigate opioid-induced respiratory depression is cotreatment with nonopioid respiratory stimulants. Effective stimulants prevent respiratory depression without affecting the analgesic opioid response. Several pharmaceutical classes of nonopioid respiratory stimulants are currently under investigation. The majority acts at sites within the brainstem respiratory network including drugs that act at α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors (ampakines), 5-hydroxytryptamine receptor agonists, phospodiesterase-4 inhibitors, D1-dopamine receptor agonists, the endogenous peptide glycyl-glutamine, and thyrotropin-releasing hormone. Others act peripherally at potassium channels expressed on oxygen-sensing cells of the carotid bodies, such as doxapram and GAL021 (Galleon Pharmaceuticals Corp., USA). In this review we critically appraise the efficacy of these agents. We conclude that none of the experimental drugs are adequate for therapeutic use in opioid-induced respiratory depression and all need further study of efficacy and toxicity. All discussed drugs, however, do highlight potential mechanisms of action and possible templates for further study and development.
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16
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Madah‐Amiri D, Gjersing L, Clausen T. Naloxone distribution and possession following a large-scale naloxone programme. Addiction 2019; 114:92-100. [PMID: 30129078 PMCID: PMC6585734 DOI: 10.1111/add.14425] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 04/09/2018] [Accepted: 08/10/2018] [Indexed: 11/29/2022]
Abstract
AIMS To examine uptake following a large-scale naloxone programme by estimating distribution rates since programme initiation and the proportion among a sample of high-risk individuals who had attended naloxone training, currently possessed or had used naloxone. We also estimated the likelihood of naloxone possession and use as a function of programme duration, individual descriptive and substance use indicators. DESIGN (1) Distribution data (June 2014-August 2017) and date of implementation for each city and (2) a cross-sectional study among a sample of illicit substance users interviewed September 2017. SETTING Seven Norwegian cities. PARTICIPANTS A total of 497 recruited users of illegal opioids and/or central stimulants. MEASUREMENTS Primary outcomes: naloxone possession and use. Random-intercepts logistic regression models (covariates: male, age, homelessness/shelter use, overdose, incarceration, opioid maintenance treatment, income sources, substance use indicators, programme duration). FINDINGS Overall, 4631 naloxone nasal sprays were distributed in the two pilot cities, with a cumulative rate of 495 per 100 000 population. In the same two cities, among high-risk individuals, 44% and 62% reported current naloxone possession. The possession rates of naloxone corresponded well to the duration of each participating city's distribution programme. Overall, in the six distributing cities, 58% reported naloxone training, 43% current possession and 15% naloxone use. The significant indicators for possession were programme duration [adjusted odds ratios (aOR) = 1.44, 95% confidence interval (CI = 0.82-2.37], female gender (aOR = 1.97, 95% CI = 1.20-3.24) and drug-dealing (aOR = 2.36, 95% CI = 1.42-3.93). The significant indicators for naloxone use were programme duration (aOR = 1.49 95%, CI = 1.15-1.92), homelessness/shelter use (aOR = 2.06, 95% CI = 1.02-4.17), opioid maintenance treatment (OMT) (aOR = 2.07, 95% CI = 1.13-3.78), drug-dealing (aOR = 2.40, 95% CI = 1.27-4.54) and heroin injecting (aOR = 2.13, 95% CI = 1.04-4.38). CONCLUSIONS A large-scale naloxone programme in seven Norwegian cities with a cumulative distribution rate of 495 per 100 000 population indicated good saturation in a sample of high-risk individuals, with programme duration in each city as an important indicator for naloxone possession and use.
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Affiliation(s)
| | | | - Thomas Clausen
- Norwegian Centre for Addiction ResearchUniversity of OsloOsloNorway
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