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Bredenberg E, Olsen H, Ladka M, Beekman K, Black JC, Ellis MS, Monte AA. People entering opioid substance use treatment have low rates of naloxone knowledge and possession. Drug Alcohol Depend 2025; 271:112645. [PMID: 40073803 DOI: 10.1016/j.drugalcdep.2025.112645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Revised: 02/18/2025] [Accepted: 02/26/2025] [Indexed: 03/14/2025]
Abstract
BACKGROUND AND AIMS Deaths from opioid overdose are increasing in the United States (US) and distribution of the opioid antagonist naloxone is one key strategy to reduce mortality. In this cross-sectional survey, we assess the association of high-risk behaviors with possession of naloxone and knowledge of where to find it. SETTING AND PARTICIPANTS 5663 adults entering treatment for opioid use disorder at facilities throughout the US during the calendar year 2022 were surveyed. ANALYSIS Using a logistic regression analysis, we compared self-reported ownership of naloxone and knowledge of where to find naloxone between individuals with different self-reported types and routes of opioid use, as well as those with a history of opioid overdose compared to those without. FINDINGS Patients reporting fentanyl, heroin, and more than one type of opioid use had higher rates of naloxone possession than those reporting oxycodone use alone. Patients that reported injection drug use were more likely to possess (61 %) and know where to get (77 %) naloxone than those who did not inject drugs (44 % possessed and 58 % knew where to find naloxone, p < 0.001 for each comparison). Patients with a self-reported history of overdose were more likely to possess (59 %) and know where to get (77 %) naloxone than those without a history of overdose (42 % and 55 % respectively, p < 0.001 for each comparison). CONCLUSIONS Gaps in naloxone possession and knowledge persist amongst patients entering treatment for opioid use disorder. Additional efforts to expand naloxone ownership are critical, including comprehensive educational programs, involvement of community-based organizations, and bystander training.
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Affiliation(s)
- Erin Bredenberg
- Department of Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Heather Olsen
- Rocky Mountain Poison & Drug Safety, Denver Health and Hospital Authority, Denver, CO, USA
| | - Michael Ladka
- Rocky Mountain Poison & Drug Safety, Denver Health and Hospital Authority, Denver, CO, USA
| | - Kyle Beekman
- Rocky Mountain Poison & Drug Safety, Denver Health and Hospital Authority, Denver, CO, USA
| | - Joshua C Black
- Rocky Mountain Poison & Drug Safety, Denver Health and Hospital Authority, Denver, CO, USA
| | - Matthew S Ellis
- Department of Psychiatry, Washington University in St Louis, School of Medicine, St Louis, MO, USA
| | - Andrew A Monte
- Rocky Mountain Poison & Drug Safety, Denver Health and Hospital Authority, Denver, CO, USA; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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Cano M, Jones A, Silverstein SM, Daniulaityte R, LoVecchio F. Naloxone administration and survival in overdoses involving opioids and stimulants: An analysis of law enforcement data from 63 Pennsylvania counties. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2025; 135:104678. [PMID: 39637491 PMCID: PMC11724750 DOI: 10.1016/j.drugpo.2024.104678] [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: 08/27/2024] [Revised: 11/22/2024] [Accepted: 11/28/2024] [Indexed: 12/07/2024]
Abstract
BACKGROUND In consideration of rising opioid-stimulant deaths in the United States, this study explored rates of naloxone administration and survival in suspected opioid overdoses with, versus without, stimulants co-involved. METHODS The study analyzed 26,635 suspected opioid-involved overdoses recorded by law enforcement/first-responders in the Pennsylvania Overdose Information Network in 63 Pennsylvania counties, January 2018-July 2024. All measures, including suspected drug involvement, were based on first-responder assessment/report. Relative frequencies and chi-square tests were first used to compare suspected opioid overdoses with, versus without, stimulants (cocaine or methamphetamine) co-involved. Next, mediation analyses tested naloxone administration as a mediator in the association between stimulant co-involvement (in opioid overdoses) and survival. RESULTS Naloxone was reportedly administered in 72.2 % of the suspected opioid-no-cocaine overdoses, compared to 55.1 % of the opioid-cocaine-involved overdoses, and 72.1 % of the opioid-no-methamphetamine overdoses vs. 52.4 % of the opioid-methamphetamine-involved overdoses. With respect to survival rates, 18.0 % of the suspected opioid-no-cocaine overdoses ended in death, compared to 41.3 % of the opioid-cocaine overdoses; 18.1 % of the opioid-no-methamphetamine overdoses ended in death, versus 42.9 % of the opioid-methamphetamine overdoses. In mediation analyses (adjusted for demographics, county, year, and other drug co-involvement), naloxone administration mediated 38.7 % (95 % Confidence Interval [CI], 31.3-46.0 %) of the association between suspected cocaine co-involvement and survival and 39.2 % (95 % CI, 31.3-47.1 %) of the association between suspected methamphetamine co-involvement and survival. CONCLUSIONS Among suspected opioid overdoses recorded in the Pennsylvania Overdose Information Network, stimulant co-involvement was associated with lower naloxone administration and higher fatality, with naloxone partially mediating the association between stimulant co-involvement and death.
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Affiliation(s)
- Manuel Cano
- School of Social Work, Arizona State University, 411 N Central Ave Suite 863, Phoenix, AZ 85004, United States.
| | - Abenaa Jones
- The Department of Human Development and Family Studies, The Consortium on Substance Use and Addiction, The Pennsylvania State University, 218 Health and Human Development Building, University Park, PA 16802, United States
| | - Sydney M Silverstein
- Wright State University Boonshoft School of Medicine, 2555 University Blvd., Dayton, OH 45435, United States
| | - Raminta Daniulaityte
- College of Health Solutions, Arizona State University, 425 N 5th Street, Phoenix, AZ 85004, United States
| | - Frank LoVecchio
- College of Health Solutions, Arizona State University, 425 N 5th Street, Phoenix, AZ 85004, United States; Valleywise Health Medical Center, 2601 E Roosevelt St., Phoenix, AZ 85008, United States
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Dickson MF, Annett J, Walker M, Leukefeld C, Webster JM, Levi MM, Tillson M, Staton M. Overdose Experiences Among a Sample of Women in Jail with Opioid Use Disorder. Subst Use Misuse 2024; 59:1911-1920. [PMID: 39069728 PMCID: PMC11444883 DOI: 10.1080/10826084.2024.2383982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Background: Previous non-fatal overdose may increase risk of overdose fatality for women reentering the community following incarceration, but pre-incarceration overdose experiences are understudied. This study describes the prevalence and correlates of non-fatal overdose prior to jail among women with opioid use disorder (OUD). Methods: Women (N = 700) were randomly selected from eight Kentucky jails, screened for OUD, and interviewed as part of the NIDA-funded Kentucky Justice Community Opioid Innovation Network (JCOIN) trial. Descriptive statistics were used to examine women's prior overdose experiences, while bivariate analyses and logistic regression were used to identify correlates of overdose in the 90 days prior to jail. Results: Analyses found that 55.4% of women had overdosed in their lifetime, and 21.4% overdosed in the 90 days prior to jail. Of those who overdosed in the 90 days prior to jail, heroin (80.7%) was the most-commonly used drug prior to overdose, 35.2% received emergency, medically-attended services post-overdose, and 92.4% were administered naloxone - primarily by acquaintances. Overdosing in the 90 days prior to jail was positively correlated with identifying as a sexual minority, being from an urban community, childhood victimization, as well as recent heroin, fentanyl, and injection drug use. Conclusions: Findings indicate that prior overdose is common among jailed women with OUD, and although naloxone was often administered, few women received medically-attended services post-overdose. Results highlight the importance of distributing naloxone to community members and women reentering the community from jail, and suggest additional research is needed to understand factors inhibiting medical care following an overdose.
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Affiliation(s)
- Megan F. Dickson
- University of Kentucky Center on Drug and Alcohol Research, 643 Maxwelton Ct, Lexington, KY 40508, USA
- University of Kentucky College of Medicine, Department of Behavioral Science,109 Medical Behavioral Science Building, Lexington, KY 40536, USA
| | - Jaxin Annett
- University of Kentucky Center on Drug and Alcohol Research, 643 Maxwelton Ct, Lexington, KY 40508, USA
| | - Meghan Walker
- University of Kentucky College of Medicine, 800 Park St, Bowling Green, KY 42101, USA
| | - Carl Leukefeld
- University of Kentucky Center on Drug and Alcohol Research, 643 Maxwelton Ct, Lexington, KY 40508, USA
- University of Kentucky College of Medicine, Department of Behavioral Science,109 Medical Behavioral Science Building, Lexington, KY 40536, USA
| | - J. Matthew Webster
- University of Kentucky Center on Drug and Alcohol Research, 643 Maxwelton Ct, Lexington, KY 40508, USA
- University of Kentucky College of Medicine, Department of Behavioral Science,109 Medical Behavioral Science Building, Lexington, KY 40536, USA
| | - Mary M. Levi
- Department of Psychology, University of Kentucky College of Arts and Sciences, Lexington, KY, USA
| | - Martha Tillson
- University of Kentucky Center on Drug and Alcohol Research, 643 Maxwelton Ct, Lexington, KY 40508, USA
| | - Michele Staton
- University of Kentucky Center on Drug and Alcohol Research, 643 Maxwelton Ct, Lexington, KY 40508, USA
- University of Kentucky College of Medicine, Department of Behavioral Science,109 Medical Behavioral Science Building, Lexington, KY 40536, USA
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4
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Victor G, Ray B, Watson DP. Use of harm reduction strategies by individuals with a history of incarceration: A short report using baseline data collected from the STAMINA clinical trial. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 162:209376. [PMID: 38641053 DOI: 10.1016/j.josat.2024.209376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/20/2024] [Accepted: 04/14/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Due to the considerably heightened risk of overdose immediately following jail or prison release, expansion of harm reduction interventions for citizens returning to the community after an incarceration episode should be of utmost concern. However, there are no studies examining the adoption and use of harm reduction among this population. This short report examines the use of individual-level harm reduction strategies (HRS) among people who use drugs, comparing those who have lifetime histories of incarceration with those who do not. METHODS This study included baseline data (N = 274) from a larger clinical trial, which recruited participants at two syringe service programs. Fisher's exact tests examine correlations between HRS and lifetime incarceration. RESULTS Significant variation in HRS use were observed by demographic characteristics. Those with lifetime incarceration histories were less likely to report ensuring naloxone was available when using, using when others were present, using fentanyl test strips, using a trusted drug supplier, and using some other HRS compared to those without lifetime incarceration histories. Similarly, those with lifetime incarceration histories were also less likely to report using non-prescribed buprenorphine and methadone, which could potentially reduce overdose risk even if not explicitly used as an HRS. CONCLUSION The results suggest that one of the populations at highest risk of overdose is least likely to use strategies that may reduce overdose risk. Targeted efforts to increase exposure to HRS learning opportunities and access to these resources could help reduce overdose disparities for people returning to the community after incarceration.
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Affiliation(s)
- Grant Victor
- School of Social Work, Rutgers, The State University of New Jersey, 390 George Street, New Brunswick, NJ 08901, USA; Rutgers Addiction Research Center, The State University of New Jersey, 671 Hoes Lane West, Piscataway, NJ 08854, USA.
| | - Bradley Ray
- RTI International, Division for Applied Justice Research, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - Dennis P Watson
- Chestnut Health Systems, 221 West Walton Street, Chicago, IL 60610, USA.
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Budesa Z, Vance K, Smith R, Carpenter R, Banks D, Green L, Marshall BDL, Schackman BR, Zang X, Winograd R. Missouri's Overdose Field Report: descriptive analysis, survival trends, and naloxone dosing patterns from a community-based survey tool, 2018-2022. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024; 50:413-425. [PMID: 38917333 PMCID: PMC11305909 DOI: 10.1080/00952990.2024.2358046] [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] [Received: 10/02/2023] [Revised: 05/14/2024] [Accepted: 05/17/2024] [Indexed: 06/27/2024]
Abstract
Background: Missouri's Overdose Field Report (ODFR) is a community-based reporting system which intends to capture overdoses which may not be otherwise recorded.Objectives: Describe the factors related to non-fatal overdoses reported to Missouri's ODFR.Methods: This study used a descriptive epidemiological approach to examine the demographics and circumstances of overdoses reported to the ODFR. We used binary logistic regression to evaluate factors associated with survival and ordinal logistic regression to evaluate factors associated with number of doses used. Factors were chosen based on their relevance to overdose education and survival, and naloxone distribution.Results: Between 2018 and 2022, 12,225 overdoses (67% male; 78% White) were reported through the ODFR, with a 96% (n = 11,225) survival rate. Overdose survival (ps < .02) was associated with younger age (OR = .58), no opioid and stimulant co-involvement (OR = .61), and private location (OR = .48). Intramuscular naloxone in particular was associated with a significantly higher odds of survival compared to nasal naloxone (OR = 2.11). An average of 1.6 doses of naloxone per incident were administered. Additional doses were associated (ps < .02) with being older (OR = .45), female (OR = .90), nasal naloxone (versus intravenous) (OR = .65), and the belief fentanyl was present (OR = 1.49).Conclusion: Our reporting form provides a comprehensive picture of the events surrounding reported overdoses, including factors associated with survival, how much naloxone was used, and the effects of respondents believing fentanyl was involved. Missouri's report can provide support for current naloxone dosing, contextualize refusing post-overdose transport, and can be used to improve overdose response by community and first responders.
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Affiliation(s)
- Zach Budesa
- Advocates for Human Potential, Inc., Sudbury, MA, USA
| | - Kyle Vance
- Missouri Institute of Mental Health, University of Missouri—St. Louis, St. Louis, MO, USA
| | - Ryan Smith
- Missouri Institute of Mental Health, University of Missouri—St. Louis, St. Louis, MO, USA
| | - Ryan Carpenter
- Department of Psychological Sciences, University of Missouri—St. Louis, St. Louis, MO, USA
| | - Devin Banks
- Department of Psychological Sciences, University of Missouri—St. Louis, St. Louis, MO, USA
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Lauren Green
- Missouri Institute of Mental Health, University of Missouri—St. Louis, St. Louis, MO, USA
| | - Brandon DL Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Xiao Zang
- Division of Health Policy & Management, University of Minnesota, Minneapolis, MN, USA
| | - Rachel Winograd
- Missouri Institute of Mental Health, University of Missouri—St. Louis, St. Louis, MO, USA
- Department of Psychological Sciences, University of Missouri—St. Louis, St. Louis, MO, USA
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Resko SM, Pasman E, Hicks DL, Lee G, Ellis JD, O'Shay S, Brown S, Agius E. Naloxone Knowledge and Attitudes Towards Overdose Response Among Family Members of People who Misuse Opioids. J Community Health 2024; 49:70-77. [PMID: 37450091 DOI: 10.1007/s10900-023-01257-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
Providing family members of individuals with opioid use disorders (OUD) naloxone is a cost-effective way to prevent overdose deaths. However, misconceptions and negative attitudes towards naloxone hinder family engagement with naloxone programs. This study examines factors associated with knowledge and attitudes toward naloxone among adults with close family members who misused opioids. Adults with family members (parent, step-parent, child, spouse, sibling, or step-sibling) who misused opioids (N = 299) completed a web-based survey. Participants were recruited through treatment providers, community groups, and social media. Surveys assessed naloxone knowledge, attitudes toward overdose response, demographics, completion of naloxone training, attitude toward medications for OUD, and family members' overdose history. Multiple regression was used to identify factors associated with naloxone knowledge (Model 1) and attitudes toward overdose response (Model 2). A graduate degree (B = .35, p < .003) and a history of overdose (B = 0.21, p = .032) were associated with greater naloxone knowledge. Age (B = .11, p < .001), race/ethnicity (B = -1.39, p = .037), naloxone training (B = 2.70, p < .001), and more positive attitude toward medications for OUD (B = 1.50, p = .003) were associated with attitudes toward overdose response. Family members are potential allies in reducing drug overdose deaths, and families may need broader education about naloxone. Awareness of previous overdose was associated with greater naloxone knowledge. Findings related to race/ethnicity suggest the need to reach family members of minoritized racial groups to provide access to naloxone training. Findings point to where education and distribution efforts may focus on increasing knowledge and improving attitudes among those closest to people with OUD.
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Affiliation(s)
- Stella M Resko
- School of Social Work, Wayne State University, Detroit, MI, US.
- Wayne State University, Merrill Palmer Skillman Institute, Detroit, MI, US.
| | - Emily Pasman
- School of Social Work, Wayne State University, Detroit, MI, US
| | | | - Guijin Lee
- School of Public Health, University of Memphis, Memphis, TN, US
| | | | - Sydney O'Shay
- Communication Studies and Philosophy, Utah State University, Logan, UT, US
| | - Suzanne Brown
- School of Social Work, Wayne State University, Detroit, MI, US
| | - Elizabeth Agius
- School of Social Work, Wayne State University, Detroit, MI, US
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7
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Pamplin JR, King C, Cooper C, Bennett AS, Elliott L, Davis CS, Rouhani S, Townsend TN. Pathways to racial disparities in the effects of Good Samaritan Laws: A mixed methods pilot study. Drug Alcohol Depend 2023; 249:110823. [PMID: 37336006 DOI: 10.1016/j.drugalcdep.2023.110823] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/02/2023] [Accepted: 06/03/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Drug overdose deaths continue to rise, and considerable racial inequities have emerged. Overdose Good Samaritan laws (GSLs) are intended to encourage overdose witnesses to seek emergency assistance. However, evidence of their effectiveness is mixed, and little is known regarding racial disparities in their implementation. This study examined GSL impact by assessing racial differences in awareness of and trust in New York state's GSL. METHODS Using a sequential mixed methods design, Black and white participants were recruited from an existing longitudinal cohort study of people who use illicit opioids in New York City to participate in a quantitative survey and qualitative interviews. Racially stratified survey responses were analyzed using chi-squared tests, Fisher exact tests, or t-tests. Qualitative interviews were analyzed using a hybrid inductive-deductive approach. RESULTS Participants (n=128) were 56% male and predominantly aged 50 years or older. Most met criteria for severe opioid use disorder (81%). Fifty-seven percent reported that the New York GSL makes them more likely to call 911 even though 42% reported not trusting law enforcement to abide by the GSL; neither differed by race. Black people were less likely to have heard of the GSL (36.1% vs 60%) and were less likely to have accurate information regarding its protections (40.4% vs 49.6%). CONCLUSIONS Though GSLs may reduce negative impacts of the criminalization of people who use drugs, their implementation may exacerbate existing racial disparities. Resources should be directed towards harm reduction strategies that do not rely on trust in law enforcement.
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Affiliation(s)
- John R Pamplin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States; Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States.
| | - Carla King
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States; Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States; Center for Drug Use and HIV Research (CDUHR), School of Global Public Health, New York University, New York, NY, United States
| | - Claire Cooper
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - 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 (CDUHR), School of Global Public Health, New York University, New York, NY, United States; Center for Anti-racism, Social Justice & Public Health, School of Global Public Health, New York University, New York, NY, United States
| | - Luther Elliott
- 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 (CDUHR), School of Global Public Health, New York University, New York, NY, United States
| | - Corey S Davis
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States; Network for Public Health Law, Edina, MN, United States
| | - Saba Rouhani
- Center for Drug Use and HIV Research (CDUHR), School of Global Public Health, New York University, New York, NY, United States; Center for Anti-racism, Social Justice & Public Health, 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, NY, United States
| | - Tarlise N Townsend
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States; Rory Meyers College of Nursing, New York University, New York, NY, United States
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Sohn M, Delcher C, Talbert JC, Cheng Y, Xu Y, Jadhav ED, Freeman PR. The Impact of Naloxone Coprescribing Mandates on Opioid-Involved Overdose Deaths. Am J Prev Med 2023; 64:483-491. [PMID: 36496279 DOI: 10.1016/j.amepre.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/21/2022] [Accepted: 10/13/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Since 2017, a total of 10 states have mandated naloxone coprescribing intended to prevent fatal opioid overdoses. This study aims to assess the association between naloxone coprescribing/offering mandates and opioid-involved overdose deaths on the basis of the opioid type. METHODS Data on overdose deaths from 1999 to 2020 came from the National Center for Health Statistics CDC WONDER Online Database. This study examined deaths stratified by illicit/synthetic opioids and prescription/treatment opioids. Difference-in-difference negative binomial regression models estimated average marginal effects and 95% CIs. Covariates included opioid dispensing rate, Good Samaritan law, pharmacy-based naloxone access law, mandatory use of prescription drug monitoring program, and recreational cannabis dispensaries. Data collection and analysis were conducted in 2022. RESULTS Ten states implemented naloxone coprescribing/offering mandates during the period. Coprescribing/offering mandates significantly reduced the number of prescription/treatment overdose deaths by 8.61 per state per quarter (95% CI= -15.13, -2.09), a 16% reduction from the counterfactual estimates. Coprescribing/offering mandates did not significantly impact illicit/synthetic overdose deaths (average marginal effect=0.32; 95% CI= -18.27, 18.91). CONCLUSIONS Coprescribing/offering mandates prevent overdose deaths for its target population, individuals using prescription/treatment opioids. These mandates do not appear to impact populations using illicit/synthetic opioids; thus, expanded efforts are needed to reach these individuals.
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Affiliation(s)
- Minji Sohn
- College of Pharmacy, Ferris State University, Big Rapids, Michigan.
| | - Chris Delcher
- Institute for Pharmaceutical Outcomes and Policy (IPOP), Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, Kentucky
| | - Jeffery C Talbert
- Institute for Biomedical Informatics, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Yue Cheng
- Institute for Pharmaceutical Outcomes and Policy (IPOP), Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, Kentucky
| | - Yong Xu
- Marketing Department, College of Business, Ferris State University, Big Rapids, Michigan
| | - Emmanuel D Jadhav
- College of Health Professions, Ferris State University, Big Rapids, Michigan
| | - Patricia R Freeman
- Institute for Pharmaceutical Outcomes and Policy (IPOP), Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, Kentucky
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Ackermann E, Kievit B, Xavier J, Barbic S, Ferguson M, Greer A, Loyal J, Mamdani Z, Palis H, Pauly B, Slaunwhite A, Buxton JA. Awareness and knowledge of the Good Samaritan Drug Overdose Act among people at risk of witnessing an overdose in British Columbia, Canada: a multi-methods cross sectional study. Subst Abuse Treat Prev Policy 2022; 17:42. [PMID: 35614474 PMCID: PMC9131579 DOI: 10.1186/s13011-022-00472-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Bystanders to drug overdoses often avoid or delay calling 9–1-1 and cite fear of police involvement as a main reason. In 2017, the Good Samaritan Drug Overdose Act (GSDOA) was enacted by the Canadian government to provide people present at an overdose with legal protection from charges for simple drug possession, and conditions stemming from simple possession. Few studies have taken a multi-methods approach to evaluating the GSDOA. We used quantitative surveys and qualitative interviews to explore awareness, understanding, and perceptions of the GSDOA in people at risk of witnessing an overdose. Methods Quantitative cross-sectional surveys and qualitative telephone interviews were conducted with adults and youth at risk of witnessing an overdose across British Columbia. Cross-sectional survey participants were recruited at 19 Take Home Naloxone sites and online through Foundry. Multivariable logistic regression models were constructed hierarchically to determine factors associated with GSDOA awareness. Telephone interview participants were recruited by research assistants with lived/living experience of substance use. Deductive and inductive thematic analyses were conducted to identify major themes. Results Overall, 52.7% (n = 296) of the quantitative study sample (N = 453) reported being aware of the GSDOA. In multivariable analysis, cellphone possession (adjusted odds ratio [AOR] = 2.19; 95% confidence interval [CI] 1.36, 3.54) and having recently witnessed an opioid overdose (AOR = 2.34; 95% CI 1.45, 3.80) were positively associated with GSDOA awareness. Young adults (25 – 34 years) were more likely to be aware of the Act (AOR = 2.10; 95% CI 1.11, 3.98) compared to youth (16–24 years). Qualitative interviews (N = 42) revealed that many overestimated the protections offered by the GSDOA. To increase awareness and knowledge of the Act among youth, participants recommended adding the GSDOA to school curricula and using social media. Word of mouth was suggested to reach adults. Conclusion Both awareness and knowledge of the GSDOA remain low in BC, with many overestimating the protections the Act offers. Dissemination efforts should be led by people with lived/living experience and should target those with limited awareness and understanding of the Act as misunderstandings can erode trust in law enforcement and harm reduction policy. Supplementary Information The online version contains supplementary material available at 10.1186/s13011-022-00472-4.
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10
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Reader SW, Walton GH, Linder SH. Review and inventory of 911 Good Samaritan Law Provisions in the United States. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 110:103896. [PMID: 36343430 DOI: 10.1016/j.drugpo.2022.103896] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/14/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND 911 Good Samaritan Laws (GSLs) confer limited legal immunity to bystanders in possession of controlled substances who report emergency overdoses. While these laws may decrease opioid overdose mortality, current literature reduces GSLs to a small number of variables, overlooking substantial differences in implementation and statutory context which dramatically alter their applicability. METHODS We identified all state GSLs and their legislative history, characterizing features into four categories using a novel framework: breadth of protected activities, burden placed on Good Samaritans, strength of protection, and exemption in coverage. When protections depended on the nature of the controlled substance, heroin served as a common point of comparison. RESULTS GSLs vary substantially across states and time. Protections depend on the quantity of substances involved and may extend to the person experiencing the overdose or persons reporting their own overdose. Protected offenses range from possession of controlled substances to drug-induced homicide. In some states, Good Samaritans must complete substance use treatment or administer naloxone to retain protections. Immunity ranges from protection from arrest to merely procedural protections at trial, and may even exclude persons in possession of opioids. Exemptions target persons engaging in chronic substance use, such as persons invoking protection multiple times or previously reporting an overdose. CONCLUSION States offer Good Samaritans substantially different protections even when the statutes confer nominally comparable immunities. Accommodating this heterogeneity will enhance the validity of future studies into these laws and their efficacy.
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Affiliation(s)
- Shane W Reader
- School of Public Health, University of Texas Health Science Center at Houston, United States.
| | - Gretchen H Walton
- School of Public Health, University of Texas Health Science Center at Houston, United States
| | - Stephen H Linder
- School of Public Health, University of Texas Health Science Center at Houston, United States
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11
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Intention to seek emergency medical services during community overdose events in British Columbia, Canada: a cross-sectional survey. Subst Abuse Treat Prev Policy 2022; 17:56. [PMID: 35883186 PMCID: PMC9315848 DOI: 10.1186/s13011-022-00484-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Canada and the United States continue to experience increasing overdose deaths attributed to highly toxic illicit substances, driven by fentanyl and its analogues. Many bystanders report being hesitant to call 9-1-1 at an overdose due to fears around police presence and arrests. In Canada, a federal law was enacted in 2017, the Good Samaritan Drug Overdose Act (GSDOA), to provide protection from simple drug possession and related charges when 9-1-1 is called to an overdose. There is limited evidence, however, that the GSDOA has improved rates of intention to call 9-1-1 at overdose events. We therefore sought to examine intent to call 9-1-1 among persons who received GSDOA education and were at risk of witnessing an overdose. Methods A cross-sectional survey was conducted with people at risk of witnessing an overdose recruited at 19 Take Home Naloxone (THN) program sites across British Columbia as well as online through Foundry from October 2020 to April 2021. Descriptive statistics were used to examine intention to call 9-1-1 at future overdoses. Multivariable logistic regression models were built in hierarchical fashion to examine factors associated with intention to call 9-1-1. Results Overall, 89.6% (n = 404) of the eligible sample reported intention to call 9-1-1. In the multivariable model, factors positively associated with intention to call 9-1-1 included identifying as a cisgender woman (adjusted odds ratio [AOR]: 3.37; 95% CI: 1.19–9.50) and having previous GSDOA awareness ([AOR]: 4.16; 95% CI: 1.62–10.70). Having experienced a stimulant overdose in the past 6 months was negatively associated with intention to call 9-1-1 ([AOR]: 0.24; 95% CI: 0.09–0.65). Conclusion A small proportion of the respondents reported that, despite the enactment of GSDOA, they did not intend to call 9-1-1 and those who were aware of the act were more likely to report an intention to call at future overdose events. Increasing GSDOA awareness and/or additional interventions to support the aims of the GSDOA could address ongoing reluctance to seek emergency medical care by people who use drugs. Supplementary Information The online version contains supplementary material available at 10.1186/s13011-022-00484-0.
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12
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Filteau MR, Green B, Kim F, McBride KA. 'It's the same thing as giving them CPR training': rural first responders' perspectives on naloxone. Harm Reduct J 2022; 19:111. [PMID: 36192736 PMCID: PMC9531424 DOI: 10.1186/s12954-022-00688-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 09/13/2022] [Indexed: 12/03/2022] Open
Abstract
The Substance Abuse and Mental Health Services Administration's (SAMHSA) Harm Reduction grant program expanded access to several harm reduction strategies to mitigate opioid overdose fatalities, including expanding access to naloxone. Interviews with first responders in a frontier and remote (FAR) state were conducted to understand their job responsibilities in relation to overdose response and prevention and their perceptions of training laypersons to administer naloxone. This study includes 22 interviews with law enforcement, EMS and/or fire personnel, and members of harm reduction-focused community organizations. The study finds widespread support for increasing access to naloxone and training laypersons in naloxone administration throughout Montana, due to rural first responders' inability to meet the needs of residents and an overall lack of resources to address addiction and the effects of fentanyl. Participants from harm reduction-focused community organizations convey support for training lay persons, but also illuminate that real and perceived cultural opposition to harm reduction strategies could reduce the likelihood that laypeople enroll in naloxone training. This study adds to the literature because it focuses on first responders in a FAR area that would benefit from layperson naloxone education and administration training due to its geographic expansiveness and the area's overall lack of access to medications for opioid use disorder or other treatment services. Expanding harm reduction approaches, like increasing access and training laypersons to administer naloxone, might be FAR residents' best chance for surviving an opioid overdose.
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Affiliation(s)
| | | | - Frances Kim
- JG Research and Evaluation, Bozeman, MT, USA
| | - Ki-Ai McBride
- Montana Department of Health and Human Services, Behavioral Health and Disabilities Disorders Division, Helena, MT, USA
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13
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Townsend TN, Hamilton LK, Rivera-Aguirre A, Davis CS, Pamplin JR, Kline D, Rudolph KE, Cerdá M. Use of an Inverted Synthetic Control Method to Estimate Effects of Recent Drug Overdose Good Samaritan Laws, Overall and by Black/White Race/Ethnicity. Am J Epidemiol 2022; 191:1783-1791. [PMID: 35872589 PMCID: PMC9989361 DOI: 10.1093/aje/kwac122] [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: 11/18/2020] [Revised: 05/03/2022] [Accepted: 07/07/2022] [Indexed: 01/29/2023] Open
Abstract
Overdose Good Samaritan laws (GSLs) aim to reduce mortality by providing limited legal protections when a bystander to a possible drug overdose summons help. Most research into the impact of these laws is dated or potentially confounded by coenacted naloxone access laws. Lack of awareness and trust in GSL protections, as well as fear of police involvement and legal repercussions, remain key deterrents to help-seeking. These barriers may be unequally distributed by race/ethnicity due to racist policing and drug policies, potentially producing racial/ethnic disparities in the effectiveness of GSLs for reducing overdose mortality. We used 2015-2019 vital statistics data to estimate the effect of recent GSLs on overdose mortality, overall (8 states) and by Black/White race/ethnicity (4 states). Given GSLs' near ubiquity, few unexposed states were available for comparison. Therefore, we generated an "inverted" synthetic control method (SCM) to compare overdose mortality in new-GSL states with that in states that had GSLs throughout the analytical period. The estimated relationships between GSLs and overdose mortality, both overall and stratified by Black/White race/ethnicity, were consistent with chance. An absence of effect could result from insufficient protection provided by the laws, insufficient awareness of them, and/or reticence to summon help not addressable by legal protections. The inverted SCM may be useful for evaluating other widespread policies.
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Affiliation(s)
| | | | | | | | | | | | | | - Magdalena Cerdá
- Correspondence to Dr. Magdalena Cerdá, Department of Population Health, Center for Opioid Epidemiology and Policy, 180 Madison Avenue, New York, NY 10016 (e-mail: )
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14
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Ray B, Hedden BJ, Carroll JJ, Del Pozo B, Wagner K, Kral AH, O'Donnell D, Victor G, Huynh P. Prevalence and correlates of incarceration following emergency medical services response to overdose. Drug Alcohol Depend 2022; 238:109571. [PMID: 35868181 DOI: 10.1016/j.drugalcdep.2022.109571] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/21/2022] [Accepted: 07/08/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND To describe the prevalence of incarceration among survivors of non-fatal overdose addressed through an emergency medical services (EMS) response, and compare incarceration by whether the emergency was for opioid-involved or stimulant-involved overdose. METHODS Administrative records on 192,113 EMS incidents and 70,409 jail booking events occurring between January 1, 2019 and December 31, 2020 in Indianapolis, Indiana were record-linked at the event level. Incarceration taking place within 6-hours of an EMS incident was associated with that incident. Logistic regression was used to calculate adjusted odds ratios (AOR) of incarceration after an overdose. RESULTS Among all EMS incidents, 2.6% were followed by incarceration. For overdose EMS incidents, the prevalence of incarceration was 10.0%. Overdose incidents had higher odds than non-overdose incidents of leading to a charge of felony, booked on a warrant, and transferred to another law enforcement agency upon release. Prevalence of incarceration following a stimulant-involved overdose was 21.3%, compared to 9.3% for opioid-involved overdose survivors. Compared to persons from other EMS incidents, overdose survivors had greater odds of incarceration (AOR=3.48, 95% confidence interval (CI)= 3.22, 3.75, p < .001), with opioid-involved overdoses (AOR=3.03, 95% CI=2.76, 3.33, p < .001) and stimulant-involved overdoses (AOR=6.70, 95% CI=5.26, 8.55, p < .001) leading to higher odds of incarceration. CONCLUSION Incarceration in county jail followed one in ten overdose-involved EMS responses. As illicit drug consumption increasingly involves stimulants, the frequency of incarceration following these events is likely to increase. Policy changes and interventions are needed to reduce incarceration after overdose emergencies.
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Affiliation(s)
- Bradley Ray
- RTI International, Division for Applied Justice Research, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA.
| | - Bethany J Hedden
- Center for Behavioral Health and Justice, Wayne State University, School of Social Work, 5447 Woodward Avenue, Detroit, MI 48202, USA
| | - Jennifer J Carroll
- North Carolina State University, Department of Sociology and Anthropology, 10 Current Drive, Suite 334, Raleigh, NC 27606-8017, USA
| | - Brandon Del Pozo
- The Warren Alpert School of Medicine of Brown University, 222 Richmond St, Providence, RI 02903, USA
| | - Karla Wagner
- University of Nevada, Reno, School of Public Health, 1644 N. Virginia St., Reno, NV 89557, USA
| | | | - Daniel O'Donnell
- Indiana University School of Medicine, Indianapolis Emergency Medical Services, 3930 Georgetown Rd., Indianapolis, IN 46254, USA
| | - Grant Victor
- Rutgers University, School of Social Work, 120 Albany St, New Brunswick, NJ 08901, USA
| | - Phil Huynh
- Center for Behavioral Health and Justice, Wayne State University, School of Social Work, 5447 Woodward Avenue, Detroit, MI 48202, USA
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15
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Xavier J, Greer A, Pauly B, Loyal J, Mamdani Z, Ackermann E, Barbic S, Buxton JA. "There are solutions and I think we're still working in the problem": The limitations of decriminalization under the good Samaritan drug overdose act and lessons from an evaluation in British Columbia, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 105:103714. [PMID: 35561485 DOI: 10.1016/j.drugpo.2022.103714] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/20/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Drug prohibition has been associated with increased risk of overdose. However, drug prohibition remains the dominant drug policy, including in Canada with the Controlled Drugs and Substances Act. In 2017, the Good Samaritan Drug Overdose Act (GSDOA) was enacted, to encourage people to contact emergency medical services by providing bystanders at the scene of an overdose with legal protection for simple possession and conditions related to simple possession. METHODS We conducted an evaluation of the GSDOA in British Columbia, Canada that included one-on-one interviews with people who use illicit drugs (PWUD), to determine peoples' experiences and perceptions surrounding this form of decriminalization. We present findings from a thematic analysis of 37 interviews. RESULTS We identified limitations of the GSDOA at overdose events; key themes and concerns causing PWUD to hesitate to or avoid contacting emergency medical services included drug confiscation, the thin line between simple possession and drug trafficking, and enforcement of other charges and court ordered conditions that are not legally protected by the GSDOA. Moreover, participants discussed the GSDOA as inequitable; benefiting some while excluding PWUD with intersecting marginalized identities. CONCLUSION Our findings are pertinent in light of many jurisdictions across the world considering dejure decriminalization, including BC and Vancouver. The GSDOA and associated limitations that emerged in our evaluation can serve to guide jurisdictions implementing or amending dejure decriminalization policies.
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Affiliation(s)
- Jessica Xavier
- British Columbia Center for Disease Control,655W 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Alissa Greer
- School of Criminology, Simon Fraser University,8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - Bernadette Pauly
- School of Nursing, University of Victoria, 3800 Finnerty Road, HSD Building, Victoria, BC V8P 5C2, Canada
| | - Jackson Loyal
- British Columbia Center for Disease Control,655W 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Zahra Mamdani
- British Columbia Center for Disease Control,655W 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Emma Ackermann
- British Columbia Center for Disease Control,655W 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Skye Barbic
- Occupational Science & Occupational Therapy, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z8, Canada; British Columbia Center for Disease Control,655W 12th Avenue, Vancouver, BC V5Z 4R4, Canada.
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16
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McLeod KE, Xavier J, Okhowat A, Williams S, Korchinski M, Young P, Papamihali K, Martin RE, Monaghan A, Sharifi N, Buxton JA. Knowledge of the Good Samaritan Drug Overdose Act and possession of a naloxone kit among people recently released from prison. Int J Prison Health 2022; 18:43-54. [PMID: 34633774 DOI: 10.1108/ijph-04-2021-0033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE This study aims to describe knowledge of Canada's Good Samaritan Drug Overdose Act (GSDOA) and take home naloxone (THN) training and kit possession among people being released from provincial correctional facilities in British Columbia. DESIGN/METHODOLOGY/APPROACH The authors conducted surveys with clients of the Unlocking the Gates Peer Health Mentoring program on their release. The authors compared the characteristics of people who had and had not heard of the GSDOA and who were in possession of a THN kit. FINDINGS In this study, 71% people had heard of the GSDOA, and 55.6% were in possession of a THN kit. This study found that 99% of people who had heard of the GSDOA indicated that they would call 911 if they saw an overdose. Among people who perceived themselves to be at risk of overdose, 28.3% did not have a THN kit. Only half (52%) of participants had a mobile phone, but 100% of those with a phone said they would call 911 if they witnessed an overdose. ORIGINALITY/VALUE The authors found that people with knowledge of the GSDOA were likely to report that they would call 911 for help with an overdose. Education about the GSDOA should be a standard component of naloxone training in correctional facilities. More than one in four people at risk of overdose were released without a naloxone kit, highlighting opportunities for training and distribution. Access to a cellphone is important in enabling calls to 911 and should be included in discharge planning.
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Affiliation(s)
- Katherine E McLeod
- School of Population and Public Health, The University of British Columbia, Vancouver, Canada
| | | | - Ali Okhowat
- Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | | | - Mo Korchinski
- School of Nursing, The University of British Columbia, Vancouver Canada and Unlocking the Gates Services Society, Maple Ridge, Canada
| | - Pamela Young
- School of Nursing, The University of British Columbia, Vancouver Canada and Unlocking the Gates Services Society, Maple Ridge, Canada
| | | | - Ruth Elwood Martin
- School of Population and Public Health, The University of British Columbia, Vancouver, Canada
| | - Angus Monaghan
- Correctional Health Services, Provincial Health Services Authority, Vancouver, Canada
| | - Nader Sharifi
- Correctional Health Services, Provincial Health Services Authority, Vancouver, Canada
| | - Jane A Buxton
- School of Population and Public Health, The University of British Columbia, Vancouver, Canada and BC Centre for Disease Control, Vancouver, Canada
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17
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Sabounchi NS, Heckmann R, D'Onofrio G, Walker J, Heimer R. Assessing the impact of the Good Samaritan Law in the state of Connecticut: a system dynamics approach. Health Res Policy Syst 2022; 20:5. [PMID: 34991591 PMCID: PMC8734429 DOI: 10.1186/s12961-021-00807-w] [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: 05/21/2021] [Accepted: 12/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although Good Samaritan laws (GSLs) have been widely adopted throughout the United States, their efficacy in individual states is often unknown. This paper offers an approach for assessing the impact of GSLs and insight for policy-makers and public health officials who wish to know whether they should expect to see outcomes from similar policy interventions. METHODS Utilizing a system dynamics (SD) modeling approach, the research team conducted a policy evaluation to determine the impact of GSLs on opioid use disorder (OUD) in Connecticut and evaluated the GSL based upon the following health outcomes: (1) emergency department (ED) visits for overdose, (2) behavioral changes of bystanders, and (3) overdose deaths. RESULTS The simulation model suggests that Connecticut's GSL has not yet affected overdose deaths but has resulted in bystander behavioral changes, such as increased 911 calls for overdose. ED visits have increased as the number of opioid users has increased. CONCLUSIONS The simulation results indicate that the number of opioid-related deaths will continue to increase and that the GSL alone cannot effectively control the crisis. However, the SD approach that was used will allow policymakers to evaluate the effectiveness of the GSL over time using a simulation framework. This SD model demonstrates great potential by producing simulations that allow policymakers to assess multiple strategies for combating the opioid crisis and select optimal public health interventions.
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Affiliation(s)
- Nasim S Sabounchi
- Department of Health Policy and Management, Center for Systems and Community Design, City University of New York (CUNY) Graduate School of Public Health and Health Policy, 55 W. 125th Street, New York, NY, 10027, United States of America.
| | - Rebekah Heckmann
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - Gail D'Onofrio
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - Jennifer Walker
- Binghamton University-State University of New York, Binghamton, NY, United States of America
| | - Robert Heimer
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, CT, United States of America
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18
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Andraka-Christou B, Nguyen T, Harris S, Atkins DN, Totaram R, Golan O, Koval A, Madeira J. Harm Reduction Policy Support among Students at Two U.S. Universities. Subst Use Misuse 2022; 57:1185-1195. [PMID: 35491710 DOI: 10.1080/10826084.2022.2069265] [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: 10/18/2022]
Abstract
Background: The U.S. is undergoing an opioid overdose crisis. Harm reduction (HR) policies are associated with decreased overdose deaths and incidence of communicable diseases, yet legality of HR policies differs across U.S. jurisdictions. College student perceptions of HR policies are underexplored, even though their voting behavior has increased in recent years. We sought to compare their support of different HR policies and to explore relationships between demographic characteristics and support for HR policies. Methods: We collected cross-sectional, convenience sample survey data from undergraduate students at two large public universities, one in the Midwest and one in the Southeast, during Fall 2018/Spring 2019. We analyzed data using descriptive statistics and logistic regressions. Results: The final sample included 1,263 respondents. Good Samaritan laws (n = 833, 66%) and naloxone distribution (n = 476, 37.7%) were most commonly supported, while heroin maintenance treatment (n = 232, 18.4%) and heroin decriminalization (n = 208, 16.5%) were least supported. Democrat/liberal or less religious/spiritual respondents supported HR policies more than their Republican/conservative or religious/spiritual counterparts. Midwestern students were more likely to support syringe services programs. Conclusion: HR education initiatives could target religious and/or Republican/conservative students, as they have lower HR support. Among HR policies, Good Samaritan policies may be easiest to pass in college communities.
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Affiliation(s)
- Barbara Andraka-Christou
- School of Global Health Management & Informatics, University of Central Florida, Orlando, Florida, USA.,Department of Internal Medicine, University of Central Florida (Secondary Joint Appointment), Orlando, Florida, USA
| | - Thuy Nguyen
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Shana Harris
- Department of Internal Medicine, University of Central Florida (Secondary Joint Appointment), Orlando, Florida, USA.,Department of Anthropology, University of Central Florida, Orlando, Florida, USA
| | - Danielle N Atkins
- School of Global Health Management & Informatics, University of Central Florida, Orlando, Florida, USA
| | - Rachel Totaram
- School of Global Health Management & Informatics, University of Central Florida, Orlando, Florida, USA
| | - Olivia Golan
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Andriy Koval
- School of Global Health Management & Informatics, University of Central Florida, Orlando, Florida, USA
| | - Jody Madeira
- Maurer School of Law, Indiana University-Bloomington, Bloomington, Indiana, USA
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van der Meulen E, Chu SKH. "The Law Doesn't Protect Me": Examining the Effectiveness of Good Samaritan Drug Overdose Legislation. Subst Use Misuse 2022; 57:1392-1399. [PMID: 35676857 DOI: 10.1080/10826084.2022.2083173] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: Amid an unprecedented overdose crisis in Canada, the federal government passed the Good Samaritan Drug Overdose Act, which provides immunity from simple drug possession charges to overdose witnesses who phone 911. The law was meant to address the barriers posed by police presence and to encourage bystanders to seek emergency supports. Objectives: Our goal was to examine the effectiveness of the Good Samaritan law from the perspective of people who use drugs. We wanted to find out how aware they were of the law's protections and limitations, if first responders were adhering to the legislation, and if it ultimately had an impact on bystanders' helpseeking behaviors. Methods: We engaged a participatory research process that included surveys and focus groups with 109 people who use drugs in Ontario, Canada. This article focuses on the qualitative findings from focus group with 40 individuals in three cities. Results: Our results reveal that people who use drugs are confused about the law's safeguards, and based on their negative experiences with police, do not trust police to uphold the letter or spirit of the legislation. As a result, many engage in strategies to avoid contact with law enforcement. Conclusions/Importance: Greater knowledge of the law is beneficial, but even with such knowledge, mistrust of police and fear of criminal charges continue to deter people from calling 911. Good Samaritan laws would be more effective if they included a broader range of protections beyond simple possession and if police did not routinely attend overdoses.
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Affiliation(s)
- Emily van der Meulen
- Toronto Metropolitan University, Department of Criminology, Toronto, Ontario, Canada
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20
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Moallef S, Choi J, Milloy MJ, DeBeck K, Kerr T, Hayashi K. A drug-related Good Samaritan Law and calling emergency medical services for drug overdoses in a Canadian setting. Harm Reduct J 2021; 18:91. [PMID: 34446026 PMCID: PMC8393452 DOI: 10.1186/s12954-021-00537-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 08/13/2021] [Indexed: 11/21/2022] Open
Abstract
Background People who use drugs (PWUD) are known to fear calling emergency medical services (EMS) for drug overdoses. In response, drug-related Good Samaritan Laws (GSLs) have been widely adopted in the USA and Canada to encourage bystanders to call emergency medical services (EMS) in the event of a drug overdose. However, the effect of GSLs on EMS-calling behaviours has been understudied. We sought to identify factors associated with EMS-calling, including the enactment of the Canadian GSL in May 2017, among PWUD in Vancouver, Canada, a setting with an ongoing overdose crisis. Methods Data were derived from three prospective cohort studies of PWUD in Vancouver in 2014–2018. Multivariable logistic regression was used to determine factors associated with EMS-calling among PWUD who witnessed an overdose event. An interrupted time series (ITS) analysis was employed to assess the impact of GSL on monthly prevalence of EMS-calling. Results Among 540 eligible participants, 321 (59%) were males and 284 (53%) reported calling EMS. In multivariable analysis, ever having administered naloxone three or more times (adjusted odds ratio [AOR] 2.00; 95% confidence interval [CI] 1.08–3.74) and residence in the Downtown Eastside (DTES) neighbourhood of Vancouver (AOR 1.96; 95% CI 1.23–3.13) were positively associated with EMS-calling, while living in a single occupancy hotel (SRO) was negatively associated with EMS-calling (AOR 0.51; 95% CI 0.30–0.86). The post-GSL enactment period was not associated with EMS-calling (AOR 0.81; 95% CI 0.52–1.25). The ITS found no significant difference in the monthly prevalence of EMS-calling between pre- and post-GSL enactment periods. Conclusion We observed EMS being called about half the time and the GSL did not appear to encourage EMS-calling. We also found that individuals living in SROs were less likely to call EMS, which raises concern given that fatal overdose cases are concentrated in SROs in our setting. The link between many naloxone administrations and EMS-calling could indicate that those with prior experience in responding to overdose events were more willing to call EMS. Increased efforts are warranted to ensure effective emergency responses for drug overdoses among PWUD. Supplementary Information The online version contains supplementary material available at 10.1186/s12954-021-00537-w.
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Affiliation(s)
- Soroush Moallef
- Faculty of Health Sciences, Simon Fraser University, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.,British Columbia Centre On Substance Use, St. Paul's Hospital, Vancouver, BC, Canada
| | - JinCheol Choi
- British Columbia Centre On Substance Use, St. Paul's Hospital, Vancouver, BC, Canada
| | - M-J Milloy
- British Columbia Centre On Substance Use, St. Paul's Hospital, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kora DeBeck
- British Columbia Centre On Substance Use, St. Paul's Hospital, Vancouver, BC, Canada.,School of Public Policy, Simon Fraser University, Burnaby, BC, Canada
| | - Thomas Kerr
- British Columbia Centre On Substance Use, St. Paul's Hospital, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kanna Hayashi
- Faculty of Health Sciences, Simon Fraser University, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada. .,British Columbia Centre On Substance Use, St. Paul's Hospital, Vancouver, BC, Canada.
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21
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Watson DP, Weathers T, McGuire A, Cohen A, Huynh P, Bowes C, O’Donnell D, Brucker K, Gupta S. Evaluation of an emergency department-based opioid overdose survivor intervention: Difference-in-difference analysis of electronic health record data to assess key outcomes. Drug Alcohol Depend 2021; 221:108595. [PMID: 33610095 PMCID: PMC8026710 DOI: 10.1016/j.drugalcdep.2021.108595] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND In recent years, a number of emergency department (ED)-based interventions have been developed to provide supports and/or treatment linkage for people who use opioids. However, there is limited research supporting the effectiveness of the majority of these interventions. Project POINT is an ED-based intervention aimed at providing opioid overdose survivors with naloxone and recovery supports and connecting them to evidence-based medications for opioid use disorder (MOUD). An evaluation of POINT was conducted. METHODS A difference-in-difference analysis of electronic health record data was completed to understand the difference in outcomes for patients admitted to the ED when a POINT staff member was working versus times when they were not. The observation window was January 1, 2012 to July 6, 2019, which included N = 1462 unique individuals, of which 802 were in the POINT arm. Outcomes of focus include MOUD opioid prescriptions dispensed, active non-MOUD opioid prescriptions dispensed, naloxone access, and drug poisonings. RESULTS The POINT arm had a significant increase in MOUD prescriptions dispensed, non-MOUD prescriptions dispensed, and naloxone access (all p-values < 0.001). There was no significant effect related to subsequent drug poisoning-related hospital admissions. CONCLUSIONS The results support the assertion that POINT is meeting its two primary goals related to increasing naloxone access and connecting patients to MOUD. Generalization of these results is limited; however, the evaluation contributes to a nascent area of research and can serve a foundation for future work.
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Affiliation(s)
- Dennis P. Watson
- Chestnut Health Systems, Lighthouse Institute, 221 W. Walton St., Chicago, IL 60610
| | - Tess Weathers
- Indiana University Richard M. Fairbanks School of Public Health, Department of Social and Behavioral Sciences, 1050 Wishard Blvd., Indianapolis, IN, 46202, United States.
| | - Alan McGuire
- Richard L. Roudebush VAMC, Health Services Research and Development, 1481 W. 10th St (11H) Rm. C8108, Indianapolis, IN, 46202, United States; Indiana University Purdue University Indianapolis, Department of Psychology, 402 N. Blackford St., Indianapolis, IN, 46202, United States.
| | - Alex Cohen
- GiveWell, 1714 Franklin Street, Oakland, CA, 94612, United States.
| | - Philip Huynh
- Wayne State University, School of Social Work, Center for Behavioral Health and Justice, 5201 Cass Avenue Suite 226, Detroit, MI, 48202, United States.
| | - Clay Bowes
- Indiana University School of Medicine, 340 W. 10th St., Indianapolis, IN, 46202, United States.
| | - Daniel O’Donnell
- Indiana University School of Medicine, Department of Emergency Medicine, 720 Eskenazi Ave., Indianapolis, IN 46202
| | | | - Sumedha Gupta
- Department of Economics, Indiana University Purdue University Indianapolis, United States.
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22
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Bauer C, Champagne-Langabeer T, Bakos-Block C, Zhang K, Persse D, Langabeer JR. Patterns and risk factors of opioid-suspected EMS overdose in Houston metropolitan area, 2015-2019: A Bayesian spatiotemporal analysis. PLoS One 2021; 16:e0247050. [PMID: 33705402 PMCID: PMC7951926 DOI: 10.1371/journal.pone.0247050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 01/29/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Opioid-related overdose deaths are the top accidental cause of death in the United States, and development of regional strategies to address this epidemic should begin with a better understanding of where and when overdoses are occurring. METHODS AND FINDINGS In this study, we relied on emergency medical services data to investigate the geographical and temporal patterns in opioid-suspected overdose incidents in one of the largest and most ethnically diverse metropolitan areas (Houston Texas). Using a cross sectional design and Bayesian spatiotemporal models, we identified zip code areas with excessive opioid-suspected incidents, and assessed how the incidence risks were associated with zip code level socioeconomic characteristics. Our analysis suggested that opioid-suspected overdose incidents were particularly high in multiple zip codes, primarily south and central within the city. Zip codes with high percentage of renters had higher overdose relative risk (RR = 1.03; 95% CI: [1.01, 1.04]), while crowded housing and larger proportion of white citizens had lower relative risks (RR = 0.9; 95% CI: [0.84, 0.96], RR = 0.97, 95% CI: [0.95, 0.99], respectively). CONCLUSIONS Our analysis illustrated the utility of Bayesian spatiotemporal models in assisting the development of targeted community strategies for local prevention and harm reduction efforts.
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Affiliation(s)
- Cici Bauer
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
- * E-mail:
| | - Tiffany Champagne-Langabeer
- ACE Research Lab, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Christine Bakos-Block
- ACE Research Lab, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Kehe Zhang
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - David Persse
- Office of Emergency Medical Services, City of Houston Fire Department, Houston, Texas, United States of America
| | - James R. Langabeer
- ACE Research Lab, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
- Department of Emergency Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
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23
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Moallef S, DeBeck K, Milloy MJ, Somers J, Kerr T, Hayashi K. Knowledge of a Drug-Related Good Samaritan Law Among People Who Use Drugs, Vancouver, Canada. HEALTH EDUCATION & BEHAVIOR 2021; 49:629-638. [PMID: 33660550 PMCID: PMC8812464 DOI: 10.1177/1090198121999303] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Across the United States and Canada drug-related Good Samaritan laws (GSLs) have been enacted to encourage observers of acute drug overdose events to contact emergency medical services (EMS) without fear of legal repercussions. However, little is known about the working knowledge of GSLs among people who use illicit drugs (PWUD). We sought to evaluate the prevalence and factors associated with accurate knowledge of a GSL among PWUD in Vancouver, Canada, 1 year after the GSL was enacted. METHOD We used data from participants in three community-recruited prospective cohort studies of PWUD interviewed between June and November 2018. Multivariable logistic regression was used to identify factors associated with accurate knowledge of the GSL. RESULTS Among 1,258 participants, including 760 males (60%), 358 (28%) had accurate knowledge of the GSL. In multivariable analyses, participants who reported ever having a negative police encounter (defined as being stopped, searched, or detained by the police) were less likely to have accurate knowledge of the GSL (adjusted odds ratio [AOR] = 0.70; 95% CI [0.54, 0.90]), while those involved in drug dealing were more likely to have accurate knowledge of the GSL (AOR = 1.50; 95% CI [1.06, 2.06]). DISCUSSION Despite having been enacted for a full year, approximately three quarters of participants did not have accurate GSL knowledge, warranting urgent educational efforts among PWUD. Additional research is needed to understand whether GSLs can mitigate the fears of legal repercussions among those engaged in drug dealing and with past negative experiences with the police.
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Affiliation(s)
- Soroush Moallef
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, British Columbia, Canada.,Simon Fraser University, Burnaby, British Columbia, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, British Columbia, Canada.,Simon Fraser University, Burnaby, British Columbia, Canada
| | - M J Milloy
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
| | - Julian Somers
- Simon Fraser University, Burnaby, British Columbia, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, British Columbia, Canada.,Simon Fraser University, Burnaby, British Columbia, Canada
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24
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Grella CE, Ostlie E, Scott CK, Dennis ML, Carnevale J, Watson DP. A scoping review of factors that influence opioid overdose prevention for justice-involved populations. Subst Abuse Treat Prev Policy 2021; 16:19. [PMID: 33618744 PMCID: PMC7898779 DOI: 10.1186/s13011-021-00346-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There is a high risk of death from opioid overdose following release from prison. Efforts to develop and implement overdose prevention programs for justice-involved populations have increased in recent years. An understanding of the gaps in knowledge on prevention interventions is needed to accelerate development, implementation, and dissemination of effective strategies. METHODS A systematic search process identified 43 published papers addressing opioid overdose prevention in criminal justice settings or among justice-involved populations from 2010 to February 2020. Cross-cutting themes were identified, coded and qualitatively analyzed. RESULTS Papers were coded into five categories: acceptability (n = 8), accessibility (n = 4), effectiveness (n = 5), feasibility (n = 7), and participant overdose risk (n = 19). Common themes were: (1) Acceptability of naloxone is associated with injection drug use, overdose history, and perceived risk within the situational context; (2) Accessibility of naloxone is a function of the interface between corrections and community; (3) Evaluations of overdose prevention interventions are few, but generally show increases in knowledge or reductions in opioid overdose; (4) Coordinated efforts are needed to implement prevention interventions, address logistical challenges, and develop linkages between corrections and community providers; (5) Overdose is highest immediately following release from prison or jail, often preceded by service-system interactions, and associated with drug-use severity, injection use, and mental health disorders, as well as risks in the post-release environment. CONCLUSION Study findings can inform the development of overdose prevention interventions that target justice-involved individuals and policies to support their implementation across criminal justice and community-based service systems.
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Affiliation(s)
| | - Erika Ostlie
- Carnevale Associates LLC, 4 Belinder Rd, Gaithersburg, MD 20878 USA
| | - Christy K. Scott
- Chestnut Health Systems, 221 W. Walton St, Chicago, IL 60610 USA
| | | | - John Carnevale
- Carnevale Associates LLC, 4 Belinder Rd, Gaithersburg, MD 20878 USA
| | - Dennis P. Watson
- Chestnut Health Systems, 221 W. Walton St, Chicago, IL 60610 USA
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25
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Jones CM, Bekheet F, Park JN, Alexander GC. The Evolving Overdose Epidemic: Synthetic Opioids and Rising Stimulant-Related Harms. Epidemiol Rev 2020; 42:154-166. [PMID: 33511987 DOI: 10.1093/epirev/mxaa011] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 10/18/2020] [Accepted: 10/26/2020] [Indexed: 12/18/2022] Open
Abstract
The opioid overdose epidemic is typically described as having occurred in 3 waves, with morbidity and mortality accruing over time principally from prescription opioids (1999-2010), heroin (2011-2013), and illicit fentanyl and other synthetic opioids (2014-present). However, the increasing presence of synthetic opioids mixed into the illicit drug supply, including with stimulants such as cocaine and methamphetamine, as well as rising stimulant-related deaths, reflects the rapidly evolving nature of the overdose epidemic, posing urgent and novel public health challenges. We synthesize the evidence underlying these trends, consider key questions such as where and how concomitant exposure to fentanyl and stimulants is occurring, and identify actions for key stakeholders regarding how these emerging threats, and continued evolution of the overdose epidemic, can best be addressed.
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26
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You HS, Ha J, Kang CY, Kim L, Kim J, Shen JJ, Park SM, Chun SY, Hwang J, Yamashita T, Lee SW, Dounis G, Lee YJ, Han DH, Byun D, Yoo JW, Kang HT. Regional variation in states' naloxone accessibility laws in association with opioid overdose death rates-Observational study (STROBE compliant). Medicine (Baltimore) 2020; 99:e20033. [PMID: 32481373 DOI: 10.1097/md.0000000000020033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Though overall death from opioid overdose are increasing in the United States, the death rate in some states and population groups is stabilizing or even decreasing. Several states have enacted a Naloxone Accessibility Laws to increase naloxone availability as an opioid antidote. The extent to which these laws permit layperson distribution and possession varies. The aim of this study is to investigate differences in provisions of Naloxone Accessibility Laws by states mainly in the Northeast and West regions, and the impact of naloxone availability on the rates of drug overdose deaths.This cross-sectional study was based on the National Vital Statistics System multiple cause-of-death mortality files. The average changes in drug overdose death rates between 2013 and 2017 in relevant states of the Northeast and West regions were compared according to availability of naloxone to laypersons.Seven states in the Northeast region and 10 states in the Western region allowed layperson distribution of naloxone. Layperson possession of naloxone was allowed in 3 states each in the Northeast and the Western regions. The average drug overdose death rates increased in many states in the both regions regardless of legalization of layperson naloxone distribution. The average death rates of 3 states that legalized layperson possession in the West region decreased (-0.33 per 100,000 person); however, in states in the West region that did not allow layperson possession and states in the Northeast region regardless of layperson possession increased between 2013 and 2017.The provision to legalize layperson possession of naloxone was associated with decreased average opioid overdose death rates in 3 states of the West region.
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Affiliation(s)
- Hyo-Sun You
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Chungbuk
| | - Jane Ha
- Department of Medicine, Korea University College of Medicine, Seoul, Korea
| | | | | | | | - Jay J Shen
- Department of Health Care Administration and Policy, School of Public Health
| | - Seong-Min Park
- Department of Criminal Justice, Greenspun College of Urban Affairs, University of Nevada Las Vegas, Nevada
| | | | - Jinwook Hwang
- Department of Thoracic and Cardiovascular Surgery, Korea University College of Medicine
| | - Takashi Yamashita
- Department of Sociology, Anthropology, and Health Administration and Policy, University of Maryland Baltimore County, Baltimore, Maryland
| | - Se Won Lee
- Department of Physical Medicine and Rehabilitation, Mountain View Hospital
| | - Georgia Dounis
- School of Dental Medicine, University of Nevada Las Vegas, Las Vegas, Nevada
| | - Yong-Jae Lee
- Department of Family Medicine, Yonsei University College of Medicine
| | - Dong-Hun Han
- Department of Health Care Administration and Policy, School of Public Health
- Deparment of Preventive Dentistry, School of Dentistry, Seoul National University, Seoul, Korea
| | - David Byun
- Department of Medicine, Southern Nevada Veterans Affairs Health System, North Las Vegas, Nevada
| | - Ji Won Yoo
- Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, 1701 W. Charleston Blvd Ste 230, Las Vegas, NV
| | - Hee-Taik Kang
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Chungbuk
- Department of Health Care Administration and Policy, School of Public Health
- Department of Medicine, Chungbuk National University College of Medicine, Cheongju, Chungbuk, Korea
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27
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The effectiveness of drug-related Good Samaritan laws: A review of the literature. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 90:102773. [PMID: 32467017 DOI: 10.1016/j.drugpo.2020.102773] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/30/2019] [Accepted: 04/18/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND The United States (US) and Canada are in the midst of an opioid overdose epidemic. Many people who use illicit drugs (PWUD) do not call an emergency number 911 at the scene of an overdose due to fear of arrest. In the US and Canada, when an individual calls 911, both emergency medical services (EMS) and police are notified to attend the overdose event. In response, many settings in North America have introduced drug-related 'Good Samaritan' laws (GSLs) that aim to encourage PWUD to call 911 by providing legal immunity (mainly protections from drugs possessed for personal use) to those at the scene of the overdose. However, little is known about the effectiveness of these laws in increasing calls to 911. METHODS We conducted a literature review of the published literature between 2005 and 2019 to examine the effectiveness of GSLs. Searches were referenced using keywords that included: "good samaritan", "overdose", "emergency services", and "drug use". RESULTS Among 68 articles identified, after eligibility screening, 12 publications were deemed to meet the inclusion criteria. These publications were largely quantitative observational studies (9/12), with a minority (3/12) being qualitative in design. Two major themes emerged: "knowledge of GSLs and calling EMS" and "overdose-related hospital admissions and mortality assessment". CONCLUSION At this time, the current body of evidence regarding the effectiveness of GSLs in increasing calls to EMS and reducing drug-related harms is limited and mixed. Studies show that PWUD have low levels of knowledge regarding GSLs while some evidence suggests their effectiveness in increasing calls to EMS at the scene of an overdose. Given the current overdose crisis, further investigation is warranted to establish the effectiveness of these laws in reducing drug-related harms.
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28
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Schneider KE, Park JN, Allen ST, Weir BW, Sherman SG. Knowledge of Good Samaritan Laws and Beliefs About Arrests Among Persons Who Inject Drugs a Year After Policy Change in Baltimore, Maryland. Public Health Rep 2020; 135:393-400. [PMID: 32264789 PMCID: PMC7238711 DOI: 10.1177/0033354920915439] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Delivering and receiving prompt medical care during an overdose are imperative to ensure survival. Good Samaritan laws encourage people to call 911 during an overdose by providing immunity from selected drug arrests (eg, low-level possession). However, it is unclear whether persons who inject drugs (PWID) are aware of and understand these laws and their implications. We examined awareness among PWID of the 2015 Good Samaritan law in Maryland and their beliefs about whether they could be arrested for calling 911 or having an overdose. METHODS We surveyed 298 PWID in Baltimore, Maryland. We estimated the proportion who knew what the Good Samaritan law addressed and who believed they could be arrested for calling 911 or overdosing. We used a multivariate model to assess the association between harm-reduction services and knowledge of the Good Samaritan law or beliefs about getting arrested for calling 911 or overdosing. RESULTS Of PWID, 56 of 298 (18.8%) knew what the Good Samaritan law addressed, 43 of 267 (16.1%) believed they could be arrested for calling 911, and 32 of 272 (11.8%) believed they could be arrested for having an overdose. After adjusting for demographic characteristics, accessing the syringe services program was associated with accurate knowledge and the belief that PWID could be arrested for calling 911; however, training in overdose reversal was not associated. CONCLUSIONS Most PWID were unaware of the Good Samaritan law; this lack of awareness is a barrier to preventing overdose deaths. Educating PWID about Good Samaritan laws is essential, and such education should include police to ensure that law enforcement is congruent with Good Samaritan laws and does not perpetuate mistrust between police and PWID.
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Affiliation(s)
- Kristin E. Schneider
- Department of Mental Health, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD, USA
| | - Ju Nyeong Park
- Department of Health, Behavior and Society, Johns Hopkins
Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sean T. Allen
- Department of Health, Behavior and Society, Johns Hopkins
Bloomberg School of Public Health, Baltimore, MD, USA
| | - Brian W. Weir
- Department of Health, Behavior and Society, Johns Hopkins
Bloomberg School of Public Health, Baltimore, MD, USA
| | - Susan G. Sherman
- Department of Health, Behavior and Society, Johns Hopkins
Bloomberg School of Public Health, Baltimore, MD, USA
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29
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Neale J, Brown C, Campbell ANC, Jones JD, Metz VE, Strang J, Comer SD. How competent are people who use opioids at responding to overdoses? Qualitative analyses of actions and decisions taken during overdose emergencies. Addiction 2019; 114:708-718. [PMID: 30476356 PMCID: PMC6411430 DOI: 10.1111/add.14510] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/29/2018] [Accepted: 11/21/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Providing take-home naloxone (THN) to people who use opioids is an increasingly common strategy for reversing opioid overdose. However, implementation is hindered by doubts regarding the ability of people who use opioids to administer naloxone and respond appropriately to overdoses. We aimed to increase understanding of the competencies required and demonstrated by opioid users who had recently participated in a THN programme and were subsequently confronted with an overdose emergency. DESIGN Qualitative study designed to supplement findings from a randomized controlled trial of overdose education and naloxone distribution. Interviews were audio-recorded, transcribed, systematically coded and analysed via Iterative Categorization. SETTING New York City, USA. PARTICIPANTS Thirty-nine people who used opioids (32 men, 7 women; aged 22-58 years). INTERVENTION Trial participants received brief or extended overdose training and injectable or nasal naloxone. MEASUREMENTS The systematic coding frame comprised deductive codes based on the topic guide and more inductive codes emerging from the data. FINDINGS In 38 of 39 cases the victim was successfully resuscitated; the outcome of one overdose intervention was unknown. Analyses revealed five core overdose response 'tasks': (1) overdose identification; (2) mobilizing support; (3) following basic first aid instructions; (4) naloxone administration; and (5) post-resuscitation management. These tasks comprised actions and decisions that were themselves affected by diverse cognitive, emotional, experiential, interpersonal and social factors over which lay responders often had little control. Despite this, participants demonstrated high levels of competency. They had acquired new skills and knowledge through training and brought critical 'insider' understanding to overdose events and the resuscitation actions which they applied. CONCLUSIONS People who use opioids can be trained to respond appropriately to opioid overdoses and thus to save their peers' lives. Overdose response requires both practical competency (e.g. skills and knowledge in administering basic first aid and naloxone) and social competency (e.g. willingness to help others, having the confidence to be authoritative and make decisions, communicating effectively and demonstrating compassion and care to victims post-resuscitation).
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Affiliation(s)
- Joanne Neale
- National Addiction Centre, King's College London, London, UK
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Caral Brown
- National Addiction Centre, King's College London, London, UK
| | - Aimee N C Campbell
- Division on Substance Use Disorders, Columbia University Medical Center and New York State Psychiatric Institute, New York, USA
| | - Jermaine D Jones
- Division on Substance Use Disorders, Columbia University Medical Center and New York State Psychiatric Institute, New York, USA
| | - Verena E Metz
- Division on Substance Use Disorders, Columbia University Medical Center and New York State Psychiatric Institute, New York, USA
| | - John Strang
- National Addiction Centre, King's College London, London, UK
| | - Sandra D Comer
- Division on Substance Use Disorders, Columbia University Medical Center and New York State Psychiatric Institute, New York, USA
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