1
|
Hughto JMW, Kelly PJA, Vento SA, Pletta DR, Noh M, Silcox J, Rich JD, Green TC. Characterizing and responding to stimulant overdoses: Findings from a mixed methods study of people who use cocaine and other stimulants in New England. Drug Alcohol Depend 2025; 266:112501. [PMID: 39608288 DOI: 10.1016/j.drugalcdep.2024.112501] [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: 07/31/2024] [Revised: 10/04/2024] [Accepted: 11/05/2024] [Indexed: 11/30/2024]
Abstract
PURPOSE To explore people who use stimulants' (PWUS) stimulant overdose experiences and identify factors associated with calling 911 for personal and witnessed stimulant overdoses. METHODS From 2022-2023, 222 people in Massachusetts and Rhode Island with past-30-day illicit stimulant use were surveyed. Adjusted multivariable logistic regression models examined the association between sociodemographics, substance use, and stimulant overdose history and whether 911 was called for participants' last personally experienced and witnessed stimulant overdoses. RESULTS Overall, 42.2 % of PWUS witnessed- and 34.5 % personally overdosed on stimulants. Nearly half (48.7 %) of participants who overdosed used crack cocaine prior, 35.5 % reported extremely severe symptoms (e.g., heart attack, stroke, seizure, loss of consciousness), and 34.2 % said 911 was called at their last overdose. Among those who last witnessed a stimulant overdose, 41.5 % reported crack cocaine involvement, and 47.9 % said 911 was called (20.0 % personally called). Higher educational attainment and experiencing extremely severe symptoms were positively associated with 911 being called at participants' last stimulant overdose, whereas the number of overdoses witnessed and crack cocaine use by the person overdosing were negatively associated with 911 being called at participants' last witnessed stimulant overdose (all p-values<.05). CONCLUSION Stimulant overdoses were common. Most participants reported moderate-to-severe symptoms, yet 911 was called in less than half of personal or witnessed stimulant overdoses. Emergency help-seeking also varied by symptom severity, stimulant type, and the sociodemographics of the person overdosing. Research is needed to understand barriers to formal help-seeking and the practices PWUS engage in to prevent fatal stimulant overdoses.
Collapse
Affiliation(s)
- Jaclyn M W Hughto
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912, USA; Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912, USA; Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912, USA; Center of Biomedical Research Excellence on Opioids and Overdose, Rhode Island Hospital, 1125 North Main Street, Providence, RI 02903, USA.
| | - Patrick J A Kelly
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912, USA.
| | - Stephanie A Vento
- Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912, USA.
| | - David R Pletta
- Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912, USA.
| | - Madeline Noh
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912, USA; Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912, USA.
| | - Joseph Silcox
- Brandeis University Opioid Policy Research Collaborative, 415 South Street, Waltham, MA, USA; University of Massachusetts - Boston, 100 Morrissey Boulevard, Boston, MA 02125, USA.
| | - Josiah D Rich
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912, USA; Center of Biomedical Research Excellence on Opioids and Overdose, Rhode Island Hospital, 1125 North Main Street, Providence, RI 02903, USA; The Warren Alpert School of Medicine of Brown University, 222 Richmond Street, Providence, RI 02912, USA.
| | - Traci C Green
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912, USA; Center of Biomedical Research Excellence on Opioids and Overdose, Rhode Island Hospital, 1125 North Main Street, Providence, RI 02903, USA; The Warren Alpert School of Medicine of Brown University, 222 Richmond Street, Providence, RI 02912, USA; Brandeis University Opioid Policy Research Collaborative, 415 South Street, Waltham, MA, USA.
| |
Collapse
|
2
|
Thompson RL, Sabounchi NS, Ali SS, Heimer R, D'Onofrio G, Heckmann R. Using qualitative system dynamics modeling to understand overdose bystander behavior in the context of Connecticut's Good Samaritan Laws and identify effective policy options. Harm Reduct J 2024; 21:124. [PMID: 38937759 PMCID: PMC11210010 DOI: 10.1186/s12954-024-00990-3] [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: 11/30/2023] [Accepted: 03/22/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Good Samaritan Laws are a harm reduction policy intended to facilitate a reduction in fatal opioid overdoses by enabling bystanders, first responders, and health care providers to assist individuals experiencing an overdose without facing civil or criminal liability. However, Good Samaritan Laws may not be reaching their full impact in many communities due to a lack of knowledge of protections under these laws, distrust in law enforcement, and fear of legal consequences among potential bystanders. The purpose of this study was to develop a systems-level understanding of the factors influencing bystander responses to opioid overdose in the context of Connecticut's Good Samaritan Laws and identify high-leverage policies for improving opioid-related outcomes and implementation of these laws in Connecticut (CT). METHODS We conducted six group model building (GMB) workshops that engaged a diverse set of participants with medical and community expertise and lived bystander experience. Through an iterative, stakeholder-engaged process, we developed, refined, and validated a qualitative system dynamics (SD) model in the form of a causal loop diagram (CLD). RESULTS Our resulting qualitative SD model captures our GMB participants' collective understanding of the dynamics driving bystander behavior and other factors influencing the effectiveness of Good Samaritan Laws in the state of CT. In this model, we identified seven balancing (B) and eight reinforcing (R) feedback loops within four narrative domains: Narrative 1 - Overdose, Calling 911, and First Responder Burnout; Narrative 2 - Naloxone Use, Acceptability, and Linking Patients to Services; Narrative 3 - Drug Arrests, Belief in Good Samaritan Laws, and Community Trust in Police; and Narrative 4 - Bystander Naloxone Use, Community Participation in Harm Reduction, and Cultural Change Towards Carrying Naloxone. CONCLUSIONS Our qualitative SD model brings a nuanced systems perspective to the literature on bystander behavior in the context of Good Samaritan Laws. Our model, grounded in local knowledge and experience, shows how the hypothesized non-linear interdependencies of the social, structural, and policy determinants of bystander behavior collectively form endogenous feedback loops that can be leveraged to design policies to advance and sustain systems change.
Collapse
Affiliation(s)
- Rachel L Thompson
- Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, 55 West 125th Street, New York, NY, 10027, USA
| | - Nasim S Sabounchi
- Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, 55 West 125th Street, New York, NY, 10027, USA
- Department of Health Policy and Management, City University of New York Graduate School of Public Health and Health Policy, 55 West 125th Street, New York, NY, 10027, USA
| | - Syed Shayan Ali
- University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Robert Heimer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, 60 College Street, New Haven, CT, 06520, USA
- Center for Interdisciplinary Research on AIDS at Yale, 135 College St., Suite 200, New Haven, CT, 06520, USA
| | - Gail D'Onofrio
- Department of Emergency Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 065108, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520, USA
| | - Rebekah Heckmann
- Department of Emergency Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 065108, USA.
| |
Collapse
|
3
|
Seo B, Rider N, Rioux W, Teare A, Jones S, Taplay P, Monty Ghosh S. Understanding the barriers and facilitators to implementing and sustaining Mobile Overdose Response Services from the perspective of Canadian key interest groups: a qualitative study. Harm Reduct J 2024; 21:28. [PMID: 38308262 PMCID: PMC10837862 DOI: 10.1186/s12954-024-00946-7] [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: 11/23/2023] [Accepted: 01/25/2024] [Indexed: 02/04/2024] Open
Abstract
INTRODUCTION Unregulated supply of fentanyl and adulterants continues to drive the overdose crisis. Mobile Overdose Response Services (MORS) are novel technologies that offer virtual supervised consumption to minimize the risk of fatal overdose for those who are unable to access other forms of harm reduction. However, as newly implemented services, they are also faced with numerous limitations. The aim of this study was to examine the facilitators and barriers to the adoption of MORS in Canada. METHODS A total of 64 semi-structured interviews were conducted between November 2021 and April 2022. Participants consisted of people who use substances (PWUS), family members of PWUS, health care professionals, harm reduction workers, MORS operators, and members of the general public. Inductive thematic analysis was used to identify the major themes and subthemes. RESULTS Respondents revealed that MORS facilitated a safe, anonymous, and nonjudgmental environment for PWUS to seek harm reduction and other necessary support. It also created a new sense of purpose for operators to positively contribute to the community. Further advertising and promotional efforts were deemed important to increase its awareness. However, barriers to MORS implementation included concerns regarding privacy/confidentiality, uncertainty of funding, and compassion fatigue among the operators. CONCLUSION Although MORS were generally viewed as a useful addition to the currently existing harm reduction services, it's important to monitor and tackle these barriers by engaging the perspectives of key interest groups.
Collapse
Affiliation(s)
- Boogyung Seo
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Nathan Rider
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - William Rioux
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Adrian Teare
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | | | | | - S Monty Ghosh
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
- Department of Internal Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
| |
Collapse
|
4
|
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.
Collapse
|
5
|
Bolster J, Pithia P, Batt AM. Emerging Concepts in the Paramedicine Literature to Inform the Revision of a Pan-Canadian Competency Framework for Paramedics: A Restricted Review. Cureus 2022; 14:e32864. [PMID: 36699791 PMCID: PMC9870303 DOI: 10.7759/cureus.32864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 12/24/2022] Open
Abstract
The National Occupational Competency Profile (NOCP)-the competency framework for paramedics in Canada-is presently undergoing revision. Since the NOCP was published in 2011, paramedic practice, healthcare, and society have changed dramatically. To inform the revision, we sought to identify emerging concepts in the literature that would inform the development of competencies for paramedics. We conducted a restricted literature review and content analysis of all published and grey literature pertaining to or informing Canadian paramedicine from 2011 to 2022. Three authors performed a title, abstract, and full-text review to identify and label concepts informed by existing findings. A total of 302 articles were categorized into 11 emerging concepts related to competencies: inclusion, diversity, equity, and accessibility (IDEA) in paramedicine; social responsiveness, justice, equity, and access; anti-racism; healthy professionals; evidence-informed practice and systems; complex adaptive systems; learning environment; virtual care; clinical reasoning; adaptive expertise; and planetary health. This review identified emerging concepts to inform the development of the 2023 National Occupational Standard for Paramedics (NOSP). These concepts will inform data analysis, the development of group discussions, and competency identification.
Collapse
Affiliation(s)
- Jennifer Bolster
- Paramedicine, Monash University, Melbourne, AUS
- Clinical Governance and Professional Practice, British Columbia Emergency Health Services, Vancouver, CAN
- Centre for Research and Innovation, Fanshawe College, London, CAN
| | - Priya Pithia
- Centre for Research and Innovation, Fanshawe College, London, CAN
| | - Alan M Batt
- Paramedicine, Monash University, Melbourne, AUS
- Centre for Research and Innovation, Fanshawe College, London, CAN
| |
Collapse
|
6
|
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.
Collapse
|
7
|
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.
Collapse
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.
| |
Collapse
|