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van Draanen J, Adwell A, Wettemann C, Fockele CE, Goh B, Perlmutter DL, Williams GW, Holland N, Frohe T. "You might be nice, but where you take me, they're not gonna be": Preferences for field-based post-overdose interventions. Drug Alcohol Rev 2024. [PMID: 39205432 DOI: 10.1111/dar.13926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 07/17/2024] [Accepted: 07/18/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION Emergency medical services (EMS) systems are piloting interventions to respond to overdoses with additional services such as leave-behind naloxone and medication for opioid use disorder, but little is known about the perspectives of people who use drugs (PWUD) on these interventions being delivered by EMS during an overdose response. METHODS The Consolidated Framework for Implementation Research guided the development of data collection tools, the analytic strategy and the organisation of results. A community engaged method was used which included both academically trained researchers and community trained researchers who are also PWUD. This study used semi-structured interviews to gather data from 13 PWUD in King County, Washington in June 2022. Data were analysed using thematic analysis. RESULTS The people interviewed for this study viewed EMS distribution of leave-behind naloxone and field-based buprenorphine favourably. They viewed EMS facilitation of hepatitis C virus and HIV testing in the field less favourably and were concerned about stigmas associated with those results. Additional themes emerged regarding: the need for different approaches to post-overdose care; the need for new services, including post-overdose trauma counselling and an alternative destination to the emergency department; and the harms of law enforcement presence at overdose responses. DISCUSSION AND CONCLUSIONS This study found strong support for leave-behind naloxone and field-initiated buprenorphine. Further training for EMS should include trauma-informed care and strategies to address burnout and increase compassion. Alternatives to the emergency department as a post-overdose destination are needed. These strategies should be considered by jurisdictions revising overdose response protocols.
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Affiliation(s)
- Jenna van Draanen
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, USA
| | - Addy Adwell
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, USA
| | - Courteney Wettemann
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, USA
- Research with Expert Advisors on Drug Use, Seattle, USA
| | | | - Brenda Goh
- Department of Health Systems and Population Health, University of Washington, Seattle, USA
| | - David L Perlmutter
- Department of Health Systems and Population Health, University of Washington, Seattle, USA
| | | | | | - Tessa Frohe
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
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Song M, Desai IK, Meyer A, Shah H, Saloner B, Sherman SG, Allen ST, Tomko C, Schneider KE, Krawczyk N, Whaley S, Churchill J, Harris SJ. Exploring trauma and wellbeing of people who use drugs after witnessing overdose: A qualitative study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 122:104239. [PMID: 37890394 DOI: 10.1016/j.drugpo.2023.104239] [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: 06/05/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND The national overdose crisis is often quantified by overdose deaths, but understanding the traumatic impact for those who witness and respond to overdoses can help elucidate mental health needs and opportunities for intervention for this population. Many who respond to overdoses are people who use drugs. This study adds to the literature on how people who use drugs qualitatively experience trauma resulting from witnessing and responding to overdose, through the lens of the Trauma-Informed Theory of Individual Health Behavior. METHODS We conducted 60-min semi-structured, in-depth phone interviews. Participants were recruited from six states and Washington, DC in March-April 2022. Participants included 17 individuals who witnessed overdose(s) during the COVID-19 pandemic. The interview guide was shaped by theories of trauma. The codebook was developed using a priori codes from the interview guide; inductive codes were added during content analysis. Transcripts were coded using ATLAS.ti. RESULTS A vast majority reported trauma from witnessing overdoses. Participants reported that the severity of trauma varied by contextual factors such as the closeness of the relationship to the person overdosing or whether the event was their first experience witnessing an overdose. Participants often described symptoms of trauma including rumination, guilt, and hypervigilance. Some reported normalization of witnessing overdoses due to how common overdoses were, while some acknowledged overdoses will never be "normal." The impacts of witnessing overdose on drug use behaviors varied from riskier substance use to increased motivation for treatment and safer drug use practices. CONCLUSION Recognizing the traumatic impact of witnessed overdoses is key to effectively addressing the full range of sequelae of the overdose crisis. Trauma-informed approaches should be central for service providers when they approach this subject with clients, with awareness of how normalization can reduce help-seeking behaviors and the need for psychological aftercare. We found increased motivation for behavior change after witnessing, which presents opportunity for intervention.
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Affiliation(s)
- Minna Song
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD 21205, USA.
| | - Isha K Desai
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD 21205, USA; Department of Health Policy and Management, George Washington University, 950 New Hampshire Ave, #2, Washington, DC 20052, USA
| | - Avery Meyer
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD 21205, USA
| | - Hridika Shah
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD 21205, USA
| | - Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD 21205, USA
| | - Susan G Sherman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD 21205, USA
| | - Sean T Allen
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD 21205, USA
| | - Catherine Tomko
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD 21205, USA
| | - Kristin E Schneider
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD 21205, USA
| | - Noa Krawczyk
- Center for Opioid Epidemiology and Policy, Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, New York, NY, 10065, USA
| | - Sara Whaley
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD 21205, USA
| | - Jade Churchill
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD 21205, USA
| | - Samantha J Harris
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD 21205, USA
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Kesich Z, Ibragimov U, Komro K, Lane K, Livingston M, Young A, Cooper HLF. "I'm not going to lay back and watch somebody die": a qualitative study of how people who use drugs' naloxone experiences are shaped by rural risk environment and overdose education/naloxone distribution intervention. Harm Reduct J 2023; 20:166. [PMID: 37946233 PMCID: PMC10636969 DOI: 10.1186/s12954-023-00900-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/04/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Overdoses have surged in rural areas in the U.S. and globally for years, but harm reduction interventions have lagged. Overdose education and naloxone distribution (OEND) programs reduce overdose mortality, but little is known about people who use drugs' (PWUD) experience with these interventions in rural areas. Here, we analyze qualitative data with rural PWUD to learn about participants' experiences with an OEND intervention, and about how participants' perceptions of their rural risk environments influenced the interventions' effects. METHODS Twenty-nine one-on-one, semi-structured qualitative interviews were conducted with rural PWUD engaged in the CARE2HOPE OEND intervention in Appalachian Kentucky. Interviews were conducted via Zoom, audio-recorded, and transcribed verbatim. Thematic analysis was conducted, guided by the Rural Risk Environment Framework. RESULTS Participants' naloxone experiences were shaped by all domains of their rural risk environments. The OEND intervention transformed participants' roles locally, so they became an essential component of the local rural healthcare environment. The intervention provided access to naloxone and information, thereby increasing PWUDs' confidence in naloxone administration. Through the intervention, over half of participants gained knowledge on naloxone (access points, administration technique) and on the criminal-legal environment as it pertained to naloxone. Most participants opted to accept and carry naloxone, citing factors related to the social environment (responsibility to their community) and physical/healthcare environments (overdose prevalence, suboptimal emergency response systems). Over half of participants described recent experiences administering intervention-provided naloxone. These experiences were shaped by features of the local rural social environment (anticipated negative reaction from recipients, prior naloxone conversations). CONCLUSIONS By providing naloxone paired with non-stigmatizing health and policy information, the OEND intervention offered support that allowed participants to become a part of the healthcare environment. Findings highlight need for more OEND interventions; outreach to rural PWUD on local policy that impacts them; tailored strategies to help rural PWUD engage in productive dialogue with peers about naloxone and navigate interpersonal conflict associated with overdose reversal; and opportunities for rural PWUD to formally participate in emergency response systems as peer overdose responders. Trial registration The ClinicalTrials.gov ID for the CARE2HOPE intervention is NCT04134767. The registration date was October 19th, 2019.
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Affiliation(s)
- Zora Kesich
- Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA.
| | - Umedjon Ibragimov
- Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Kelli Komro
- Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Kenneth Lane
- College of Public Health, University of Kentucky, Lexington, KY, 40536, USA
| | - Melvin Livingston
- Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - April Young
- College of Public Health, University of Kentucky, Lexington, KY, 40536, USA
| | - Hannah L F Cooper
- Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
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Natale I, Harvey C, Wood P, Anderson K. "It can save your life, that's all I know," barriers and facilitators for engagement in take-home naloxone for people receiving opioid substitution treatment in regional Australia: An explorative study. QUALITATIVE RESEARCH IN MEDICINE & HEALTHCARE 2023; 7:10868. [PMID: 37692452 PMCID: PMC10483482 DOI: 10.4081/qrmh.2023.10868] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 05/07/2023] [Indexed: 09/12/2023] Open
Abstract
Engagement in take-home naloxone (THN) programs by people receiving opioid substitution treatment (OST) in Australia is low despite methadone being a significant contributor to opioid overdose deaths. Our aim was to explore barriers and facilitators for OST patients to engage in THN. We used a descriptive qualitative design with thematic analysis to gain insight into naloxone uptake by people engaged in an OST program in regional Australia. Eleven participants were interviewed; eight had previously engaged with THN. Barriers to THN included limited knowledge and understanding, lack of information, and not personally experiencing an overdose. Facilitators included having a traumatic experience of overdose, knowledge and understanding of THN and overdose, empowerment in carrying naloxone, and expanding THN programs. Support for the expansion of THN programs is desired among participants, and widespread peer distribution is understood to be the key to success. This study found that prior traumatic experience of overdose facilitates acceptance of THN, and being offered THN was the most important factor in engagement. Less clear is how to engage people who lack a traumatic overdose experience.
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Affiliation(s)
| | - Craig Harvey
- Drugs and Alcohol Services, Barwon Health, Geelong
| | - Pene Wood
- La Trobe University, Bendigo, Australia
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Urmanche AA, Harocopos A. Experiences Administering Naloxone Among People in Different Social Roles: People Who Use Opioids and Family Members and Friends. JOURNAL OF DRUG ISSUES 2023; 53:475-489. [PMID: 37829614 PMCID: PMC10569559 DOI: 10.1177/00220426221133024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Unintentional drug overdose deaths continue to be a critical public health issue. Naloxone, a nonscheduled, safe, and effective drug that reverses opioid-involved overdoses is available to non-medically trained individuals ("lay people"), but there is scant information about how people in different social roles experience naloxone administration. We conducted 24 in-depth interviews with people who use opioids (PWUO; n = 15) and family members and friends of people who use opioids (FF; n = 9) who had administered naloxone in response to an opioid overdose. Compared with PWUO, members of the FF group were less reticent to administer naloxone in response to an overdose. PWUO and FF had different perspectives of law enforcement and demonstrated varied knowledge of the Good Samaritan Law. While PWUO found that having and administering naloxone was empowering, FF took a more pragmatic approach, reporting the need for naloxone as an unfortunate reality of their loved one's drug use.
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Affiliation(s)
- Adelya A Urmanche
- New York City Department of Health and Mental Hygiene, Bureau of Alcohol and Drug Use Prevention, Care and Treatment, NY, USA
| | - Alex Harocopos
- New York City Department of Health and Mental Hygiene, Bureau of Alcohol and Drug Use Prevention, Care and Treatment, NY, USA
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Holmén E, Hammarberg A, Kåberg M, Storbjörk J. Take-Home Naloxone and risk management from the perspective of people who survived an opioid overdose in Stockholm - An analysis informed by drug, set and setting. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 115:104021. [PMID: 37011507 DOI: 10.1016/j.drugpo.2023.104021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Take-Home Naloxone (THN) programs were introduced in Sweden in 2018 - a country with one of the highest rates of overdose mortality in the EU and a severe stigmatisation of people who inject drugs. This qualitative study builds on the international research that has expanded a previously narrow and medical focus on overdose deaths. It uses Zinberg's framework to look beyond the role of the "drug" to include the attitudes and personality of the person ("set") and contextual factors ("setting"). This study explores the impacts of THN from the perspective of overdose survivors. METHODS Between November 2021 and May 2022 semi-structured interviews were conducted with 22 opioid overdose survivors, recruited among clients of the Stockholm needle and syringe program. All the participants had been treated with naloxone in an overdose situation. The interviews were processed through thematic analysis using deductive and inductive coding in accordance with the theoretical framework. RESULTS Interviewees included men and women who used different types of drugs. THN has impacted on "drug" in terms of naloxone-induced withdrawal symptoms and peers having to deal with survivors' emotions. Exploring "set" revealed feelings of shame following naloxone revival for the person who overdosed. Despite such reactions, participants retained an overwhelmingly positive attitude towards THN. Participants integrated THN into their risk management practices ("setting") and some acknowledged that THN provided a new way to treat overdoses without necessarily needing to interact with authorities, especially the police. CONCLUSION The THN program has influenced "drug, set and setting" for participants, providing increased safety at drug-intake and transferring overdose management and the burden of care to the community. The lived experience of participants also exposes the limitations of THN indicating that there are additional unmet needs beyond THN programs, particularly in terms of "setting".
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Affiliation(s)
- E Holmén
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Needle and Syringe program, Stockholm Centre for Dependency Disorders, Stockholm, Sweden.
| | - A Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Centre for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - M Kåberg
- Stockholm Needle and Syringe program, Stockholm Centre for Dependency Disorders, Stockholm, Sweden; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - J Storbjörk
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
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Wagner KD, Marks C, Felsher M, Latkin C, Pearson JL, Falade-Nwulia OO. Individual and social network correlates of responding to multiple overdoses among a cohort of people who use drugs. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 5:100107. [PMID: 36688935 PMCID: PMC9854250 DOI: 10.1016/j.dadr.2022.100107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background The purpose of this study was to identify characteristics of people who respond to two or more overdoses (i.e., multiple overdose responders; MOR) compared to those who respond to zero or one, and the association between MOR status and changes in network size. Methods Secondary analysis of data from a randomized trial among 199 PWUD in Baltimore, MD (2016-2019). We used cross-tabulation, 𝜒 2 , and ANOVA models to identify cross-sectional associations between overdose response and demographic, drug use, and network size; and ANCOVA models to examine the relationship between baseline MOR status and change in network size. Results From the cohort of 199, 185 people provided data on overdose response at baseline; 197 provided data at 6-month follow-up. At baseline, 27.6% of participants were classified as MORs (ever). Correlates of MOR status included homelessness; age; injecting drug use; quality of interactions with police (respectful vs. not); and use of powder cocaine, prescription opioids, and heroin. MORs had larger networks and their network size decreased more over time, but the association was not statistically significant. At follow-up, 16% were classified as MORs (past 6 months); correlates of follow-up MOR status were similar to those at baseline. Conclusions Overdose prevention interventions rely on PWUD to respond to overdoses. Identifying factors associated with MOR status could increase intervention efficiency and providing MORs with support could increase sustainability. Our findings suggest that PWUD experiencing homelessness, using cocaine and heroin, and demonstrating increased salience of overdose in their lives would benefit from targeted programs.
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Affiliation(s)
- Karla D. Wagner
- School of Public Health, University of Nevada, Reno; Reno, Nevada, USA,Corresponding Author: 1664 N. Virginia St. MC 0274; Reno, NV 89557, (K.D. Wagner)
| | - Charles Marks
- School of Public Health, University of Nevada, Reno; Reno, Nevada, USA
| | - Marisa Felsher
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine; Baltimore, MD, USA
| | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins School of Medicine; Baltimore, MD, USA
| | | | - Oluwaseun O Falade-Nwulia
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine; Baltimore, MD, USA
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Febres-Cordero S, Smith DJ. Stayin' Alive in Little 5: Application of Sentiment Analysis to Investigate Emotions of Service Industry Workers Responding to Drug Overdoses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13103. [PMID: 36293685 PMCID: PMC9603661 DOI: 10.3390/ijerph192013103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/29/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
The opioid epidemic has increasingly been recognized as a public health issue and has challenged our current legal, social, and ethical beliefs regarding drug use. The epidemic not only impacts persons who use drugs, but also those around them, including people who do not expect to witness an overdose. For example, in the commercial district of Little 5 Points, Atlanta, GA, many service industry workers have become de facto responders to opioid overdoses when a person experiences an opioid-involved overdose in their place of employment. To provide additional insights into >300 pages of interview data collected from service industry workers that have responded to an opioid overdose while at work, we utilized a mixed-methods approach to conduct this sentiment analysis. First, using R version 4.2.1, a data-science based textual analytic approach was applied to the interview data. Using a corpus algorithm, each line of interview text was characterized as one of the eight following sentiments, anger, anticipation, disgust, fear, joy, sadness, surprise, or trust. Once having identified statements that fit into each of these eight codes, qualitative thematic analysis was conducted. The three most prevalent emotions elucidated from these interviews with service industry workers were trust, anticipation, and joy with 20.4%, 16.2%, and 14.7% across all statements, respectively labeled as each emotion. Thematic analysis revealed three themes in the data: (1) individuals have a part to address in the opioid epidemic, (2) communities have many needs related to the opioid crisis, and (3) structural forces create pathways and barriers to opioid overdose response and rescue. This analysis thematically identified roles service industry workers have in addressing the opioid crisis in Atlanta. Similarly, community needs and barriers to responding to an opioid-involved overdose were characterized. Uniquely, this study found key sentiments related to each of these themes. Future research can leverage these findings to inform the development of overdose prevention and response interventions for service industry works that systematically address common emotions and beliefs trainees may have.
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Affiliation(s)
- Sarah Febres-Cordero
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30332, USA
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Troberg K, Isendahl P, Blomé MA, Dahlman D, Håkansson A. Characteristics of and Experience Among People Who Use Take-Home Naloxone in Skåne County, Sweden. Front Public Health 2022; 10:811001. [PMID: 35359781 PMCID: PMC8960176 DOI: 10.3389/fpubh.2022.811001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/01/2022] [Indexed: 01/10/2023] Open
Abstract
Background Opioid overdose related injury or death can be prevented by bystander naloxone administration. For naloxone to be present when and where overdoses occur, opioid prevention education and naloxone distribution (OPEND) must be established on a broad level. This is the 30-month follow-up of the first multi-site naloxone project in Sweden, implemented at 31 sites in the County of Skåne 2018. Aim To address participant characteristics and factors associated with returning for naloxone refill and with having used naloxone for overdose reversal. An additional aim was to describe self-reported reasons for naloxone refill and overdose experiences. Methods Data were collected during June 2018-December 2020 through questionnaires at baseline and upon naloxone refill of the initial and subsequent naloxone kit. Descriptive statistics was used to address participant characteristics, those returning for naloxone refill and reporting overdose reversal. Chi-2 test was used for variable comparison between groups. Factors associated with overdose reversals were examined by logistic regression analysis. Reasons for naloxone refill, overdose situation and management were presented descriptively. Results Among 1,079 study participants, 22% (n = 235) returned for naloxone refill, of which 60% (n = 140) reported a total of 229 overdose reversals. Reversals were more likely to be reported by participants trained at needle exchange programs (NEPs) [adjusted odds ratio (AOR) = 5.18, 95% Confidence interval (CI) = 3.38-7.95)], with previous experience of own (AOR = 1.63, 95% CI = 1.03-2.58) or witnessed (AOR = 2.12, 95% CI = 1.05-4.29) overdose, or who had used sedatives during the last 30 days before initial training (AOR = 1.56, 95% CI = 1.04-2.33). A majority of overdoses reportedly occurred in private settings (62%), where the victim was a friend (35%) or acquaintance (31%) of the rescuer. Conclusion Participants with own risk factors associated with overdose (e.g., injection use, concomitant use of benzodiazepines and previous experience of own overdose) were more likely to report administering naloxone for overdose reversal. Overdose management knowledge was high. The findings indicate that implementation of multi-site OPEND reaches individuals at particularly high risk of own overdose in settings with limited previous harm reduction strategies and favors a further scaling up of naloxone programs in similar settings.
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Affiliation(s)
- Katja Troberg
- Division of Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Malmö Addiction Centre, Region Skåne, Malmö, Sweden
| | - Pernilla Isendahl
- Department of Infectious Disease, University Hospital Skåne, Malmö, Sweden
| | - Marianne Alanko Blomé
- Department of Infectious Disease, University Hospital Skåne, Malmö, Sweden
- Regional Office for Communicable Disease Control, Malmö, Sweden
| | - Disa Dahlman
- Division of Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Region Skåne, Malmö, Sweden
| | - Anders Håkansson
- Division of Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Malmö Addiction Centre, Region Skåne, Malmö, Sweden
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Martignetti L, Sun W. Perspectives of Stakeholders of Equitable Access to Community Naloxone Programs: A Literature Review. Cureus 2022; 14:e21461. [PMID: 35223245 PMCID: PMC8858082 DOI: 10.7759/cureus.21461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 12/02/2022] Open
Abstract
The purpose of this review is to examine the existing literature about facilitators and barriers influencing equitable access to naloxone programs by individuals who use opioids. A total of 49 published articles were examined, which generated four overarching themes:(1) Stigma as a barrier to access; (2) Lack of a wide range of stakeholder perspectives; (3) Need for a comprehensive understanding of factors affecting equitable access to naloxone programs; (4) Facilitators to increase the access of community naloxone programs. Our review highlighted the importance of advocacy in practice, education, administration, and policy to address the health inequities that exist in naloxone distribution programs. Advocacy activities involve the need for health care professionals to engage in social justice practice through evidence-based informed research about the facts of opioid use; challenging the stigma toward victim-blaming against naloxone users; as well as promoting program development and health policy to bring about equitable access to naloxone programs by marginalized and socially disadvantaged populations.
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Parkes T, Foster R, McAuley A, Steven D, Matheson C, Baldacchino A. Chronic pain, prescribed opioids and overdose risk: a qualitative exploration of the views of affected individuals and family members. DRUGS: EDUCATION, PREVENTION AND POLICY 2022. [DOI: 10.1080/09687637.2021.2022100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Tessa Parkes
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Rebecca Foster
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Andrew McAuley
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - Catriona Matheson
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Alex Baldacchino
- Population and Behavioural Science Division, School of Medicine, University of St Andrews, St Andrews, UK
- NHS Addiction Services, NHS Fife, Kirkcaldy, UK
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Walker S, Dietze P, Poznyak V, Campello G, Kashino W, Dzhonbekov D, Kiriazova T, Nikitin D, Terlikbayeva A, Nevendorff L, Busse A, Krupchanka D. More than saving lives: Qualitative findings of the UNODC/WHO Stop Overdose Safely (S-O-S) project. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 100:103482. [PMID: 35042142 DOI: 10.1016/j.drugpo.2021.103482] [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: 05/11/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The Stop Overdose Safely (S-O-S) initiative-developed in compliance with WHO guidelines-aims to prevent opioid overdose deaths. Under the umbrella of this initiative a multi-country project was implemented in Kazakhstan, Kyrgyzstan, Tajikistan, and Ukraine, that involved overdose recognition and response training, including the provision of take-home naloxone (THN). More than 14,000 potential overdose witnesses were trained and more than 16,000 THN kits were distributed across the participating countries. This paper reports on the qualitative component of an evaluation aiming to understand the views and experiences of S-O-S project participants. METHODS Data were drawn from focus group discussions with 257 project participants from across all four countries, including people who use and inject drugs, and others likely to witness an opioid overdose. Data were analysed thematically. RESULTS Findings revealed how past experiences of trauma and loss related to overdose death were common, as was appreciation and gratitude for the opportunity to participate in the S-O-S training. Participants described how they shared knowledge and skills with others. Empowerment and destigmatising narratives featured prominently, and highlighted how for people who use drugs, feeling valued and cared about-not only by families and friends, but by health care providers, and sometimes police-was a positive outcome of their participation. Nevertheless, findings also revealed how real experiences of fear regarding police intervention was a barrier to carrying naloxone and intervening when faced with an overdose situation. CONCLUSION Our analysis found that the S-O-S project produced positive outcomes that go well beyond saving lives. Despite identifying barriers to THN uptake, our findings support a growing body of evidence that broad access to THN as part of a continuum of care can enhance the health and wellbeing of people who use drugs and their communities, in low- to middle-income countries.
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Affiliation(s)
- Shelley Walker
- Burnet Institute, Behaviours and Health Risks Program, 85 Commercial Road, GPO Box 2284, Melbourne, Victoria, 3004, Australia; National Drug Research Institute, Faculty of Health Sciences, Curtin University, 85 Commercial Road, GPO Box 2284, Melbourne, Victoria, 3004, Australia.
| | - Paul Dietze
- Burnet Institute, Behaviours and Health Risks Program, 85 Commercial Road, GPO Box 2284, Melbourne, Victoria, 3004, Australia; School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne Victoria, 3004, Australia; National Drug Research Institute, Faculty of Health Sciences, Curtin University, 85 Commercial Road, GPO Box 2284, Melbourne, Victoria, 3004, Australia
| | - Vladimir Poznyak
- Alcohol, Drugs and Addictive Behaviours Unit, Department of Mental Health and Substance Use, World Health Organization, Avenue Appia 20, 1202, Geneva, Switzerland
| | - Giovanna Campello
- Prevention, Treatment and Rehabilitation Section, Drug Prevention and Health Branch, United Nations Office on Drugs and Crime, P.O. Box 500, A-1400 Vienna, Austria
| | - Wataru Kashino
- Prevention, Treatment and Rehabilitation Section, Drug Prevention and Health Branch, United Nations Office on Drugs and Crime, P.O. Box 500, A-1400 Vienna, Austria
| | | | - Tetiana Kiriazova
- Ukrainian Institute on Public Health Policy, 5 Biloruska Street, Office 20, 27, Kyiv, 04050, Ukraine
| | - Danil Nikitin
- Global Research Institute (GLORI) Foundation, 125 Suyumbaev Street Bishkek, 720011, Kyrgyzstan
| | - Assel Terlikbayeva
- Global Health Research Center of Central Asia (GHRCCA), 38B Shashkina Street, Almaty, Kazakhstan
| | - Laura Nevendorff
- Burnet Institute, Behaviours and Health Risks Program, 85 Commercial Road, GPO Box 2284, Melbourne, Victoria, 3004, Australia
| | - Anja Busse
- Prevention, Treatment and Rehabilitation Section, Drug Prevention and Health Branch, United Nations Office on Drugs and Crime, P.O. Box 500, A-1400 Vienna, Austria
| | - Dzmitry Krupchanka
- Alcohol, Drugs and Addictive Behaviours Unit, Department of Mental Health and Substance Use, World Health Organization, Avenue Appia 20, 1202, Geneva, Switzerland
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13
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Neale J, Farrugia A, Campbell AN, Dietze P, Dwyer R, Fomiatti R, Jones JD, Comer SD, Fraser S, Strang J. UNDERSTANDING PREFERENCES FOR TYPE OF TAKE-HOME NALOXONE DEVICE: INTERNATIONAL QUALITATIVE ANALYSIS OF THE VIEWS OF PEOPLE WHO USE OPIOIDS. DRUGS (ABINGDON, ENGLAND) 2022; 29:109-120. [PMID: 35813841 PMCID: PMC9268211 DOI: 10.1080/09687637.2021.1872499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Take-home naloxone (THN) is provided to non-medically trained people to reverse potential opioid overdoses. There is an increasing range of effective intramuscular (IM) and intranasal (IN) naloxone devices and this paper explores the types preferred by people who use opioids, using consumer behaviour literature to interpret the findings. Methods Data derive from two unconnected qualitative studies involving audio-recorded semi-structured interviews. Study 1 was conducted in the United States (n=21 users of non-medical/illicit opioids). Study 2 was conducted in Australia (n=42 users of non-medical/illicit or prescribed opioids). Findings Most participants preferred IN naloxone. Preferences were based on the ease, speed, safety and comfort of each device and underpinned by accounts of overdose revivals as being very rushed and frightening situations. Preferences related to complex interactions between the naloxone device ('product'); the knowledge, skills, experience and attitudes of the lay responder ('consumer'), and when, where and how naloxone was to be used ('usage situation'). Conclusions THN programs should offer choice of device when possible and nasal naloxone if resources permit. Asking people which devices they prefer and why and treating them as valued consumers of naloxone products can generate insights that improve future naloxone technology and increase THN uptake and usage.
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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
| | | | - Aimee N. Campbell
- Division on Substance Use Disorders, Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, USA
| | - Paul Dietze
- Program on Behaviours and Health Risks, Burnet Institute, Melbourne, Australia.,National Drug Research Institute, Curtin University, Melbourne, Australia
| | - Robyn Dwyer
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Renae Fomiatti
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Jermaine D. Jones
- Division on Substance Use Disorders, Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, USA
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Mercer F, Miler JA, Pauly B, Carver H, Hnízdilová K, Foster R, Parkes T. Peer Support and Overdose Prevention Responses: A Systematic 'State-of-the-Art' Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12073. [PMID: 34831839 PMCID: PMC8621858 DOI: 10.3390/ijerph182212073] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 01/14/2023]
Abstract
Overdose prevention for people who use illicit drugs is essential during the current overdose crisis. Peer support is a process whereby individuals with lived or living experience of a particular phenomenon provide support to others by explicitly drawing on these experiences. This review provides a systematic search and evidence synthesis of peer support within overdose prevention interventions for people who use illicit drugs. A systematic search of six databases (CINAHL, SocINDEX, PsycINFO, MEDLINE, Scopus, and Web of Knowledge) was conducted in November 2020 for papers published in English between 2000 and 2020. Following screening and full-text review, 46 papers met criteria and were included in this review. A thematic analysis approach was used to synthesize themes. Important findings include: the value of peers in creating trusted services; the diversity of peers' roles; the implications of barriers on peer-involved overdose prevention interventions; and the stress and trauma experienced by peers. Peers play a pivotal role in overdose prevention interventions for people who use illicit drugs and are essential to the acceptability and feasibility of such services. However, peers face considerable challenges within their roles, including trauma and burnout. Future interventions must consider how to support and strengthen peer roles in overdose settings.
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Affiliation(s)
- Fiona Mercer
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling FK9 4LA, Scotland, UK; (J.A.M.); (H.C.); (K.H.); (R.F.); (T.P.)
| | - Joanna Astrid Miler
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling FK9 4LA, Scotland, UK; (J.A.M.); (H.C.); (K.H.); (R.F.); (T.P.)
| | - Bernie Pauly
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC V8P 5C2, Canada;
| | - Hannah Carver
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling FK9 4LA, Scotland, UK; (J.A.M.); (H.C.); (K.H.); (R.F.); (T.P.)
| | - Kristina Hnízdilová
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling FK9 4LA, Scotland, UK; (J.A.M.); (H.C.); (K.H.); (R.F.); (T.P.)
| | - Rebecca Foster
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling FK9 4LA, Scotland, UK; (J.A.M.); (H.C.); (K.H.); (R.F.); (T.P.)
| | - Tessa Parkes
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling FK9 4LA, Scotland, UK; (J.A.M.); (H.C.); (K.H.); (R.F.); (T.P.)
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15
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Tse WC, Djordjevic F, Borja V, Picco L, Lam T, Olsen A, Larney S, Dietze P, Nielsen S. Does naloxone provision lead to increased substance use? A systematic review to assess if there is evidence of a 'moral hazard' associated with naloxone supply. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 100:103513. [PMID: 34798434 DOI: 10.1016/j.drugpo.2021.103513] [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: 08/02/2021] [Revised: 10/15/2021] [Accepted: 10/16/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Take home naloxone (THN) programs have been rapidly upscaled in response to increasing opioid-related mortality. One often cited concern is that naloxone provision could be associated with increased opioid use, due to the availability of naloxone to reverse opioid overdose. We conducted a systematic review to determine whether THN provision is associated with changes in substance use by participants enrolled in THN programs. METHODS We conducted a systematic review of the literature to assess changes in heroin or other substance use by people who use opioids following THN provision. RESULTS Seven studies with 2578 participants were included. Of the seven studies, there were two quasi-experimental studies and five cohort studies. Based on the Joanna Briggs Institute quality assessment, four studies were of moderate quality and three studies were of high quality. Of the five studies that reported on the primary outcome of heroin use, no study found evidence of increased heroin use across the study population. Five studies reported on other substance use (benzodiazepines, alcohol, cocaine, amphetamine, cannabis, prescription opioids), none of which found evidence of an increase in other substance use associated with THN provision. Four studies reported on changes in overdose frequency following THN provision: three studies reporting no change, and one study of people prescribed opioids finding a reduction in opioid-related emergency department attendances for participants who received naloxone. CONCLUSION We found no evidence that THN provision was associated with increased opioid use or overdose. Concerns that THN supply may lead to increased substance use were not supported by data from reviewed studies.
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Affiliation(s)
- Wai Chung Tse
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, VIC 3199, Australia; Monash University School of Medicine, Clayton Campus, Clayton, VIC 3800, Australia
| | - Filip Djordjevic
- Burnet Institute Centre for Epidemiology and Population Health Research, Melbourne, VIC 3004, Australia
| | - Viandro Borja
- Alfred Mental and Addiction Health program, Alfred Health, Melbourne, VIC 3181, Australia
| | - Louisa Picco
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, VIC 3199, Australia
| | - Tina Lam
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, VIC 3199, Australia
| | - Anna Olsen
- Australian National University College of Health & Medicine, Australia
| | - Sarah Larney
- Université de Montréal and Centre de Recherche du CHUM, 2900 Edouard Montpetit Blvd, Montreal, Quebec H3T 1J4, Canada
| | - Paul Dietze
- Burnet Institute Centre for Epidemiology and Population Health Research, Melbourne, VIC 3004, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, VIC 3199, Australia.
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16
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Brandt L, Campbell ANC, Jones JD, Martinez S, Neale J, Parkin S, Brown C, Strang J, Comer SD. Emotional reactions of trained overdose responders who use opioids following intervention in an overdose event. Subst Abus 2021; 43:581-591. [PMID: 34520679 PMCID: PMC8810579 DOI: 10.1080/08897077.2021.1975870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: Our aim was to explore emotional reactions to intervening in an overdose event from the perspective of individuals who use opioids (peer responders). In addition, we were interested in the impact this experience may have on peer responders' feelings about helping in an overdose situation in the future. Methods: For this qualitative sub-study of a randomized controlled trial (RCT), data from 61 interviews were analyzed thematically using an inductive approach. Results: Peer responders had diverse emotional reactions to the overdose event. These ranged from a sense of pride and other positive feelings associated with their ability to help to ambivalence about being involved in situations perceived as challenging and burdensome. There were few reports of the overdose event as an exclusively negative experience. Many peer responders perceived it as their duty to use naloxone again if required. However, some had ambivalent feelings toward this responsibility, which may be related to negative experiences with previous intervention efforts. Conclusions: The capacity of people who use opioids to help reduce the harms associated with opioid overdose is experienced as empowering by some. Nonetheless, engaging peer responders in strategies to reduce opioid-related mortality should be coupled with appropriate resources to process their experiences and emotional responses.
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Affiliation(s)
- Laura Brandt
- Division on Substance Use Disorders, New York State Psychiatric Institute & Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Aimee N. C. Campbell
- Division on Substance Use Disorders, New York State Psychiatric Institute & Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Jermaine D. Jones
- Division on Substance Use Disorders, New York State Psychiatric Institute & Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Suky Martinez
- Division on Substance Use Disorders, New York State Psychiatric Institute & Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Joanne Neale
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
- South London and Maudsley NHS Foundation Trust, Camberwell, London, UK
| | - Stephen Parkin
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Caral Brown
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - John Strang
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, Camberwell, London, UK
| | - Sandra D. Comer
- Division on Substance Use Disorders, New York State Psychiatric Institute & Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
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17
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Cid A, Patten A, Grindrod K, Beazely MA. Frequently asked questions about naloxone: Part 1. Can Pharm J (Ott) 2021; 154:301-304. [PMID: 34484479 DOI: 10.1177/17151635211034528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 06/28/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Ashley Cid
- School of Pharmacy, University of Waterloo, Kitchener, Ontario
| | - Alec Patten
- School of Pharmacy, University of Waterloo, Kitchener, Ontario
| | - Kelly Grindrod
- School of Pharmacy, University of Waterloo, Kitchener, Ontario
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18
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Macleod ER, Tajbakhsh I, Hamilton-Wright S, Laliberte N, Wiese JL, Matheson FI. "They're not doing enough.": women's experiences with opioids and naloxone in Toronto. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2021; 16:26. [PMID: 33743756 PMCID: PMC7980746 DOI: 10.1186/s13011-021-00360-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 03/04/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Amid increasing opioid overdose deaths in Canada since 2010 and a changing naloxone access landscape, there is a need for up-to-date research on Canadian women's experiences with opioids. Studies on Canadian take-home naloxone programs are promising, but research beyond these programs is limited. Our study is the first to focus on women's experiences and perspectives on the opioid crisis in Ontario, Canada's most populous province, since the opioid crisis began in 2010. OBJECTIVE Our objective was to address research knowledge gaps involving Canadian women with criminal justice involvement who use opioids, and identify flaws in current policies, responses, and practices. While the opioid overdose crisis persists, this lack of research inhibits our ability to determine whether overdose prevention efforts, especially involving naloxone, are meeting their needs. METHODS We conducted semi-structured, qualitative interviews from January to April 2018 with 10 women with experience of opioid use. They were recruited through the study's community partner in Toronto. Participants provided demographic information, experiences with opioids and naloxone, and their perceptions of the Canadian government's responses to the opioid crisis. Interviews were transcribed verbatim and inductive thematic analysis was conducted to determine major themes within the data. RESULTS Thematic analysis identified seven major concerns despite significant differences in participant life and opioid use experiences. Participants who had used illicit opioids since naloxone became available over-the-counter in 2016 were much more knowledgeable about naloxone than participants who had only used opioids prior to 2016. The portability, dosage form, and effects of naloxone are important considerations for women who use opioids. Social alienation, violence, and isolation affect the wellbeing of women who use opioids. The Canadian government's response to the opioid crisis was perceived as inadequate. Participants demonstrated differing needs and views on ideal harm reduction approaches, despite facing similar structural issues surrounding stigma, addiction management, and housing. CONCLUSIONS Participants experienced with naloxone use found it to be useful in preventing fatal overdose, however many of their needs with regards to physical, mental, and social health, housing, harm reduction, and access to opioid treatment remained unmet.
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Affiliation(s)
- Emilie R Macleod
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B1W8, Canada
| | - Iren Tajbakhsh
- Elizabeth Fry Society Toronto, 215 Wellesley Street East, Toronto, ON, M4X 1G1, Canada
| | - Sarah Hamilton-Wright
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B1W8, Canada
| | - Nancy Laliberte
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Jessica L Wiese
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B1W8, Canada
| | - Flora I Matheson
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B1W8, Canada. .,Dalla Lana School of Public Health, University of Toronto, 55 College St Room 500, Toronto, ON, M5T 3M7, Canada.
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19
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Parkin S, Neale J, Brown C, Jones JD, Brandt L, Castillo F, Campbell ANC, Strang J, Comer SD. A qualitative study of repeat naloxone administrations during opioid overdose intervention by people who use opioids in New York City. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 87:102968. [PMID: 33096365 PMCID: PMC7940548 DOI: 10.1016/j.drugpo.2020.102968] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Take-home naloxone (THN) kits have been designed to provide community members (including people who use drugs, their families and/or significant others) with the necessary resources to address out-of-hospital opioid overdose events. Kits typically include two doses of naloxone. This 'twin-pack' format means that lay responders need information on how to use each dose. Advice given tends to be based on dosage algorithms used by medical personnel. However, little is currently known about how and why people who use drugs, acting as lay responders, decide to administer the second dose contained within single THN kits. The aim of this article is to explore this issue. METHODS Data were generated from a qualitative semi-structured interview study that was embedded within a randomised controlled trial examining the risks and benefits of Overdose Education and Naloxone Distribution (OEND) training in New York City (NYC). Analysis for this article focuses upon the experiences of 22 people who use(d) opioids and who provided repeat naloxone administrations (RNA) during 24 separate overdose events. The framework method of analysis was used to compare the time participants believed had passed between each naloxone dose administered ('subjective response interval') with the 'recommended response interval' (2-4 minutes) given during OEND training. Framework analysis also charted the various reasons and rationale for providing RNA during overdose interventions. RESULTS When participants' subjective response intervals were compared with the recommended response interval for naloxone dosing, three different time periods were reported for the 24 overdose events: i. 'two doses administered in under 2 minutes' (n = 10); ii. 'two doses administered within 2-4 minutes' (n = 7), and iii. 'two doses administered more than 4 minutes apart' (n = 7). A variety of reasons were identified for providing RNA within each of the three categories of response interval. Collectively, reasons for RNA included panic, recognition of urgency, delays in retrieving naloxone kit, perceptions of recipients' responsiveness/non-responsiveness to naloxone, and avoidance of Emergency Response Teams (ERT). CONCLUSION Findings suggest that decision-making processes by people who use opioids regarding how and when to provide RNA are influenced by factors that relate to the emergency event. In addition, the majority of RNA (17/24) occurred outside of the recommended response interval taught during OEND training. These findings are discussed in terms of evidence-based intervention and 'evidence-making intervention' with suggestions for how RNA guidance may be developed and included within future/existing models of OEND training.
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Affiliation(s)
- Stephen Parkin
- National Addiction Centre, King's College London, 4 Windsor Walk, Denmark Hill, SE5 8BB, United Kingdom.
| | - Joanne Neale
- National Addiction Centre, King's College London, 4 Windsor Walk, Denmark Hill, SE5 8BB, United Kingdom; South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London; Centre for Social Research in Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Caral Brown
- National Addiction Centre, King's College London, 4 Windsor Walk, Denmark Hill, SE5 8BB, United Kingdom
| | - Jermaine D Jones
- Division on Substance Use Disorders, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 120, New York, NY 10032, United States
| | - Laura Brandt
- Division on Substance Use Disorders, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 120, New York, NY 10032, United States
| | - Felipe Castillo
- Division on Substance Use Disorders, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 120, New York, NY 10032, United States
| | - Aimee N C Campbell
- Division on Substance Use Disorders, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 120, New York, NY 10032, United States
| | - John Strang
- National Addiction Centre, King's College London, 4 Windsor Walk, Denmark Hill, SE5 8BB, United Kingdom; South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London
| | - Sandra D Comer
- Division on Substance Use Disorders, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 120, New York, NY 10032, United States
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20
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Neale J, Kalk NJ, Parkin S, Brown C, Brandt L, Campbell ANC, Castillo F, Jones JD, Strang J, Comer SD. Factors associated with withdrawal symptoms and anger among people resuscitated from an opioid overdose by take-home naloxone: Exploratory mixed methods analysis. J Subst Abuse Treat 2020; 117:108099. [PMID: 32811629 PMCID: PMC7491601 DOI: 10.1016/j.jsat.2020.108099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 07/06/2020] [Accepted: 07/25/2020] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Take-home naloxone (THN) is a clinically effective and cost-effective means of reducing opioid overdose fatality. Nonetheless, naloxone administration that successfully saves a person's life can still produce undesirable and harmful effects. AIM To better understand factors associated with two widely reported adverse outcomes following naloxone administration; namely the person resuscitated displays: i. withdrawal symptoms and ii. anger. METHODS A mixed methods study combining a randomized controlled trial of overdose education and naloxone prescribing to people with opioid use disorder and semi-structured qualitative interviews with trial participants who had responded to an overdose whilst in the trial. All data were collected in New York City (2014-2019). A dataset (comprising demographic, pharmacological, situational, interpersonal, and overdose training related variables) was generated by transforming qualitative interview data from 47 overdose events into dichotomous variables and then combining these with quantitative demographic and overdose training related data from the main trial. Associations between variables within the dataset and reports of: i. withdrawal symptoms and ii. anger were explored using chi-squared tests, t-tests, and logistic regressions. RESULTS A multivariate logistic regression found that people who had overdosed were significantly more likely to display anger if the person resuscitating them criticized, berated or chastised them during resuscitation (adjusted OR = 27 [95% CI = 4.0-295]). In contrast, they were significantly less likely to display anger if the person resuscitating them communicated positively with them (OR = 0.10 [95% CI = 0.01-0.78]). Both positive and negative communication styles were independently associated with anger, and communication was associated with 59% of the variance in anger. There was no evidence that people who displayed withdrawal symptoms were more likely to display anger than those not displaying withdrawal symptoms, and neither displaying withdrawal symptoms nor displaying anger were associated with using more drugs after resuscitation. CONCLUSIONS Contrary to common assumptions, withdrawal symptoms and anger following naloxone administration may be unrelated phenomena. Findings are consistent with previous research that has suggested that a lay responder's positive or reassuring communication style may lessen anger post overdose. Implications for improving THN programmes and naloxone administration are discussed.
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Affiliation(s)
- Joanne Neale
- National Addiction Centre, King's College London, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, United Kingdom; Centre for Social Research in Health, University of New South Wales, Sydney, NSW 2052, Australia; South London and Maudsley NHS Foundation Trust, Camberwell, London, SE5 8AZ, United Kingdom.
| | - Nicola J Kalk
- National Addiction Centre, King's College London, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, United Kingdom; South London and Maudsley NHS Foundation Trust, Camberwell, London, SE5 8AZ, United Kingdom.
| | - Stephen Parkin
- National Addiction Centre, King's College London, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, United Kingdom.
| | - Caral Brown
- National Addiction Centre, King's College London, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, United Kingdom.
| | - Laura Brandt
- Division on Substance Use Disorders, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 120, New York, NY 10032, United States.
| | - Aimee N C Campbell
- Division on Substance Use Disorders, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 120, New York, NY 10032, United States.
| | - Felipe Castillo
- Division on Substance Use Disorders, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 120, New York, NY 10032, United States.
| | - Jermaine D Jones
- Division on Substance Use Disorders, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 120, New York, NY 10032, United States.
| | - John Strang
- National Addiction Centre, King's College London, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, United Kingdom; South London and Maudsley NHS Foundation Trust, Camberwell, London, SE5 8AZ, United Kingdom.
| | - Sandra D Comer
- Division on Substance Use Disorders, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 120, New York, NY 10032, United States.
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21
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Kahn LS, Wozniak M, Vest BM, Moore C. “Narcan encounters:” overdose and naloxone rescue experiences among people who use opioids. Subst Abus 2020; 43:113-126. [DOI: 10.1080/08897077.2020.1748165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Linda S. Kahn
- Primary Care Research Institute, Department of Family Medicine, University at Buffalo, New York, USA
| | - Monika Wozniak
- Primary Care Research Institute, Department of Family Medicine, University at Buffalo, New York, USA
| | - Bonnie M. Vest
- Primary Care Research Institute, Department of Family Medicine, University at Buffalo, New York, USA
| | - Cheryll Moore
- Erie County Department of Health, University at Buffalo, Buffalo, New York, USA
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22
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Farrugia A. Commentary on Elliott et al. (2019): How stigma shapes overdose revival and possible avenues to disrupt it. Addiction 2019; 114:1387-1388. [PMID: 31250494 DOI: 10.1111/add.14660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 05/13/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Adrian Farrugia
- Social Studies of Addiction Concepts Research Program, Faculty of Health Sciences, National Drug Research Institute, Curtin University, Melbourne, Vic, Australia
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