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Petrovitch D, Himes KP, Jump A, Freiermuth CE, Braun RS, Brown JL, Lyons MS, Punches BE, Sprague JE, Littlefield AK. State program enables the identification of factors associated with naloxone awareness, self-efficacy, and use for overdose reversal: A cross-sectional, observational study in an urban emergency department population. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 167:209506. [PMID: 39265916 DOI: 10.1016/j.josat.2024.209506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 08/05/2024] [Accepted: 08/27/2024] [Indexed: 09/14/2024]
Abstract
INTRODUCTION To assist the state of Ohio in addressing the opioid epidemic, the Ohio Attorney General appointed experts in a variety of academic disciplines to the Scientific Committee on Opioid Prevention and Education (SCOPE). The focus of SCOPE is the application of scientific principles to the development of prevention and educational strategies for reducing substance use disorder and related harms (e.g., promoting naloxone awareness). Naloxone awareness is a step in the naloxone cascade, which is a useful model for understanding the sequential steps laypeople must take to prepare themselves to intervene using naloxone; other steps include training and previous administration experience. Prior work has explored correlates of these steps among individuals with risky substance use, but fewer studies have focused on broader populations containing potential bystanders (e.g., family and community members). METHODS This study was a secondary data analysis of patients from three urban emergency departments. Subsamples differed across five models (n = 479-1208) and included opioid-exposed and -naïve participants. Logistic regression characterized clinically useful sociodemographic predictors (e.g., race, ethnicity, education, employment, housing status) of naloxone awareness, self-efficacy (which relates to training), and previous-overdose administration. Two additional logistic regressions tested associations between risk factors for witnessing an opioid overdose and two cascade steps (awareness and self-efficacy). RESULTS Non-White race, Hispanic ethnicity, and lower education predicted not being aware of naloxone; non-White race also predicted lower naloxone self-efficacy, and older age predicted lack of previous-overdose administration. Having family members with risky opioid use was heavily associated with awareness, while personal substance-use behaviors and previous overdose witnessing were associated with both awareness and higher naloxone self-efficacy. CONCLUSIONS Characteristics associated with lower likelihood of completing each cascade step highlight opportunities for targeted interventions. Specifically, findings indicated the importance of expanding naloxone education and training programs to more diverse populations and to family members of individuals with risky opioid use. Further, these findings demonstrate how a state-funded program such as SCOPE can have a positive impact on identifying strategies that may assist in reducing mortality associated with opioid overdose.
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Affiliation(s)
- Dan Petrovitch
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA.
| | - Katie P Himes
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA.
| | - Alayna Jump
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA.
| | - Caroline E Freiermuth
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA; Center for Addiction Research, University of Cincinnati, Cincinnati, OH, USA.
| | - Robert S Braun
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA.
| | - Jennifer L Brown
- Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA.
| | - Michael S Lyons
- Department of Emergency Medicine, The Ohio State University, Columbus, OH, USA.
| | - Brittany E Punches
- Department of Emergency Medicine, The Ohio State University, Columbus, OH, USA; College of Nursing, The Ohio State University, Columbus, OH, USA.
| | - Jon E Sprague
- The Ohio Attorney General's Center for the Future of Forensic Science, Bowling Green State University, Bowling Green, OH, USA.
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Schwieger L, Carpenter JE, Moran TP, Erowid F, Cornelison M, Evans D, Morgan B, Murray BP. Access to, Experience with, and Attitudes towards Take Home Naloxone: An Online Survey. J Community Health 2024; 49:526-534. [PMID: 38127295 DOI: 10.1007/s10900-023-01321-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2023] [Indexed: 12/23/2023]
Abstract
The opioid public health crisis continues to burden individuals, communities, and economies. Public health opinion has emphasized the need for increased access to harm reduction services, but there is a dearth of information on the views and experiences of people who use opioids. Our study aimed to investigate the prevalence of naloxone use, attitudes, and experiences with naloxone among an online community of people who use drugs. We performed a cross-sectional survey looking at experiences with and attitudes towards take-home naloxone. Data is presented descriptively, with analysis of the differences between people who do and do not use opioids using the χ2 and Fisher's exact tests. There were 1,143 respondents, of whom 70% were from the United States. Only 38% of participants who use opioids had received naloxone training, but 56% of these individuals said that they felt comfortable using a naloxone kit. Nearly all respondents (95%) said they would be willing to use naloxone on someone who had overdosed and approximately 90% would want naloxone used on them in case of an overdose. Regarding harm reduction, 24% of respondents said they had access to safe use programs, and 33% said they had access to clean needle exchange programs. A majority of the participants who use opioids were in favor of having naloxone with them when using drugs and believed naloxone should be freely available. This study demonstrates the receptiveness of take-home naloxone and highlights the need for better implementation of naloxone within communities that use opioids.
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Affiliation(s)
| | | | - Tim P Moran
- Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Dabney Evans
- Emory University School of Public Health, Atlanta, GA, USA
| | - Brent Morgan
- Emory University School of Medicine, Atlanta, GA, USA
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Chen XY, Wang L, Ma X, Yang F, Wang X, Xu P, Xu LL, Di B. Development of fentanyl-specific monoclonal antibody (mAb) to antagonize the pharmacological effects of fentanyl. Toxicol Appl Pharmacol 2024; 486:116918. [PMID: 38570042 DOI: 10.1016/j.taap.2024.116918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 03/17/2024] [Accepted: 03/30/2024] [Indexed: 04/05/2024]
Abstract
Fentanyl, a critical component of opioid analgesics, poses a severe threat to public health, exacerbating the drug problem due to its potential fatality. Herein, we present two novel haptens designed with different attachment sites conjugated to keyhole limpet hemocyanin (KLH), aiming to develop an efficacious vaccine against fentanyl. KLH-Fent-1 demonstrated superior performance over KLH-Fent-2 in antibody titer, blood-brain distribution, and antinociceptive tests. Consequently, we immunized mice with KLH-Fent-1 to generate fentanyl-specific monoclonal antibodies (mAbs) using the hybridoma technique to compensate for the defects of active immunization in the treatment of opioid overdose and addiction. The mAb produced by hybridoma 9D5 exhibited the ability to recognize fentanyl and its analogs with a binding affinity of 10-10 M. Subsequently, we developed a human IgG1 chimeric mAb to improve the degree of humanization. Pre-treatment with murine and chimeric mAb significantly reduced the analgesic effect of fentanyl and altered its blood-brain biodistribution in vivo. Furthermore, in a mouse model of fentanyl-induced respiratory depression, the chimeric mAb effectively reversed respiratory depression promptly and maintained a certain level during the week. The development of high-affinity chimeric mAb gives support to combat the challenges of fentanyl misuse and its detrimental consequences. In conclusion, mAb passive immunization represents a viable strategy for addressing fentanyl addiction and overdose.
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Affiliation(s)
- Xiao-Yi Chen
- Office of China National Narcotics Control Commission, China Pharmaceutical University Joint Laboratory on Key Technologies of Narcotics Control, Nanjing 210009, China; Jiangsu Key Laboratory of Drug Design and Optimization, China Pharmaceutical University, Nanjing 210009, China
| | - Li Wang
- Office of China National Narcotics Control Commission, China Pharmaceutical University Joint Laboratory on Key Technologies of Narcotics Control, Nanjing 210009, China; Jiangsu Key Laboratory of Drug Design and Optimization, China Pharmaceutical University, Nanjing 210009, China
| | - Xiao Ma
- Office of China National Narcotics Control Commission, China Pharmaceutical University Joint Laboratory on Key Technologies of Narcotics Control, Nanjing 210009, China; Jiangsu Key Laboratory of Drug Design and Optimization, China Pharmaceutical University, Nanjing 210009, China
| | - Fan Yang
- Office of China National Narcotics Control Commission, China Pharmaceutical University Joint Laboratory on Key Technologies of Narcotics Control, Nanjing 210009, China; Jiangsu Key Laboratory of Drug Design and Optimization, China Pharmaceutical University, Nanjing 210009, China
| | - Xiao Wang
- Office of China National Narcotics Control Commission, China Pharmaceutical University Joint Laboratory on Key Technologies of Narcotics Control, Nanjing 210009, China; Jiangsu Key Laboratory of Drug Design and Optimization, China Pharmaceutical University, Nanjing 210009, China
| | - Peng Xu
- Office of China National Narcotics Control Commission, China Pharmaceutical University Joint Laboratory on Key Technologies of Narcotics Control, Nanjing 210009, China; Key Laboratory of Drug Monitoring and Control, Drug Intelligence and Forensic Center, Ministry of Public Security, Beijing 100193, China.
| | - Li-Li Xu
- Office of China National Narcotics Control Commission, China Pharmaceutical University Joint Laboratory on Key Technologies of Narcotics Control, Nanjing 210009, China; Jiangsu Key Laboratory of Drug Design and Optimization, China Pharmaceutical University, Nanjing 210009, China.
| | - Bin Di
- Office of China National Narcotics Control Commission, China Pharmaceutical University Joint Laboratory on Key Technologies of Narcotics Control, Nanjing 210009, China; Jiangsu Key Laboratory of Drug Design and Optimization, China Pharmaceutical University, Nanjing 210009, China.
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Cooper-Ohm S, Habecker P, Humeniuk R, Bevins RA. Factors Associated with Gaps in Naloxone Knowledge: Evidence from a 2022 Great Plains Survey. RESEARCH SQUARE 2023:rs.3.rs-3536993. [PMID: 37961638 PMCID: PMC10635394 DOI: 10.21203/rs.3.rs-3536993/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Background The rising prevalence of fast-acting opioids in the United States suggests the increased need for non-first responder administration of naloxone. Effective administration of naloxone during an overdose requires that bystanders are familiar with, have access to, and know how to use naloxone. Methods Drawing on the 2022 Nebraska Annual Social Indicators survey, we analyzed naloxone familiarity, access, and competency to administer among a statewide, address-based sample of Nebraskan adults. Results There were significant gaps in naloxone knowledge in Nebraska. Although 75.6% of respondents were familiar with naloxone, only 18.6% knew how to access naloxone and 17.6% knew how to use naloxone. We find that more frequent religious service attendance is associated with lower odds of naloxone familiarity. Among those familiar with naloxone, a higher perception of community stigma towards opioids generally is associated with lower odds of naloxone access and competency. Higher perception of community stigma towards heroin, methamphetamines, and cocaine, however, is associated with higher odds of naloxone access. Finally, past overdose experience, lifetime illicit opioid use, being close to a person who uses opioids, and having access to illicit opioids was not significantly associated with naloxone familiarity, access, or competency among respondents in Nebraska's two largest cities, Omaha and Lincoln. Outside of these cities, past overdose experience and access to illicit opioids was associated with higher odds of naloxone access and competency, but lifetime opioid use and being close to a person who uses opioids had no effect. Conclusions Our findings highlight the continued need for education on naloxone with a specific focus on access and competency to further reduce opioid-related overdose deaths. Education campaigns targeted at places of worship or individuals close to people who use opioids may further serve those with a lower likelihood of naloxone familiarity and promote knowledge of naloxone among those with higher odds of encountering an overdose. Further work is needed to understand differences in the relationship between substance-specific perceived stigma and its association with naloxone access.
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Argenyi MS, Evans JK, Gay Y, Epstein DH, Weiss ST. The Opioid Overdose Resuscitation Education for Addiction Counselors and Trainees (Opioid Overdose REACT) naloxone response education pilot project improved confidence and knowledge among addiction counselors and trainees. Clin Toxicol (Phila) 2023; 61:509-517. [PMID: 37427894 PMCID: PMC10528373 DOI: 10.1080/15563650.2023.2229508] [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: 01/31/2023] [Revised: 06/12/2023] [Accepted: 06/20/2023] [Indexed: 07/11/2023]
Abstract
INTRODUCTION Community programs to teach nonmedical laypeople how to recognize an opioid overdose and effectively resuscitate the victim using naloxone have proliferated recently as a significant component of harm-reduction efforts. Although many such programs target laypeople like first responders or friends and family members of people who use drugs, there are currently no programs that specifically target addiction counselors, despite their work with a client population at high risk of an opioid overdose. METHODS The four-hour curriculum designed by the authors covered opioid agonist and antagonist pharmacology; opioid toxidrome signs; legal implications and indications for using the naloxone kits; and hands-on training. Participants were two cohorts of addiction counselors and addiction counseling trainees at our institution and an affiliated Opioid Treatment Program methadone clinic. Surveys testing participant knowledge and confidence were conducted at baseline, immediately post-training, six months post-training, and 12 months post-training. RESULTS Overall, opioid and naloxone pharmacology knowledge, as well as the confidence to intervene in an overdose emergency, improved among participants in both cohorts. Knowledge scores at baseline (n = 36, median 5/10) improved significantly immediately post-training (n = 31, median 7/10, P < 0.0001, Wilcoxon signed-rank test) and were sustained six (n = 19) and 12 months (n = 11) later. Two participants reported using their naloxone kits to successfully reverse a client overdose in the 12 months after taking the course. DISCUSSION These results from our knowledge translation pilot project suggest that our educational program to train addiction counselors in opioid pharmacology and toxicology, allowing them to recognize and respond to an opioid overdose, is feasible and could be effective. Specific barriers to implementing such educational programs include cost, stigma, and unclear best practice for designing and conducting these programs. CONCLUSIONS Further study of providing opioid pharmacology education and overdose and naloxone training to addiction counselors and counseling trainees appears to be warranted.
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Affiliation(s)
- Michael S. Argenyi
- Wake Forest Addiction Research and Clinical Health Program, Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC
- Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Joni K. Evans
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Yasmin Gay
- Wake Forest Addiction Research and Clinical Health Program, Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC
| | - David H. Epstein
- Translational Addiction Medicine Branch, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD
| | - Stephanie T. Weiss
- Wake Forest Addiction Research and Clinical Health Program, Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC
- Translational Addiction Medicine Branch, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD
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Filteau MR, Green B, Kim F, McBride KA. 'It's the same thing as giving them CPR training': rural first responders' perspectives on naloxone. Harm Reduct J 2022; 19:111. [PMID: 36192736 PMCID: PMC9531424 DOI: 10.1186/s12954-022-00688-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 09/13/2022] [Indexed: 12/03/2022] Open
Abstract
The Substance Abuse and Mental Health Services Administration's (SAMHSA) Harm Reduction grant program expanded access to several harm reduction strategies to mitigate opioid overdose fatalities, including expanding access to naloxone. Interviews with first responders in a frontier and remote (FAR) state were conducted to understand their job responsibilities in relation to overdose response and prevention and their perceptions of training laypersons to administer naloxone. This study includes 22 interviews with law enforcement, EMS and/or fire personnel, and members of harm reduction-focused community organizations. The study finds widespread support for increasing access to naloxone and training laypersons in naloxone administration throughout Montana, due to rural first responders' inability to meet the needs of residents and an overall lack of resources to address addiction and the effects of fentanyl. Participants from harm reduction-focused community organizations convey support for training lay persons, but also illuminate that real and perceived cultural opposition to harm reduction strategies could reduce the likelihood that laypeople enroll in naloxone training. This study adds to the literature because it focuses on first responders in a FAR area that would benefit from layperson naloxone education and administration training due to its geographic expansiveness and the area's overall lack of access to medications for opioid use disorder or other treatment services. Expanding harm reduction approaches, like increasing access and training laypersons to administer naloxone, might be FAR residents' best chance for surviving an opioid overdose.
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Affiliation(s)
| | | | - Frances Kim
- JG Research and Evaluation, Bozeman, MT, USA
| | - Ki-Ai McBride
- Montana Department of Health and Human Services, Behavioral Health and Disabilities Disorders Division, Helena, MT, USA
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Adeosun SO. Stigma by Association: To what Extent is the Attitude Toward Naloxone Affected by the Stigma of Opioid Use Disorder? J Pharm Pract 2022:8971900221097173. [PMID: 35505618 DOI: 10.1177/08971900221097173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The United States opioid epidemic is fueled by illicit opioid abuse and prescription opioid misuse and abuse. Consequently, cases of opioid use disorder (OUD, opioid addiction), opioid overdose, and related deaths have increased since the year 2000. Naloxone is an opioid antagonist that rapidly reverses opioid intoxication to prevent death from overdose. It is one of the major risk mitigation strategies recommended in the 2016 Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain. However, despite the exponential increase in dispensing and distribution of naloxone, opioid overdose and related deaths have continued to increase; suggesting that the increased naloxone supply still lags the need. This discordance is attributed at least in part to the negative attitude toward naloxone, which is based on the belief that naloxone is only meant for "addicts" and "abusers" (OUD patients). This negative attitude or so-called naloxone stigma is therefore considered a major barrier for naloxone distribution and consequently, overdose-death prevention efforts. This article presents evidence that challenges common assertions about OUD stigma being the sole and direct driving force behind naloxone stigma, and the purported magnitude of the barrier that naloxone stigma constitutes for naloxone distribution programs among the stakeholders (patients, pharmacists, and prescribers). The case was then made to operationalize and quantify the construct among the stakeholders to determine the extent to which OUD stigma drives naloxone stigma, and the relative impact of naloxone stigma as a barrier for naloxone distribution efforts.
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Affiliation(s)
- Samuel O Adeosun
- Department of Clinical Sciences, Fred Wilson School of Pharmacy, 465018High Point University, High Point NC, US
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Gugala E, Briggs O, Moczygemba LR, Brown CM, Hill LG. Opioid harm reduction: A scoping review of physician and system-level gaps in knowledge, education, and practice. Subst Abus 2022; 43:972-987. [PMID: 35426772 DOI: 10.1080/08897077.2022.2060423] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: Harm reduction includes treatment and prevention approaches rather than abstinence, as a public health strategy for mitigating the opioid epidemic. Harm reduction is a new strategy for many healthcare professionals, and gaps in knowledge and practices may lead to barriers to optimal treatment. Our objective was to identify and describe gaps in physicians' knowledge, education, and practice in harm reduction strategies related to opioid overdose. Methods: We searched the PubMed, CINAHL, and Web of Science databases for articles published between 2015 and 2021, published in English, containing empirical evidence, addressing opioid harm reduction, and identifying gaps in physicians' knowledge, education, or practice. Results: Thirty-seven studies were included. Studies examined how physicians' perceptions or stigma influenced harm reduction efforts and addressed clinical knowledge gaps in overdose treatment and prevention and OUD treatment. Less than half of the studies addressed access issues at the system level, above the individual healthcare professional. Conclusion: Individual-level interventions should be addressed with professional continuing education and curricular-based changes through experiential and interprofessional education. System-level gaps can be remedied by increasing patient access to care, creating policies favorable to harm reduction, and extending resources to provide harm reduction strategies.
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Affiliation(s)
- Emma Gugala
- TxCORE and PhARM Program, The University of Texas at Austin College of Pharmacy, Austin, TX, USA
| | - Owanate Briggs
- TxCORE and PhARM Program, The University of Texas at Austin College of Pharmacy, Austin, TX, USA
| | - Leticia R Moczygemba
- TxCORE and PhARM Program, The University of Texas at Austin College of Pharmacy, Austin, TX, USA
| | - Carolyn M Brown
- TxCORE and PhARM Program, The University of Texas at Austin College of Pharmacy, Austin, TX, USA
| | - Lucas G Hill
- TxCORE and PhARM Program, The University of Texas at Austin College of Pharmacy, Austin, TX, USA
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Hammond A, Obrecht J, Odunuyi O, Magloire P, Walsh S. Naloxone Knowledge and Attitudes of Juvenile Residents in a Detention Setting. JOURNAL OF CORRECTIONAL HEALTH CARE 2022; 28:148-154. [PMID: 35263179 DOI: 10.1089/jchc.20.10.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The opioid epidemic in the United States is financially, physically, and emotionally costly. Juvenile residents in detention settings witness overdose through personal opioid use or that of family or friends. Educational programming was developed for residents in a juvenile temporary detention center to increase knowledge of opioid overdose and nonopioid misuse. Using pre-post group surveys, we evaluated knowledge of opioid overdose, naloxone, and attitudes. Most residents recognized opioids and other substances by name, felt comfortable in their ability to recognize opioid overdose symptoms, and knew how to assist. Youth residents may be less likely to use opioids and more likely to become first responders in an overdose situation. However, some would not intervene or call for help. Instead, a potential conflict for themselves was perceived.
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Affiliation(s)
- Andrea Hammond
- Department of Human Development Nursing Science, University of Illinois at Chicago College of Nursing, Chicago, Illinois, USA
| | - Jennifer Obrecht
- Department of Human Development Nursing Science, University of Illinois at Chicago College of Nursing, Chicago, Illinois, USA
| | - Olajumoke Odunuyi
- Department of Human Development Nursing Science, University of Illinois at Chicago College of Nursing, Chicago, Illinois, USA
| | - Philippe Magloire
- Cook County Juvenile Temporary Detention Center, Chicago, Illinois, USA
| | - Susan Walsh
- Department of Human Development Nursing Science, University of Illinois at Chicago College of Nursing, Chicago, Illinois, USA
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Griner T, Strasser S. A qualitative examination of responses from a survey of pharmacy staff in Georgia regarding access to Narcan®. HEALTH EDUCATION RESEARCH 2022; 36:467-477. [PMID: 34160048 DOI: 10.1093/her/cyab024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/12/2021] [Accepted: 06/01/2021] [Indexed: 06/13/2023]
Abstract
Georgia state lawmakers enacted legislation designed to reduce opioid overdose deaths by increasing public access to rescue products, such as Narcan®. This article explores whether pharmacy employees have effectively adopted such changes into pharmacy practice. We analyzed unsolicited remarks noted during a parent telephone survey of 120 Georgia pharmacy staff regarding price, availability and barriers to layperson purchase of Narcan®. Comments regarding dispensing requirements and challenges in obtaining inventory and changes in communication style were recorded. Around 15% were unfamiliar with Narcan® as an opioid overdose reversal agent or were unaware of their pharmacy's policies governing its sale. Nearly half of those contacted did not have Narcan® in stock with some reporting that receiving Narcan® would take several days after placing an order. Over half specified requirements for purchasing Narcan® not required by law. Fewer than 15% had Narcan® available and imposed no unnecessary requirements for its purchase. During approximately 10% of the survey calls, respondents used a tone of voice or made comments suggestive of bias. We conclude that non-compliance with current laws, lack of familiarity with Narcan® and negative communication tendencies that suggest implicit bias and stigmatizing behaviors could ultimately inhibit access to opioid overdose treatment.
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Kinnard EN, Bluthenthal RN, Kral AH, Wenger LD, Lambdin BH. The naloxone delivery cascade: Identifying disparities in access to naloxone among people who inject drugs in Los Angeles and San Francisco, CA. Drug Alcohol Depend 2021; 225:108759. [PMID: 34058540 DOI: 10.1016/j.drugalcdep.2021.108759] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Opioid overdoses are a leading cause of injury death in the United States. Providing people who inject drugs (PWID) with naloxone is essential to preventing deaths. However, research regarding gaps in naloxone delivery is limited. METHODS We interviewed 536 PWID in San Francisco and Los Angeles, California from 2017 to 2018. We described naloxone engagement and re-engagement cascades, and identified factors associated with receiving naloxone in the past six months and currently owning naloxone. RESULTS The engagement cascade showed 72 % of PWID ever received naloxone, 49 % received it in the past six months, and 35 % currently owned naloxone. The re-engagement cascade showed, among PWID who received naloxone in the past six months, 74 % used and/or lost naloxone, and 67 % refilled naloxone. In multivariable analyses, identifying as Latinx (aRR = 0.53; 95 % CI: 0.39, 0.72) and Black (aRR = 0.73; 95 % CI: 0.57, 0.94) vs White were negatively associated with receiving naloxone in the past six months, while using opioids 1-29 times (aRR = 1.35; 95 % CI: 1.04, 1.75) and 30+ times (aRR = 1.52; 95 % CI: 1.17, 1.99) vs zero times in the past 30 days and witnessing an overdose in the past six months (aRR = 1.69; 95 % CI: 1.37, 2.08) were positively associated with receiving naloxone in the past six months. In multivariable analyses, being unhoused vs housed (aRR = 0.82; 95 % CI: 0.68, 0.99) was negatively associated with currently owning naloxone. CONCLUSIONS Our study adds to the literature by developing naloxone engagement and re-engagement cascades to identify disparities. Naloxone scale-up should engage populations facing inequitable access, including people of color and those experiencing homelessness.
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Affiliation(s)
- Elizabeth N Kinnard
- Division of Epidemiology, University of California Berkeley School of Public Health, 2121 Berkeley Way, Berkeley, CA, 94720, USA; Community Health Research Division, RTI International, 2150 Shattuck Avenue, Suite 800, Berkeley, CA, 94704, USA.
| | - Ricky N Bluthenthal
- Department of Preventive Medicine, Institute for Prevention Research, Keck School of Medicine, University of Southern California, 2001 N. Soto St., Los Angeles, CA, 90033, USA
| | - Alex H Kral
- Community Health Research Division, RTI International, 2150 Shattuck Avenue, Suite 800, Berkeley, CA, 94704, USA
| | - Lynn D Wenger
- Community Health Research Division, RTI International, 2150 Shattuck Avenue, Suite 800, Berkeley, CA, 94704, USA
| | - Barrot H Lambdin
- Community Health Research Division, RTI International, 2150 Shattuck Avenue, Suite 800, Berkeley, CA, 94704, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, Second Floor, San Francisco, CA, 94158, USA; Department of Global Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA
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Monico LB, Ludwig A, Lertch E, Dionne R, Fishman M, Schwartz RP, Mitchell SG. Opioid overdose experiences in a sample of US adolescents and young adults: a thematic analysis. Addiction 2021; 116:865-873. [PMID: 32770757 DOI: 10.1111/add.15216] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/20/2020] [Accepted: 07/31/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Opioid overdose deaths among adolescents and young adults have risen sharply in the United States over recent decades. This study aimed to explore the nature of adolescent and young adult perspectives on overdose experiences. DESIGN This study involved thematic analysis of interviews undertaken as part of a mixed-methods, randomized trial of extended release naltrexone (XR-NTX) versus treatment-as-usual (TAU) for adolescents and young adults (aged 15-21 years) with opioid use disorder (OUD). SETTING Participants were recruited during a residential treatment episode at Mountain Manor Treatment Center, in Baltimore, MD, USA. PARTICIPANTS/CASES As part of the qualitative component of this study, 35 adolescents/young adults completed up to three interviews: at baseline, 3 and 6 months after release from residential opioid use disorder treatment. MEASUREMENTS Semi-structured interviews solicited participant experiences with opioid use disorder treatment; their satisfaction with the medications used to treat opioid use disorder; counseling received; current substance use; issues related to treatment retention; their treatment goals; and their future outlook. FINDINGS Four broad themes emerged: (1) adolescents/young adults had difficulty identifying overdoses due to interpreting subjective symptoms and a lack of memory of the event, (2) this sample had difficulty perceiving risk that is misaligned with traditional understandings of overdose intentionality, (3) adolescents/young adults did not interpret personal overdose events as a catalyst for behavior change and (4) this sample experienced a greater impact to behavior change through witnessing an overdose of someone in their social network. CONCLUSIONS The sample of US adolescents and young adults in treatment for opioid use disorder expressed difficulty identifying whether or not they had experienced an overdose, expressed fluctuating intentionality for those events and did not have clear intentions to change their behavior. Witnessing an overdose appeared to be as salient an experience as going through an overdose oneself.
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Affiliation(s)
| | | | | | - Ross Dionne
- Pacifica Graduate Institute, Carpinteria, CA, USA
| | - Marc Fishman
- Mountain Manor Treatment Center, Baltimore, MD, USA
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13
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Bennett AS, Freeman R, Des Jarlais DC, Aronson ID. Reasons People Who Use Opioids Do Not Accept or Carry No-Cost Naloxone: Qualitative Interview Study. JMIR Form Res 2020; 4:e22411. [PMID: 33355094 PMCID: PMC7787889 DOI: 10.2196/22411] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/25/2020] [Accepted: 12/03/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Many people use opioids and are at risk of overdose. Naloxone is an opioid antagonist used to counter the effects of opioid overdose. There is an increased availability of naloxone in New York City; however, many who use opioids decline no-cost naloxone even when offered. Others may have the medication but opt not to carry it and report that they would be reluctant to administer it if they were to witness an overdose. OBJECTIVE We aim to better understand why people who use opioids may be reluctant to accept, carry, and administer naloxone, and to inform the development of messaging content that addresses barriers to its acceptance and use. METHODS We conducted formative qualitative interviews with 20 people who use opioids who are 18 years and older in New York City. Participants were recruited via key informants and chain referral. RESULTS Participants cited 4 main barriers that may impede rates of naloxone acceptance, possession, and use: (1) stigma related to substance use, (2) indifference toward overdose, (3) fear of negative consequences of carrying naloxone, and (4) fear of misrecognizing the need for naloxone. Participants also offered suggestions about messaging content to tackle the identified barriers, including messages designed to normalize naloxone possession and use, encourage shared responsibility for community health, and elicit empathy for people who use drugs. Taken together, participants' narratives hold implications for the following potential messaging content: (1) naloxone is short-acting, and withdrawal sickness does not have to be long-lasting; (2) it is critical to accurately identify an opioid-involved overdose; (3) anyone can overdose; (4) naloxone cannot do harm; and (5) the prompt administration of the medication can help ensure that someone can enjoy another day. Finally, participants suggested that messaging should also debunk myths and stereotypes about people who use drugs more generally; people who use opioids who reverse overdoses should be framed as lay public health advocates and not just "others" to be managed with stigmatizing practices and language. CONCLUSIONS It must be made a public health priority to get naloxone to people who use opioids who are best positioned to reverse an overdose, and to increase the likelihood that they will carry naloxone and use it when needed. Developing, tailoring, and deploying messages to address stigma, indifference toward overdose, fear and trepidation about reversing an overdose, and fear of police involvement may help alleviate fears among some people who are reluctant to obtain naloxone and use the medication on someone in an overdose situation.
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Affiliation(s)
- Alex S Bennett
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
- Center for Drug Use and HIV Research, School of Global Public Health, New York University, New York, NY, United States
| | - Robert Freeman
- School of Social Work, New York University, New York, NY, United States
| | - Don C Des Jarlais
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
- Center for Drug Use and HIV Research, School of Global Public Health, New York University, New York, NY, United States
- Department of Epidemiology, School of Global Public Health, New York University, New York City, NY, United States
| | - Ian David Aronson
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
- Center for Drug Use and HIV Research, School of Global Public Health, New York University, New York, NY, United States
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14
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Franklin Edwards G, Mierisch C, Mutcheson B, Horn K, Henrickson Parker S. A review of performance assessment tools for rescuer response in opioid overdose simulations and training programs. Prev Med Rep 2020; 20:101232. [PMID: 33163333 PMCID: PMC7610043 DOI: 10.1016/j.pmedr.2020.101232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/11/2020] [Accepted: 10/13/2020] [Indexed: 12/18/2022] Open
Abstract
Since the 1990s, more than 600 overdose response training and education programs have been implemented to train participants to respond to an opioid overdose in the United States. Given this substantial investment in overdose response training, valid assessment of a potential rescuers' proficiency in responding to an opioid overdose is important. The aim of this article is to review the current state of the literature on outcome measures utilized in opioid overdose response training. Thirty-one articles published between 2014 and 2020 met inclusion criteria. The reviewed articles targeted laypersons, healthcare providers, and first responders. The assessment tools included five validated questionnaires, fifteen non-validated questionnaires, and nine non-validated simulation-based checklists (e.g., completion of critical tasks and time to completion). Validated multiple choice knowledge assessment tools were commonly used to assess the outcomes of training programs. It is unknown how scores on these assessment tools may correlate with actual rescuer performance responding to an overdose. Seven studies reported ceiling effects most likely attributed to participants' background medical knowledge or experience. The inclusion of simulation-based outcome measures of performance, including the commission of critical errors and the time to naloxone administration, provides better insight into rescuer skill proficiency.
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Affiliation(s)
- G. Franklin Edwards
- Translational Biology, Medicine and Health, Virginia Tech, Blacksburg, VA, USA
- Fralin Biomedical Research Institute at VTC, Roanoke, VA, USA
- Carilion Clinic Center for Simulation, Research and Patient Safety, Roanoke, VA, USA
| | - Cassandra Mierisch
- Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
- Carilion Clinic, Department of Orthopedics and Opioid Task Force, Roanoke, VA, USA
| | | | - Kimberly Horn
- Fralin Biomedical Research Institute at VTC, Roanoke, VA, USA
- Virginia-Maryland College of Veterinary Medicine, Department of Population Health Sciences Virginia Tech, Blacksburg, VA, USA
| | - Sarah Henrickson Parker
- Fralin Biomedical Research Institute at VTC, Roanoke, VA, USA
- Carilion Clinic Center for Simulation, Research and Patient Safety, Roanoke, VA, USA
- Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
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15
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Opioid Prescribing with Take-Home Naloxone: Rationale and Recommendations. CURRENT ANESTHESIOLOGY REPORTS 2020. [DOI: 10.1007/s40140-020-00419-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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Kenney SR, Anderson BJ, Bailey GL, Herman DS, Conti MT, Stein MD. Examining Overdose and Homelessness as Predictors of Willingness to Use Supervised Injection Facilities by Services Provided Among Persons Who Inject Drugs. Am J Addict 2020; 30:21-25. [PMID: 32519449 DOI: 10.1111/ajad.13065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/26/2020] [Accepted: 05/09/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Internationally, supervised injection facilities (SIFs) have demonstrated efficacy in reducing rates of overdose and promoting entry into treatment among persons who inject drugs (PWID); however, they remain unavailable in the United States. Early findings examining American PWID illustrate high overall willingness to use SIFs. The current study expands upon this research by examining PWID's likelihood to use SIFs based on services offered (eg, provides clean needles, linkage to treatment programs) and whether known risk factors (prior overdose, homelessness) influence PWID's willingness to use a SIF. METHODS Participants (n = 184) were patients entering short-term inpatient opioid withdrawal management in Massachusetts between May 2018 and February 2019 who reported injection drug use in the prior 30 days. We examined PWID's likelihood to use a SIF if eight unique services were available, and compared if this differed by overdose history and homelessness status using ordered logistic regression and Pearson's χ2 -tests of independence. RESULTS Participants (34.2 [±8.3 SD] years of age, 68.5% male, 85.9% white, 8.2% Hispanic) reported being most likely to use SIFs that provided safety from police intervention (86.7%), entry into withdrawal management (85.9%), or clean needles (83.2%). Drug works disposal and safety from police were particularly important for PWID with a history of overdose. CONCLUSION AND SCIENTIFIC SIGNIFICANCE Overall, treatment-seeking PWIDs reported greater willingness to utilize SIFs if particular services were provided. These findings point to features of SIFs that may enhance treatment-seeking PWID's amenability to utilizing these services if such sites open in the United States. (Am J Addict 2021;30:21-25).
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Affiliation(s)
- Shannon R Kenney
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, Rhode Island.,Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Bradley J Anderson
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, Rhode Island
| | - Genie L Bailey
- Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Stanley Street Treatment and Resources, Inc, Fall River, Massachusetts
| | - Debra S Herman
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, Rhode Island.,Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Micah T Conti
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, Rhode Island
| | - Michael D Stein
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, Rhode Island.,School of Public Health, Boston University, Boston, Massachusetts
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Abstract
This paper is the fortieth consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2017 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, CUNY, 65-30 Kissena Blvd., Flushing, NY, 11367, United States.
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18
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Lin LA, Brummett CM, Waljee JF, Englesbe MJ, Gunaseelan V, Bohnert ASB. Association of Opioid Overdose Risk Factors and Naloxone Prescribing in US Adults. J Gen Intern Med 2020; 35:420-427. [PMID: 31820218 PMCID: PMC7018930 DOI: 10.1007/s11606-019-05423-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Prescribing naloxone to patients is a key strategy to prevent opioid overdoses, but little is known about the reach of naloxone prescribing. OBJECTIVE Determine patient factors associated with receiving naloxone and trends over time in patients with key overdose risk factors. DESIGN Retrospective observational study. PARTICIPANTS Using the Clinformatics DataMart, a US-wide health insurance claims dataset, we compared adults who received opioids and naloxone (opioid+naloxone) from January 2014 to June 2017 with adults who received opioids without naloxone (opioids only), matched on gender, age ± 5 years, month/year of opioid fill, and number of opioid claims. MAIN MEASURES Key patient-level opioid overdose risk factors included receipt of high-dosage opioids, concurrent benzodiazepines, history of opioid and other substance use disorders, and history of opioid overdose. RESULTS We included 3963 opioid+naloxone and 19,815 opioid only patients. Key factors associated with naloxone fills included high opioid daily dosage (50 to < 90 morphine milligram equivalents (MME): AOR = 2.43, 95% CI 2.15-2.76 and ≥ 90 MME: AOR = 3.94, 95% CI 3.47-4.46; reference: < 50 MME), receiving concurrent benzodiazepines (AOR = 1.27, 95% CI 1.16-1.38), and having a diagnosis of opioid use disorder (AOR = 1.56, 95% CI 1.40-1.73). History of opioid overdose was not associated with naloxone (AOR = 0.92, 95% CI 0.74-1.15). The percent of patients receiving naloxone increased, yet less than 2% of patients in any of the key overdose risk factor groups received naloxone by the last 6 months of the study period. CONCLUSIONS Naloxone prescribing has increased and was more likely to be co-prescribed to patients with some risk factors for overdose. However, overall prescribing remains minimal. Additional efforts are needed across health systems to increase naloxone prescribing for patients at risk for opioid overdose.
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Affiliation(s)
- Lewei Allison Lin
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI, USA.
| | - Chad M Brummett
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI, USA
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer F Waljee
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI, USA
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Michael J Englesbe
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI, USA
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Vidhya Gunaseelan
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI, USA
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Amy S B Bohnert
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI, USA
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19
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Kline A, Mattern D, Cooperman N, Dooley-Budsock P, Williams JM, Borys S. "A Blessing and a Curse:" Opioid Users' Perspectives on Naloxone and the Epidemic of Opioid Overdose. Subst Use Misuse 2020; 55:1280-1287. [PMID: 32182153 DOI: 10.1080/10826084.2020.1735437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background: To address the alarming rise in opioid overdose deaths, states have increased public access to the overdose reversal medication, naloxone. While some studies suggest that increased naloxone accessibility reduces opioid overdose deaths, others raise concerns about unintended consequences, such as increases in risky drug use and opioid re-use post-overdose to counter naloxone-induced withdrawal symptoms. Few studies have examined the impact of expanded naloxone access on the attitudes and behaviors of opioid users. Methods: In this qualitative study, we conducted in-depth, semi-structured interviews with 36 English-speaking opioid users 18+ years of age. Informants were recruited from an urban methadone clinic, a needle exchange program and a residential treatment program. The approximately hour-long interviews focused on users' attitudes and behaviors surrounding naloxone, opioid use and overdose. Transcribed audio-recordings of interviews were analyzed using NVivo. Results: Informants were ambivalent about naloxone, widely acknowledging its life-saving benefits while reporting such negative effects as severe withdrawal symptoms and the promotion of riskier drug use. Naloxone-induced withdrawal, coupled with misperceptions about naloxone's pharmacological effects, prompted overdose survivors to rapidly re-use opioids and refuse hospitalization following an overdose reversal. About half the sample believed naloxone led to greater risk-taking by others, such as fentanyl use or use in higher quantities, but did not endorse riskier drug use themselves. Conclusions: The results suggest the need for targeted education about the pharmacological effects of naloxone and better strategies for managing naloxone-induced withdrawal. Future research should focus on the extent to which naloxone is associated with greater opioid risk-taking.
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Affiliation(s)
- Anna Kline
- Division of Addiction Psychiatry, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Dina Mattern
- Division of Addiction Psychiatry, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Nina Cooperman
- Division of Addiction Psychiatry, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Patricia Dooley-Budsock
- Division of Addiction Psychiatry, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Jill M Williams
- Division of Addiction Psychiatry, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Suzanne Borys
- Division of Mental Health and Addiction Services, Trenton, New Jersey, USA
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20
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Carson L. Stigma Associated with Opioid Use Disorders in Adolescents Limits Naloxone Prescribing. J Pediatr Nurs 2019; 49:92-96. [PMID: 31669814 DOI: 10.1016/j.pedn.2019.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 09/09/2019] [Accepted: 10/03/2019] [Indexed: 12/28/2022]
Abstract
THEORETICAL PRINCIPLES Parse's theory of humanbecoming describes shame as a sense that one is failing to conform to both personal and societal expectations of high value. Shame and stigma, negative perceptions others hold of an individual based on failure to conform to societal expectations, that surround opioid use disorders are linked to patients not seeking medical treatment due to the social isolation and humiliation brought on by the disease. PHENOMENON ADDRESSED This article reviews the resistance of some health care providers to discuss the realities of substance abuse with adolescent patients and their families, and identifies how the stigma that some health care providers place on opioid use disorders makes them less likely to discuss and prescribe naloxone, the reversal agent for opioids. When families are prepared to prevent overdose deaths by administering naloxone, lives can be saved, and time can be preserved for developing long-term treatment options. RESEARCH LINKAGES Research should develop curricula that teach how to identify unconscious bias that may exist on the part of the healthcare provider, and to understand the negative effects of stigmatizing opioid use. Bedside nurses and practitioners should be equipped to educate patients and their families about naloxone and its availability, and to explain that it is a safe and effective way to prevent opioid related deaths. When presented in a nonjudgmental way, information about naloxone is a critical component in addressing the opioid epidemic, preventing deaths and providing time for further treatment options.
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Affiliation(s)
- Lydia Carson
- New York-Presbyterian Morgan Stanley Children's Hospital, NY, United States of America.
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21
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Bessen S, Metcalf SA, Saunders EC, Moore SK, Meier A, McLeman B, Walsh O, Marsch LA. Barriers to naloxone use and acceptance among opioid users, first responders, and emergency department providers in New Hampshire, USA. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 74:144-151. [PMID: 31590090 DOI: 10.1016/j.drugpo.2019.09.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 08/01/2019] [Accepted: 09/20/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The United States is in the midst of a devastating opioid crisis, and the state of New Hampshire (NH) has been disproportionately impacted. Naloxone is an opioid overdose reversal medication that is critical for saving lives. This study was conducted to understand emergency responders' and opioid users' experiences with, and opinions about, naloxone use and distribution in NH. METHODS Semi-structured interviews were conducted with 76 opioid users and 36 emergency responders in six NH counties in 2016-2017. Interviews focused on respondents' experiences with opioid use and overdose. Interviews were transcribed, coded, and reviewed for consensus among coders. Directed content analysis was used to review high-level domains and identify subthemes. RESULTS Users and responders largely agreed that naloxone had become increasingly available in NH at the time of the study. Reported responder barriers to naloxone acceptance included perceptions that increased naloxone availability may enable riskier opioid use and fails to address the underlying causes of addiction. Reported opioid-user barriers included cost, legality, and lack of knowledge regarding distribution locations and indications for use. CONCLUSION Opioid users' and emergency responders' perceptions about naloxone may limit the optimal use of naloxone within the community. This study identifies opportunities to address misconceptions about naloxone and challenges in accessing naloxone, which may improve opioid overdose prevention strategies.
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Affiliation(s)
- Sarah Bessen
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH 03755, USA.
| | - Stephen A Metcalf
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, 46 Centerra Parkway, Suite 315, Lebanon, NH, USA.
| | - Elizabeth C Saunders
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA.
| | - Sarah K Moore
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, 46 Centerra Parkway, Suite 315, Lebanon, NH, USA.
| | - Andrea Meier
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, 46 Centerra Parkway, Suite 315, Lebanon, NH, USA.
| | - Bethany McLeman
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, 46 Centerra Parkway, Suite 315, Lebanon, NH, USA.
| | - Olivia Walsh
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, 46 Centerra Parkway, Suite 315, Lebanon, NH, USA.
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, 46 Centerra Parkway, Suite 315, Lebanon, NH, USA.
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Hargraves D, White CC, Mauger MR, Puthota A, Pallerla H, Wigle P, Brubaker SL, Schlaudecker JD. Evaluation of an interprofessional naloxone didactic and skills session with medical residents and physician assistant learners. Pharm Pract (Granada) 2019; 17:1591. [PMID: 31592036 PMCID: PMC6763304 DOI: 10.18549/pharmpract.2019.3.1591] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 09/01/2019] [Indexed: 11/14/2022] Open
Abstract
Background The CDC has reported 399,230 opioid-related deaths from 1999-2017. In 2018, the US surgeon general issued a public health advisory, advising all Americans to carry naloxone. Studies show that enhanced naloxone access directly reduces death from opioid overdose. Despite this, health care professional learners report low knowledge and confidence surrounding naloxone. Therefore, it becomes critical that medical education programs incorporate didactic and experiential sessions improving knowledge, skills and attitudes regarding harm reduction through naloxone. Objectives 1. Describe the components and evaluation of a replicable and adaptable naloxone didactic and skills session model for medical providers; 2. Report the results of the evaluation from a pilot session with family medicine residents and physician assistant students; and 3. Share the session toolkit, including evaluation surveys and list of materials used. Methods In July 2017, a literature search was completed for naloxone skill training examining best practices on instruction and evaluation. A training session for family medicine residents and physician assistant learners was designed and led by University of Cincinnati College of Medicine and College of Pharmacy faculty. The same faculty designed a pre and post session evaluation form through internal review on elements targeting naloxone knowledge, attitude, and self-efficacy. Results The training session included one hour for a didactic and one hour for small group live skills demonstration in four methods of naloxone administration (syringe and ampule, nasal atomizer, branded nasal spray and auto injector). Forty-eight participants showed statistically significant (p<0.05) improvement in knowledge (67.5% to 95.9%), attitudes (71.2% to 91.2%), and self-efficacy (62.1% to 97.8%) from pre to post assessment. Forty-four of 48 participants agreed that the pace of the training was appropriate and that the information will be of use in their respective primary care practices. Supply costs for the session were USD 1,200, with the majority being reusable on subsequent trainings. Conclusions Our study of a naloxone didactic and skills session for primary care trainees demonstrated significant improvements in knowledge, self-efficacy, and attitudes. It provides an adaptable and efficient model for delivery of knowledge and skills in naloxone administration training. The pilot data suggest that the training was efficacious.
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Affiliation(s)
- Daniel Hargraves
- Department of Family & Community Medicine, College of Medicine, University of Cincinnati. Cincinnati, OH (United States).
| | - Christopher C White
- Associate Professor of Family & Community Medicine. College of Medicine, University of Cincinnati. Cincinnati, OH (United States).
| | - Marcia R Mauger
- College of Medicine, University of Cincinnati. Cincinnati, OH (United States).
| | - Aruna Puthota
- The Christ Hospital; & Family Medicine Residency Program, University of Cincinnati. Cincinnati, OH (United States).
| | - Harini Pallerla
- Department of Family & Community Medicine, College of Medicine, University of Cincinnati. Cincinnati, OH (United States).
| | - Patricia Wigle
- James L. Winkle College of Pharmacy, University of Cincinnati. Cincinnati, OH (United States).
| | - Sarah L Brubaker
- Program Coordinator, Department of Family & Community Medicine, College of Medicine, University of Cincinnati. Cincinnati, OH (United States).
| | - Jeffrey D Schlaudecker
- Associate Professor of Family & Community Medicine, College of Medicine, University of Cincinnati. Cincinnati, OH (United States).
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Tormohlen KN, Tobin KE, Davey-Rothwell MA, Latkin C. Low overdose responding self-efficacy among adults who report lifetime opioid use. Drug Alcohol Depend 2019; 201:142-146. [PMID: 31212214 PMCID: PMC6699739 DOI: 10.1016/j.drugalcdep.2019.03.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 03/14/2019] [Accepted: 03/21/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Evaluations of overdose response programs suggest effectiveness in preventing overdose-related death and individual willingness to respond to an overdose. However, knowledge of and confidence in performing response behaviors is necessary for individuals to intervene. This study assessed overdose responding self-efficacy among adults who reported lifetime opioid use. METHODS Data come from a cross-sectional survey, part of a randomized controlled trial designed for adults living with hepatitis C. Participants were 18 years old or older, and reported lifetime opioid use. Overdose responding self-efficacy was assessed by perceived knowledge and/or need for additional training to have confidence responding to an overdose. Univariate statistics were calculated for overdose responding self-efficacy, and individual characteristics and experiences. Adjusted logistic regression was used to identify variables associated with low overdose responding self-efficacy. RESULTS Of the 424 participants, 67.2% reported low overdose responding self-efficacy. Sixty percent witnessed and 30.4% experienced an overdose in the past year. Witnessing an overdose in the past year, experience with naloxone training, and receiving and using naloxone were associated with high overdose responding self-efficacy. While, apprehension with particular response behaviors (e.g. rescue breathing) was associated with low overdose responding self-efficacy. CONCLUSIONS A large proportion of adults who reported lifetime opioid use did not feel confident or knowledgeable responding to an overdose. This could be influenced by overdose exposure, specific response behaviors, and response trainings.
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Affiliation(s)
- Kayla N Tormohlen
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 888, Baltimore, MD 21205, USA.
| | - Karin E Tobin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street, 2nd Floor, Baltimore, MD 21205, USA.
| | - Melissa A Davey-Rothwell
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street, 2nd Floor, Baltimore, MD 21205, USA.
| | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 737, Baltimore, MD 21205, USA.
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Gicquelais RE, Mezuk B, Foxman B, Thomas L, Bohnert ASB. Justice involvement patterns, overdose experiences, and naloxone knowledge among men and women in criminal justice diversion addiction treatment. Harm Reduct J 2019; 16:46. [PMID: 31311572 PMCID: PMC6636104 DOI: 10.1186/s12954-019-0317-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/05/2019] [Indexed: 12/17/2022] Open
Abstract
Background Persons in addiction treatment are likely to experience and/or witness drug overdoses following treatment and thus could benefit from overdose education and naloxone distribution (OEND) programs. Diverting individuals from the criminal justice system to addiction treatment represents one treatment engagement pathway, yet OEND needs among these individuals have not been fully described. Methods We characterized justice involvement patterns among 514 people who use opioids (PWUO) participating in a criminal justice diversion addiction treatment program during 2014–2016 using a gender-stratified latent class analysis. We described prevalence and correlates of naloxone knowledge using quasi-Poisson regression models with robust standard errors. Results Only 56% of participants correctly identified naloxone as an opioid overdose treatment despite that 68% had experienced an overdose and 79% had witnessed another person overdose. We identified two latent justice involvement classes: low involvement (20.3% of men, 46.5% of women), characterized by older age at first arrest, more past-year arrests, and less time incarcerated; and high involvement (79.7% of men, 53.5% of women), characterized by younger age at first arrest and more lifetime arrests and time incarcerated. Justice involvement was not associated with naloxone knowledge. Male participants who had personally overdosed more commonly identified naloxone as an overdose treatment after adjustment for age, race, education level, housing status, heroin use, and injection drug use (prevalence ratio [95% confidence interval]: men 1.5 [1.1–2.0]). Conclusions All PWUO in criminal justice diversion programs could benefit from OEND given the high propensity to experience and witness overdoses and low naloxone knowledge across justice involvement backgrounds and genders. Electronic supplementary material The online version of this article (10.1186/s12954-019-0317-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rachel E Gicquelais
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA. .,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA. .,Department of Psychiatry, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA. .,Current Address: Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, E7133A, Baltimore, MD, 21205, USA.
| | - Briana Mezuk
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Betsy Foxman
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Laura Thomas
- Department of Psychiatry, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA.,Veterans Affairs Center for Clinical Management Research, 2215 Fuller Road, Ann Arbor, MI, 48105, USA
| | - Amy S B Bohnert
- Department of Psychiatry, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA.,Veterans Affairs Center for Clinical Management Research, 2215 Fuller Road, Ann Arbor, MI, 48105, USA
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Comparative Human Factors Evaluation of Two Nasal Naloxone Administration Devices: NARCAN ® Nasal Spray and Naloxone Prefilled Syringe with Nasal Atomizer. Pain Ther 2019; 8:89-98. [PMID: 30877583 PMCID: PMC6513948 DOI: 10.1007/s40122-019-0118-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Opioid overdose rescue situations are time-critical, high-stress scenarios that frequently require nonmedical first responders or bystanders to intervene and administer naloxone to avoid opioid-induced fatalities. Training nonmedical personnel to respond during such mentally constraining situations presents the human factors challenge of how best to design a safe and effective lay delivery system. This paper comparatively evaluates the ease of use of two nasal naloxone administration products: NARCAN® Nasal Spray and a naloxone prefilled syringe with nasal atomizer (PFS-NA). METHODS We evaluated the use requirements and usability of NARCAN® Nasal Spray versus a naloxone PFS-NA using a systems-oriented method. First, we determined the use requirements of different user groups. Next, we focused on constructing a human factors task analysis of both products. Finally, we conducted a comparative risk assessment of the tasks that were different between the two products. RESULTS Inexperienced users, such as nonmedical first responders and bystanders, are at the highest risk of incorrectly administering naloxone, particularly in high-stress emergency opioid overdose situations. The device Preparation and Medication Delivery tasks most differentiate the use of NARCAN® Nasal Spray and a PFS-NA. The level of task complexity and number of steps within those tasks is substantially greater for a PFS-NA than for the NARCAN® Nasal Spray. CONCLUSIONS NARCAN® Nasal Spray requires fewer steps and is easier to administer than a naloxone PFS-NA. Thus, using NARCAN® Nasal Spray should increase the likelihood that nonmedical personnel correctly deliver naloxone in time-critical, high-stress opioid overdose rescue situations. FUNDING ADAPT Pharma, Inc.
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Barré T, Vorspan F, Fortias M, Veyrier M, Cavagna P, Azuar J, Nicolas L, Naccache F, Barreteau H, Bellivier F, Bloch V. Pratique de l’ATU de cohorte de la naloxone intranasale (Nalscue®) : mise en place dans un CSAPA parisien. Therapie 2018; 73:495-500. [DOI: 10.1016/j.therap.2018.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 03/08/2018] [Accepted: 03/27/2018] [Indexed: 11/30/2022]
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Tobin K, Clyde C, Davey-Rothwell M, Latkin C. Awareness and access to naloxone necessary but not sufficient: Examining gaps in the naloxone cascade. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 59:94-97. [PMID: 30075401 DOI: 10.1016/j.drugpo.2018.07.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 06/22/2018] [Accepted: 07/15/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Despite promising findings of opioid overdose education and naloxone distribution (OEND) programs, overdose continues to be a major cause of mortality. The "cascade of care" is a tool for identifying steps involved in achieving optimal health outcomes. We applied the cascade concept to identify gaps in naloxone use. METHODS Data came from a cross-sectional survey of 353 individuals aged 18 and older who self-reported lifetime history of heroin use. RESULTS The sample was majority male (65%) and reported use of heroin (74%) and injection (57%) in the past 6 months. Ninety percent had ever witnessed an overdose and of these 59% were in the prior year. Awareness of naloxone (90%) was high. Of those aware, over two-thirds reported having ever received (e.g. access) (69%) or been trained to use naloxone (60%). Of those who had ever received naloxone (n = 218) over one-third reported possession never (36%) or rarely/sometimes carrying naloxone (38%), while 26% reported always carrying. Nearly half of those who had ever received naloxone reported ever use to reverse an opiate overdose (45%). Among individuals who had ever received naloxone, possession often/always compared to never was associated with being female (RRR = 2.88, 95%CI = 1.31-6.27) and ever used naloxone during an overdose (RRR = 4.68, 95%CI = 2.00-11.0). CONCLUSIONS This study identifies that consistent possession is a gap in the naloxone cascade. Future research is needed to understand reasons for not always carrying naloxone.
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Affiliation(s)
- Karin Tobin
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, 2213 McElderry Street, 2nd Floor, Baltimore, MD, 21205, USA.
| | - Catie Clyde
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, 2213 McElderry Street, 2nd Floor, Baltimore, MD, 21205, USA
| | - Melissa Davey-Rothwell
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, 2213 McElderry Street, 2nd Floor, Baltimore, MD, 21205, USA
| | - Carl Latkin
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, 2213 McElderry Street, 2nd Floor, Baltimore, MD, 21205, USA
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Watson DP, Ray B, Robison L, Huynh P, Sightes E, Walker LS, Brucker K, Duwve J. Lay responder naloxone access and Good Samaritan law compliance: postcard survey results from 20 Indiana counties. Harm Reduct J 2018; 15:18. [PMID: 29625609 PMCID: PMC5889562 DOI: 10.1186/s12954-018-0226-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/28/2018] [Indexed: 11/20/2022] Open
Abstract
Background To reduce fatal drug overdoses, two approaches many states have followed is to pass laws expanding naloxone access and Good Samaritan protections for lay persons with high likelihood to respond to an opioid overdose. Most prior research has examined attitudes and knowledge among lay responders in large metropolitan areas who actively use illicit substances. The present study addresses current gaps in knowledge related to this issue through an analysis of data collected from a broader group of lay responders who received naloxone kits from 20 local health departments across Indiana. Methods Postcard surveys were included inside naloxone kits distributed in 20 Indiana counties, for which 217 returned cards indicated the person completing it was a lay responder. The survey captured demographic information and experiences with overdose, including the use of 911 and knowledge about Good Samaritan protections. Results Few respondents had administered naloxone before, but approximately one third had witnessed a prior overdose and the majority knew someone who had died from one. Those who knew someone who had overdosed were more likely to have obtained naloxone for someone other than themselves. Also, persons with knowledge of Good Samaritan protections or who had previously used naloxone were significantly more likely to have indicated calling 911 at the scene of a previously witnessed overdose. Primary reasons for not calling 911 included fear of the police and the person who overdosed waking up on their own. Conclusions Knowing someone who has had a fatal or non-fatal overdose appears to be a strong motivating factor for obtaining naloxone. Clarifying and strengthening Good Samaritan protections, educating lay persons about these protections, and working to improve police interactions with the public when they are called to an overdose scene are likely to improve implementation and outcomes of naloxone distribution and opioid-related Good Samaritan laws.
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Affiliation(s)
- Dennis P Watson
- Department of Social and Behavioral Sciences, Center for Health Engagement and Equity Research, Indiana University Richard M. Fairbanks School of Public Health, Indiana University-Purdue University Indianapolis, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA.
| | - Bradley Ray
- School of Public and Environmental Affairs, Indiana University-Purdue University Indianapolis, 801 W. Michigan St, Indianapolis, IN, 46202, USA
| | - Lisa Robison
- Department of Social and Behavioral Sciences, Center for Health Engagement and Equity Research, Indiana University Richard M. Fairbanks School of Public Health, Indiana University-Purdue University Indianapolis, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA
| | - Philip Huynh
- Department of Social and Behavioral Sciences, Center for Health Engagement and Equity Research, Indiana University Richard M. Fairbanks School of Public Health, Indiana University-Purdue University Indianapolis, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA
| | - Emily Sightes
- Department of Social and Behavioral Sciences, Center for Health Engagement and Equity Research, Indiana University Richard M. Fairbanks School of Public Health, Indiana University-Purdue University Indianapolis, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA
| | - La Shea Walker
- Department of Social and Behavioral Sciences, Center for Health Engagement and Equity Research, Indiana University Richard M. Fairbanks School of Public Health, Indiana University-Purdue University Indianapolis, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA
| | - Krista Brucker
- Department of Emergency Medicine, Indiana University School of Medicine, Indiana University School of Medicine, 3930 Georgetown Rd, Indianapolis, IN, 46254, USA
| | - Joan Duwve
- Department of Health Policy and Management and the Center for Public Health Practice, Indiana University Richard M. Fairbanks School of Public Health, Indiana University-Purdue University Indianapolis, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA
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Pharmaceutical opioid overdose deaths and the presence of witnesses. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 55:8-13. [PMID: 29433040 DOI: 10.1016/j.drugpo.2017.12.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/29/2017] [Accepted: 12/18/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND In the past two decades, rates of pharmaceutical opioid use and harms resulting from their use (including death) have risen. The present study identified a series of fatal opioid overdoses where there was evidence that witnesses had noted symptoms consistent with overdose, and examined associated contextual factors. METHODS A retrospective review was undertaken utilising the Coroners Court of Victoria's Overdose Deaths Register for pharmaceutical opioid overdose deaths between 2011 and 2013. Information on the source of pharmaceutical opioids, co-contributing drugs, history of drug dependence, and mental illness was extracted and coded. RESULTS Pharmaceutical opioids were involved in 587 deaths, and within these, 125 cases (21%) were witnessed. The majority of these witnessed deaths (77.6%) occurred at the deceased's residence, with the witness being a partner or unrelated acquaintance who did not realise the significance of what they were witnessing. The most common contributing pharmaceutical opioids were methadone (49.6%), codeine (32.0%), and oxycodone (19.2%), with the source more often prescribed than diverted. Co-contributing drugs were involved in 110 cases, with the most common being benzodiazepines. Evidence of current dependence and mental illness was found in 53.6% of cases. CONCLUSION Most pharmaceutical opioid overdose deaths with a witness present occurred in the deceased's home, with symptoms of overdose being noted, but not acted upon. These findings support the trialling of education and/or naloxone to partners and family members of people who use pharmaceutical opioids in order to reduce overdose deaths.
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