Development of a proto-typology of opiate overdose onset

Opioid overdose experiences in a sample of US adolescents and young adults: a thematic analysis

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.

Iterative categorisation (IC) (part 2): interpreting qualitative data

Iterative categorisation (IC) is a systematic and transparent technique for analysing qualitative textual data, first presented in Addiction in 2016. IC breaks the analytical process down into stages, separating basic 'description' from more advanced 'interpretation'. This paper focuses on the interpretive analytical stage that is shown to comprise three core processes: (i) conceptualising (undertaken inductively, deductively or abductively); (ii) differentiating; and (iii) externalising. Each process is described, followed by published examples to support what has been explained. As qualitative analyses tend to be recursive rather than linear, the three processes often need to be repeated to account for all the data. Following the stages of IC will ensure that qualitative research generates improved understanding of the phenomena being studied, study findings contribute to and enhance the existing literature, the audience for any qualitative output is broad and international, and any practical implications or study recommendations are relevant to other contexts and settings.

Acceptability of smartphone applications for facilitating layperson naloxone administration during opioid overdoses

Objective

We investigated user requirements for a smartphone application to coordinate layperson administration of naloxone during an opioid overdose.

Materials and Methods

We conducted interviews and focus groups with 19 nonmedical opioid users and other community members in the Kensington neighborhood of Philadelphia, Pennsylvania, which has one of the highest overdose rates in the country. Data were analyzed using thematic analysis.

Results

We found high levels of trust and reliance within one's own social group, especially nonmedical opioid users and members of the neighborhood. Participants distrusted outsiders, including professional responders, whom they perceived as uncaring and prejudiced. Participants expressed some concern over malicious use of a location-based application, such as theft when a victim is unconscious, but overall felt the benefits could outweigh the risks. Participants also trusted community-based organizations providing services such as bystander training and naloxone distribution, and felt that a smartphone application should be integrated into these services.

Discussion

Individuals affected by opioid use and overdose reacted positively to the concept for a smartphone application, which they perceived as a useful tool that could help combat the high rate of opioid overdose fatalities in their neighborhood. A sense of unity with others who have shared their experiences could be leveraged to connect willing bystanders with victims of overdose, but risk must be mitigated for layperson responders.

Conclusion

Based on participant experiences with overdoses, trust-based considerations for the design of smartphone applications to facilitate layperson response will be critical for their adoption and use in real overdose situations.

New synthetic opioids: Part of a new addiction landscape

Synthetic opioids (SO) are a major risk for public health across the world. These drugs can be divided into 2 categories, pharmaceutical and non-pharmaceutical fentanyls. A new generation of SO has emerged on the drug market since 2010. North America is currently facing an opioid epidemic of morbi-mortality, caused by over-prescription of opioids, illegally diverted prescribed medicines, the increasing use of heroin and the emergence of SO. Furthermore, this opioid crisis is also seen in Europe. SO are new psychoactive substances characterized by different feature such as easy availability on the Internet, low price, purity, legality, and lack of detection in laboratory tests. They have not been approved or are not recommended for human use. Opioid misuse is associated with somatic and psychiatric complications. For many substances, limited pharmacological information is available, increasing the risk of harmful adverse events. Health actors and the general population need to be clearly informed of the potential risks and consequences of the diffusion and use of SO.