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Russell E, Hawk M, Neale J, Bennett A, Davis C, Hill LG, Winograd R, Kestner L, Lieberman A, Bell A, Santamour T, Murray S, Schneider KE, Walley AY, Jones TS. A call for compassionate opioid overdose response. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 133:104587. [PMID: 39299143 DOI: 10.1016/j.drugpo.2024.104587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 08/27/2024] [Accepted: 09/03/2024] [Indexed: 09/22/2024]
Abstract
High dose and long-acting opioid overdose reversal drugs can precipitate withdrawal in people who are opioid dependent. Products recently brought to market for community use in the United States (US) have drawn international concern because of their increased risk of withdrawal. At the March 18-19, 2024, Compassionate Overdose Response Summit & Naloxone Dosing Meeting, a panel of harm reduction experts issued the following call to action: 1) people who use drugs should be directly involved in decisions regarding the research, development, selection, and distribution of opioid overdose reversal products; 2) regulatory agencies and pharmaceutical manufacturers should carefully consider and communicate the risk and duration of withdrawal associated with higher dose and longer-acting opioid antagonists; 3) take-home naloxone kits should include at least two doses of an intramuscular (IM) product containing 0.4 mg or an intranasal (IN) product containing ≤4 mg; 4) At this time, high dose and long-acting opioid antagonists have no use in acute opioid overdose response; and, 5) overdose response educational materials, instructions on overdose response, and training should emphasize the restoration of breathing, avoiding withdrawal, and compassionate post-overdose support and care. High dose and long-acting opioid overdose reversal drugs were approved without testing for withdrawal and are often aggressively marketed despite decades of evidence from naloxone distribution programs worldwide that the ideal dose of naloxone is one that restores breathing without inducing withdrawal. Government agencies should direct resources to harm reduction programs to make standard dose take-home naloxone products widely available among people who use drugs. Lay bystanders, people who use drugs, their families, and professional first responders can learn and apply a compassionate approach to opioid overdose response.
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Affiliation(s)
- Erin Russell
- Health Management Associates, 2501 Woodlake Cir Suite 100, Okemos, MI 48864, USA.
| | - Mary Hawk
- University of Pittsburgh School of Public Health, Behavioral and Community Health Sciences, 130 DeSoto Street 6127 Public Health, Pittsburgh, PA 15261, USA.
| | - Joanne Neale
- King's College London, 4 Windsor Walk IoPPN, Denmark Hill, London SE5 8AB, United Kingdom.
| | - Alex Bennett
- New York University, School of Global Public Health, 708 Broadway, NY, NY 10003, USA.
| | - Corey Davis
- Network for Public Health Law, 7101 York Ave S. #270, Edina, MN 55435, USA.
| | - Lucas G Hill
- The University of Texas at Austin, 2409 University Ave, A1910, PHR 2.222, Austin, TX 78712, USA.
| | - Rachel Winograd
- University of Missouri, St. Louis, 43 Benton Ct, St. Louis, MO 63121, USA.
| | - Lauren Kestner
- Center for Prevention Services' Queen City Harm Reduction, 811 Eastway Dr., Charlotte, NC 28205, USA.
| | - Amy Lieberman
- Network for Public Health Law, 7101 York Ave S. #270, Edina, MN 55435, USA.
| | - Alice Bell
- Prevention Point Pittsburgh, 460 Melwood Ave, Suite 100, Pittsburgh, PA 15213, USA.
| | - Tim Santamour
- Florida Harm Reduction Collective, 4601 3rd Ave N., Saint Petersburg, FL 33713, USA.
| | - Stephen Murray
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02119, USA.
| | - Kristin E Schneider
- Johns Hopkins Bloomberg School of Public Health, 1812 Ashland Ave, Office 333, Baltimore, MD 21030, USA.
| | - Alexander Y Walley
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, 801 Massachusetts Ave, Boston, MA, 02119, USA.
| | - T Stephen Jones
- T. Stephen Jones Public Health Consulting, 123 Black Birch Trail, Florence MA 01062, USA.
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Akhurst J, Price O, Sutherland R, Gibbs D, Dietze P, Bruno R, Agramunt S, Colledge-Frisby S, Lenton S, Salom C, Thomas N, Peacock A. Naloxone cascade of care among people who regularly inject drugs in Australia, 2020-2022. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 133:104572. [PMID: 39245026 DOI: 10.1016/j.drugpo.2024.104572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 07/29/2024] [Accepted: 08/23/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Examining take-home naloxone (THN) uptake using a 'cascade of care' framework could help identify targets for increasing THN training and carriage among people who may witness or experience opioid overdose. We describe the THN cascade and factors associated with engagement among people who inject drugs. METHODS People aged ≥18 years in Australia who inject drugs were interviewed from 2020 to 2022, reporting lifetime THN awareness and acquisition and past-month carriage. We examined factors associated with engagement using multivariable logistic regression. RESULTS Of 2,149 participants (64 % men, mean age 44.5), 85 % had heard of naloxone, of whom 76 % were aware of THN programs. Of these, 72 % had ever participated in THN training/brief education, 92 % of whom had acquired THN. Of those who had ever acquired THN and reported past-month opioid use, 63 % always/often carried THN when using opioids. Past six-month opioid agonist treatment (OAT) (adjusted odds ratio [AOR] 2.55; 95 %CI 1.91-3.42) and ≥daily injecting (1.32; 1.01-1.73) were associated with awareness. OAT (1.79; 1.38-2.33), past-year opioid overdose (1.68; 1.18-2.42) and older age (1.02; 1.00-1.03) were associated with acquisition. Primarily injecting methamphetamine (versus heroin) in the past month was associated with lower awareness (0.43; 0.31-0.58) and acquisition (0.59; 0.44-0.78). Reporting no accommodation (squatting/sleeping rough) was associated with reduced odds of carriage (0.46; 0.24-0.88). CONCLUSION Participants reported high THN awareness and acquisition, with lower carriage. Future efforts should focus on improving THN access and reducing barriers to carriage, particularly for people experiencing homelessness or who primarily inject non-opioids.
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Affiliation(s)
- Jane Akhurst
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Olivia Price
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Rachel Sutherland
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Daisy Gibbs
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia; Burnet Institute, Melbourne, Australia
| | | | - Raimondo Bruno
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia; School of Psychological Sciences, University of Tasmania, Hobart, Australia
| | - Seraina Agramunt
- National Drug Research Institute and enAble Institute, Curtin University, Perth, Australia
| | | | - Simon Lenton
- National Drug Research Institute and enAble Institute, Curtin University, Perth, Australia
| | - Caroline Salom
- Institute for Social Science Research, The University of Queensland, Brisbane Australia
| | - Natalie Thomas
- Institute for Social Science Research, The University of Queensland, Brisbane Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia; School of Psychological Sciences, University of Tasmania, Hobart, Australia.
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Dietze P, Stewart A, Hill P, Draper B, Curtis M, Kirwan A. The National Naloxone Reference Group: A collective voice on take-home naloxone policy and practice in Australia. Drug Alcohol Rev 2024; 43:685-687. [PMID: 37920147 DOI: 10.1111/dar.13771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/14/2023] [Accepted: 10/14/2023] [Indexed: 11/04/2023]
Abstract
The National Naloxone Reference Group has played a key role in the development of take-home naloxone programs, policy and practice in Australia. In this commentary we detail the origins of the group, some of its main achievements since its inception and its future directions in light of the major policy changes around naloxone that have recently occurred in Australia.
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Affiliation(s)
- Paul Dietze
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- National Drug Research Institute and EnAble Institute, Curtin University, Melbourne, Australia
| | - Ashleigh Stewart
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | - Penny Hill
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | - Bridget Draper
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | - Michael Curtis
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | - Amy Kirwan
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
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Moullin JC, Staniland L, Uren H, Nielsen S, Lenton S. Advancing the implementation of take-home naloxone by community pharmacists: Testing the role of COM-B. Drug Alcohol Rev 2024; 43:746-759. [PMID: 38287683 DOI: 10.1111/dar.13805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 01/31/2024]
Abstract
INTRODUCTION Opioid-related overdose fatalities are rising despite the increased accessibility of take-home naloxone (THN). Targeted implementation strategies are needed to improve the distribution of naloxone. This study investigates the effectiveness of a short video targeting pharmacists that addresses implementation barriers. METHODS A pre-post, mixed methods design was adopted to examine the effect of a brief behaviour change intervention (an educational video informed by the capability, opportunity, motivation affecting behaviour (COM-B) model), on factors affecting pharmacists' implementation of THN in Western Australia. Paired samples t-tests for were used to investigate intentions, knowledge, skill, confidence, feasibility, appropriateness, acceptability, attitudes, anticipated patient reactions, social support and implementation climate. Structural equation modelling examined the associations between constructs and to test the proposed mediation of motivation on capability and opportunity affecting intentions to discuss and provide THN. RESULTS We analysed data from 102 participants. At follow-up and after all participants had viewed the video, participants had significantly improved intentions, skill, confidence, anticipated reactions, social support and perceptions that THN implementation was feasible, appropriate and acceptable. No significant differences were seen for attitudes, knowledge or implementation climate. The proposed mediation effect of motivation on the associations between opportunity and intentions and capability and intentions was not supported. DISCUSSION AND CONCLUSIONS A short video directly targeting identified implementation barriers has the ability to improve key influences in the provision of THN. Dissemination of information to community pharmacists is a challenge. Implementation strategies addressing knowledge and targeting other levels of influence on intentions and behaviour are required.
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Affiliation(s)
- Joanna C Moullin
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- enAble Institute, Curtin University, Perth, Australia
| | | | - Hannah Uren
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | - Simon Lenton
- enAble Institute, Curtin University, Perth, Australia
- National Drug Research Institute, Curtin University, Perth, Australia
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Ericson ØB, Eide D, Lobmaier P, Clausen T. Mortality risk and causes of death among people who use opioids in a take-home naloxone cohort. Drug Alcohol Depend 2024; 255:111087. [PMID: 38228056 DOI: 10.1016/j.drugalcdep.2024.111087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/18/2024]
Abstract
BACKGROUND People who use opioids (PWUO) have an excess mortality from a range of causes. The cumulative effect of behavioral, social, and health risk factors complicates the interpretation of the effects of suitable interventions. This study explores mortality causes among a cohort of PWUO in the take-home naloxone (THN) program. METHODS This was a prospective cohort study of PWUO who received THN between 2015 and 2023. Participant data was linked with death registry data. Crude mortality rates and standardized mortality ratios (SMRs) were calculated for all causes, internal causes, and accidental opioid overdoses (AOOs). In addition to age and gender, risk factors like main route of administration, polydrug use, self-experienced overdoses, and using while alone were fitted in a Cox Regression model to explore factors associated with mortality. RESULTS The 2194 participants had a considerably higher mortality ratio for all causes investigated when compared to the general population (SMR=10.9, 95 % CI = 9.3,12.6). AOOs were the most prevalent cause of death (49 %). Those who reported frequent opioid use while alone had an elevated risk of dying of 2.6 (95 % CI = 1.1,6.4) compared to those who never used while alone. CONCLUSIONS Frequent opioid use while alone was associated with elevated mortality risk, supporting the importance of overdose prevention education with naloxone distribution, and additional efforts to improve environmental and social areas for safer drug-use practices among PWUO. The variety of mortality causes found in this study illustrates the need for multifaceted and targeted interventions for people at risk of overdosing.
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Affiliation(s)
- Øystein Bruun Ericson
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, P.O. box 1039 Blindern, Oslo 0315, Norway.
| | - Desiree Eide
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, P.O. box 1039 Blindern, Oslo 0315, Norway
| | - Philipp Lobmaier
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, P.O. box 1039 Blindern, Oslo 0315, Norway; Diakonhjemmet Hospital, Division of Mental Health and Substance Abuse, P.O. box 23 Vinderen, Oslo 0319, Norway
| | - Thomas Clausen
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, P.O. box 1039 Blindern, Oslo 0315, Norway
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Ferguson N, Farrugia A, Moore D, Fraser S. Remaking the 'angry Narcanned subject': Affording new subject positions through take-home naloxone training. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 123:104253. [PMID: 37995551 DOI: 10.1016/j.drugpo.2023.104253] [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: 07/02/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/25/2023]
Abstract
Naloxone is a medication used to reverse opioid overdose. Alongside its lifesaving effects, it also has a reputation for producing distress, aggression and occasionally violence upon administration. This article analyses how take-home naloxone (THN) training initiatives address naloxone's reputation for producing aggression and conflict, and how new subject positions emerge in the context of this training. While the role of naloxone in producing aggression has been discussed in a range of research, this work emphasises that such conflict is neither inevitable nor even likely because it is contingent on several other issues such as administration practices. Building on this scholarship, we work with Bruno Latour's theorisation of technological 'affordances' to analyse THN as a socially co-produced technology that, rather than either determining or neutrally communicating actions and effects, 'affords' possibilities, capacities and subjects. Analysing data drawn from observations of THN training in Victoria, Australia, and in-depth interviews with training participants, we argue that the issue of conflict upon revival affords a subject position we term the 'angry Narcanned subject'. This subject, we note, has come to hold a powerful position in understandings of naloxone, not least because it tends to accord with stereotypes of antisocial drug users. From here, we argue that a much of THN training is focused on challenging and reframing naloxone's reputation for conflict and questioning related subject positions, especially that of the angry Narcanned subject. We argue that this process of challenging and reframing affords two new subject positions for consumers: the 'capable administrator' and the 'calmer revivee'. We conclude that while THN training affords multiple, potentially positive, subject positions, unless these initiatives are accompanied by broader interventions such as decriminalisation campaigns, they may inadvertently responsibilise people who consume opioids for addressing overdose and erase the role of prohibition, criminalisation and stigmatisation in producing overdose events.
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Affiliation(s)
- Nyssa Ferguson
- Department of Public Health, La Trobe University, Australia.
| | - Adrian Farrugia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia
| | - David Moore
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia
| | - Suzanne Fraser
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia; Centre for Social Research in Health, University of New South Wales, Australia
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Natale I, Harvey C, Wood P, Anderson K. "It can save your life, that's all I know," barriers and facilitators for engagement in take-home naloxone for people receiving opioid substitution treatment in regional Australia: An explorative study. QUALITATIVE RESEARCH IN MEDICINE & HEALTHCARE 2023; 7:10868. [PMID: 37692452 PMCID: PMC10483482 DOI: 10.4081/qrmh.2023.10868] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 05/07/2023] [Indexed: 09/12/2023] Open
Abstract
Engagement in take-home naloxone (THN) programs by people receiving opioid substitution treatment (OST) in Australia is low despite methadone being a significant contributor to opioid overdose deaths. Our aim was to explore barriers and facilitators for OST patients to engage in THN. We used a descriptive qualitative design with thematic analysis to gain insight into naloxone uptake by people engaged in an OST program in regional Australia. Eleven participants were interviewed; eight had previously engaged with THN. Barriers to THN included limited knowledge and understanding, lack of information, and not personally experiencing an overdose. Facilitators included having a traumatic experience of overdose, knowledge and understanding of THN and overdose, empowerment in carrying naloxone, and expanding THN programs. Support for the expansion of THN programs is desired among participants, and widespread peer distribution is understood to be the key to success. This study found that prior traumatic experience of overdose facilitates acceptance of THN, and being offered THN was the most important factor in engagement. Less clear is how to engage people who lack a traumatic overdose experience.
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Affiliation(s)
| | - Craig Harvey
- Drugs and Alcohol Services, Barwon Health, Geelong
| | - Pene Wood
- La Trobe University, Bendigo, Australia
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Wagner NM, Kempe A, Barnard JG, Rinehart DJ, Havranek EP, Glasgow RE, Blum J, Morris MA. Qualitative exploration of public health vending machines in young adults who misuse opioids: A promising strategy to increase naloxone access in a high risk underserved population. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 5:100094. [PMID: 36687307 PMCID: PMC9851265 DOI: 10.1016/j.dadr.2022.100094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Take home naloxone (THN) programs have been shown to effectively reverse opioid overdose events with limited adverse events, yet often miss young adults who use opioids. To identify opportunities for naloxone expansion, we conducted interviews with young adults who had used opioids. We explored young adults' experience with current THN programs, and perspectives on ideal THN programs and emerging naloxone public health vending machine (PHVM) programs shown to increase access to sterile syringes in young adults. Methods We interviewed 16 young adults receiving substance treatment services within an integrated safety net healthcare system. Participants were 18-30 years of age with a history of nonmedical prescription opioid use. Interviews obtained the patient perspective of current THN, ideal THN and PHVM programs. Interviews were transcribed and coded by team-based methods. Themes were developed using an inductive-deductive iterative approach and defined through consensus. Results Treatment was often the first exposure to naloxone. Participants recommended easy to access programs for ideal naloxone distribution and had overall positive feedback on PHVMs. Three key themes were identified to improve naloxone uptake: knowledge, convenience, and privacy. Participants identified safety, lack of police presence, and low costs as important vending machine features. Conclusions Our results identified implementation opportunities to increase naloxone uptake including convenient location and hours, privacy, and using trusted sources of information to improve program awareness. PHVMs present an opportunity to maximize these opportunities and increase access to naloxone in young adults.
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Affiliation(s)
- Nicole M. Wagner
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, 1890 North Revere Court, Aurora, CO 80045, U.S.A
- Division of General Internal Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12631 E 17th Ave., Aurora, CO 80045, U.S.A
- Corresponding author.
| | - Allison Kempe
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, 1890 North Revere Court, Aurora, CO 80045, U.S.A
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, 13123 E 16th Ave, Aurora CO 80045, U.S.A
| | - Juliana G Barnard
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, 1890 North Revere Court, Aurora, CO 80045, U.S.A
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, 13123 E 16th Ave, Aurora CO 80045, U.S.A
| | - Deborah J. Rinehart
- Division of General Internal Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12631 E 17th Ave., Aurora, CO 80045, U.S.A
- Center for Health Systems Research, Denver Health Hospital and Authority, 777 Bannock St., M.C 6551, Denver, CO 80204, U.S.A
| | - Edward P. Havranek
- Center for Health Systems Research, Denver Health Hospital and Authority, 777 Bannock St., M.C 6551, Denver, CO 80204, U.S.A
- Department of Medicine, Denver Health Hospital and Authority, 777 Bannock St., M.C 4000, Denver, CO 80204, U.S.A
| | - Russell E. Glasgow
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, 1890 North Revere Court, Aurora, CO 80045, U.S.A
- Department of Family Medicine, School of Medicine, University of Colorado Anschutz medical Campus, 12631 East 17th Street, Aurora CO 80045, U.S.A
| | - Joshua Blum
- Division of General Internal Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12631 E 17th Ave., Aurora, CO 80045, U.S.A
- Center for Health Systems Research, Denver Health Hospital and Authority, 777 Bannock St., M.C 6551, Denver, CO 80204, U.S.A
| | - Megan A Morris
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, 1890 North Revere Court, Aurora, CO 80045, U.S.A
- Division of General Internal Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12631 E 17th Ave., Aurora, CO 80045, U.S.A
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Sajwani HS, Williams AV. A systematic review of the distribution of take-home naloxone in low- and middle-income countries and barriers to the implementation of take-home naloxone programs. Harm Reduct J 2022; 19:117. [PMID: 36266701 PMCID: PMC9585764 DOI: 10.1186/s12954-022-00700-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 10/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Opioid overdose epidemic is hitting record highs worldwide, accounting for 76% of mortality related to substance use. Take-home naloxone (THN) strategies are being implemented in many developed countries that suffer from high opioid overdose death rates. They aim to provide overdose identification and naloxone administration training, along with THN delivery to opioid users and others likely to witness an overdose incident such as family members and peers. However, little is known about such measures in low- and middle-income countries (LMIC), where opioid use and opioid-related deaths are reportedly high. This systematic literature review aims to examine the distribution of THN in LMIC, review studies identifying barriers to the implementation of THN programs worldwide, and assess their applicability to LMIC. METHODS The literature was searched and analyzed for eligible studies with quality assessment. RESULTS Two studies were found from LMIC on THN programs with promising results, and 13 studies were found on the barriers identified in implementing THN programs worldwide. The main barriers to THN strategies were the lack of training of healthcare providers, lack of privileges, time constraints, cost, legislative/policy restrictions, stigma, fear of litigation, and some misperceptions around THN. CONCLUSIONS The barriers outlined in this paper are probably applicable to LMIC, but more difficult to overcome considering the differences in their response to opioid overdose, their cultural attitudes and norms, the high cost, the waivers required, the legislative differences and the severe penalties for drug-related offenses in some of these countries. The solutions suggested to counter-act these obstacles can also be more difficult to achieve in LMIC. Further research is required in this area with larger sample sizes to provide a better understanding of the obstacles to the implementation, feasibility, accessibility, and utilization of THN programs in LMIC.
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Affiliation(s)
- Hawraa Sameer Sajwani
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- University of Adelaide, Adelaide, Australia
- Virginia Commonwealth University, Richmond, VA US
- University of California, Los Angeles, Los Angeles, CA US
- Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | - Anna V Williams
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Lowenstein M, Sangha HK, Spadaro A, Perrone J, Delgado MK, Agarwal AK. Patient perspectives on naloxone receipt in the emergency department: a qualitative exploration. Harm Reduct J 2022; 19:97. [PMID: 36028882 PMCID: PMC9412772 DOI: 10.1186/s12954-022-00677-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 08/15/2022] [Indexed: 12/03/2022] Open
Abstract
Background Emergency departments (EDs) are important venues for the distribution of naloxone to patients at high risk of opioid overdose, but less is known about patient perceptions on naloxone or best practices for patient education and communication. Our aim was to conduct an in-depth exploration of knowledge and attitudes toward ED naloxone distribution among patients who received a naloxone prescription. Methods We conducted semi-structured telephone interviews with 25 adult participants seen and discharged from three urban, academic EDs in Philadelphia, PA, with a naloxone prescription between November 2020 and February 2021. Interviews focused on awareness of naloxone as well as attitudes and experiences receiving naloxone in the ED. We used thematic content analysis to identify key themes reflecting patient attitudes and experiences.
Results Of the 25 participants, 72% had previously witnessed an overdose and 48% had personally experienced a non-fatal overdose. Nineteen participants (76%) self-disclosed a history of substance use or overdose, and one reported receiving an opioid prescription during their ED visit and no history of substance use. In interviews, we identified wide variability in participant levels of knowledge about overdose risk, the role of naloxone in reducing risk, and naloxone access. A subset of participants was highly engaged with community harm reduction resources and well versed in naloxone access and use. A second subset was familiar with naloxone, but largely obtained it through healthcare settings such as the ED, while a final group was largely unfamiliar with naloxone. While most participants expressed positive attitudes about receiving naloxone from the ED, the quality of discussions with ED providers was variable, with some participants not even aware they were receiving a naloxone prescription until discharge.
Conclusions Naloxone prescribing in the ED was acceptable and valued by most participants, but there are missed opportunities for communication and education. These findings underscore the critical role that EDs play in mitigating risks for patients who are not engaged with other healthcare or community health providers and can inform future work about the effective implementation of harm reduction strategies in ED settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12954-022-00677-7.
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Affiliation(s)
- Margaret Lowenstein
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, 122 Blockley Hall, 421 Guardian Drive, Philadelphia, PA, 19104, USA. .,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA. .,Center for Addiction Medicine and Policy, University of Pennsylvania, Philadelphia, PA, USA.
| | - Hareena K Sangha
- Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Anthony Spadaro
- Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jeanmarie Perrone
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.,Center for Addiction Medicine and Policy, University of Pennsylvania, Philadelphia, PA, USA.,Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - M Kit Delgado
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.,Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Anish K Agarwal
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.,Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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11
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Monds LA, Bravo M, Mills L, Malcolm A, Gilliver R, Wood W, Harrod ME, Read P, Nielsen S, Dietze PM, Lenton S, Bleeker AM, Lintzeris N. The Overdose Response with Take Home Naloxone (ORTHN) project: Evaluation of health worker training, attitudes and perceptions. Drug Alcohol Rev 2022; 41:1085-1094. [PMID: 35442514 DOI: 10.1111/dar.13474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Naloxone is a life-saving medication that reverses opioid overdose; naloxone can be provided on a 'take-home' basis so naloxone can be administered outside of the health-care setting. The Overdose Response and Take Home Naloxone (ORTHN) project established a model of care for take-home naloxone (THN) interventions across alcohol and other drug and harm reduction services in NSW, Australia. This paper evaluates the staff training and credentialing program, and examines staff attitudes and perspectives regarding the provision of THN interventions in these settings. METHODS Staff across seven services were trained through a 'train-the-trainer' credentialing model to deliver ORTHN, including naloxone supply. Staff were surveyed regarding their experience, attitudes and knowledge on THN prior to and after training, and after 6 months. At the 6 months follow up, staff were asked about the interventions they provided, barriers and enablers to uptake, and opinions regarding future rollout. RESULTS A total of 204 staff were trained and credentialed to provide the ORTHN intervention. Most (60%) were nurses, followed by needle syringe program workers and allied health/counsellors (32%). Linear and logistic regression analyses indicated that the training program was associated with significant improvements in staff knowledge and attitudes towards overdose and THN; however, only attitudinal improvements were maintained over time. There were high rates of staff satisfaction with the ORTHN intervention and training. DISCUSSION/CONCLUSIONS The ORTHN program is 'fit for purpose' for broad implementation in these settings. A number of potential barriers (e.g. time, medication and staffing costs) and enablers (e.g. peer engagement, regulatory framework for naloxone supply) in implementing THN interventions were identified.
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Affiliation(s)
- Lauren A Monds
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia.,Discipline of Addiction Medicine, Central Clinical School, The University of Sydney, Sydney, Australia.,NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia
| | - Maria Bravo
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia.,Discipline of Addiction Medicine, Central Clinical School, The University of Sydney, Sydney, Australia.,NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia
| | - Llewellyn Mills
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia.,Discipline of Addiction Medicine, Central Clinical School, The University of Sydney, Sydney, Australia.,NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia
| | - Annie Malcolm
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia.,NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia
| | - Rosie Gilliver
- Kirketon Road Centre, South Eastern Sydney Local Health District, Sydney, Australia
| | - William Wood
- Medically Supervised Injecting Centre, Sydney, Australia
| | | | - Phillip Read
- Kirketon Road Centre, South Eastern Sydney Local Health District, Sydney, Australia.,The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | - Paul M Dietze
- National Drug Research Institute, Melbourne, Australia.,Behaviours and Health Risks Program, Burnet Institute, Melbourne, Australia
| | - Simon Lenton
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Anne M Bleeker
- Alcohol, Tobacco and Other Drug Association, Canberra, Australia
| | - Nicholas Lintzeris
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia.,Discipline of Addiction Medicine, Central Clinical School, The University of Sydney, Sydney, Australia.,NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia
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12
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Kirwan A, Winter R, Gunn J, Djordjevic F, Curtis M, Gough C, Dietze PM. The feasibility of a drug consumption room in the Australian Capital Territory. Drug Alcohol Rev 2022; 41:1440-1443. [PMID: 35038373 DOI: 10.1111/dar.13427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 12/10/2021] [Accepted: 12/10/2021] [Indexed: 11/29/2022]
Affiliation(s)
| | - Rebecca Winter
- Burnet Institute, Melbourne, Australia.,Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jack Gunn
- Burnet Institute, Melbourne, Australia
| | - Filip Djordjevic
- Burnet Institute, Melbourne, Australia.,Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Michael Curtis
- Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | - Chris Gough
- Canberra Alliance for Harm Minimisation and Advocacy, Canberra, Australia
| | - Paul M Dietze
- Burnet Institute, Melbourne, Australia.,National Drug Research Institute and enAble Institute, Faculty of Health Sciences, Curtin University, Melbourne, Australia
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13
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Black E, Monds LA, Chan B, Brett J, Hutton JE, Acheson L, Penm J, Harding S, Strumpman D, Demirkol A, Lintzeris N. Overdose and take-home naloxone in emergency settings: A pilot study examining feasibility of delivering brief interventions addressing overdose prevention with 'take-home naloxone' in emergency departments. Emerg Med Australas 2022; 34:509-518. [PMID: 35021268 DOI: 10.1111/1742-6723.13925] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/16/2021] [Accepted: 12/02/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Although most unintentional opioid deaths in Australia are attributed to pharmaceutical opioids, take-home naloxone (THN) programmes have to date predominantly targeted people using illicit opioids in drug treatment and harm reduction settings. We sought to examine the feasibility of delivering THN brief interventions (THN-BIs) with intranasal naloxone in EDs. METHODS This pilot feasibility study was conducted across three major metropolitan EDs in Sydney and Melbourne. ED staff were surveyed about their perspectives regarding THN before completing a 30-min training programme in THN-BI delivery. Patients presenting with opioid overdose or considered high risk for future overdose were eligible to receive the THN-BI. Staff survey responses were compared between hospitals and provider types using one-way analysis of variances. Patient demographic and clinical characteristics were extracted from medical records and compared between hospitals and overdose type using Fisher's exact test and one-way analysis of variances. RESULTS One hundred and twenty-two ED staff completed the survey. One hundred and ten (90.2%) agreed that EDs should provide THN-BIs, whereas 23 (19.2%) identified time constraints and 17 (12.9%) felt uncomfortable discussing overdose with patients. Fifty-seven patients received the THN-BI, with the majority (n = 50, 87.7%) having presented following opioid overdose. The median age was 44 years and 40 (71.4%) were men. Two-thirds of the overdoses (n = 31, 66.0%) were attributed to heroin with one-third (n = 16, 34%) being attributed to pharmaceutical opioids. CONCLUSIONS ED-based delivery of THN-BIs can reach a wide range of individuals at-risk of overdose. The present study supports the feasibility of THN interventions in EDs and underscores the importance of addressing implementation barriers including staff training.
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Affiliation(s)
- Eleanor Black
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia.,School of Population Health, The University of New South Wales, Sydney, New South Wales, Australia.,New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, New South Wales, Australia
| | - Lauren A Monds
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia.,New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Specialty of Addiction Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Betty Chan
- Emergency Department, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Jonathan Brett
- New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, New South Wales, Australia.,Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
| | - Jennie E Hutton
- Emergency Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Liam Acheson
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia.,National Drug and Alcohol Research Centre, The University of New South Wales, Sydney, New South Wales, Australia
| | - Jonathan Penm
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia.,Pharmacy Department, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Sally Harding
- Emergency Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Dana Strumpman
- Pharmacy Department, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Apo Demirkol
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia.,School of Population Health, The University of New South Wales, Sydney, New South Wales, Australia.,New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, New South Wales, Australia
| | - Nicholas Lintzeris
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia.,New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Specialty of Addiction Medicine, The University of Sydney, Sydney, New South Wales, Australia
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14
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Smart R, Grant S. Effectiveness and implementability of state-level naloxone access policies: Expert consensus from an online modified-Delphi process. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 98:103383. [PMID: 34340167 PMCID: PMC8671224 DOI: 10.1016/j.drugpo.2021.103383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/23/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Naloxone distribution, a key global strategy to prevent fatal opioid overdose, has been a recent target of legislation in the U.S., but there is insufficient empirical evidence from causal inference methods to identify which components of these policies successfully reduce opioid-related harms. This study aimed to examine expert consensus on the effectiveness and implementability of various state-level naloxone policies. METHODS We used the online ExpertLens platform to conduct a three-round modified-Delphi process with a purposive sample of 46 key stakeholders (advocates, healthcare providers, human/social service practitioners, policymakers, and researchers) with naloxone policy expertise. The Effectiveness Panel (n = 24) rated average effects of 15 types of policies on naloxone pharmacy distribution, opioid use disorder (OUD) prevalence, nonfatal opioid-related overdoses, and opioid-related overdose mortality. The Implementation Panel (n = 22) rated the same policies on acceptability, feasibility, affordability, and equitability. We compared ratings across policies using medians and inter-percentile ranges, with consensus measured using the RAND/UCLA Appropriateness Method Inter-Percentile Range Adjusted for Symmetry technique. RESULTS Experts reached consensus on all items. Except for liability protections and required provision of education or training, experts perceived all policies to generate moderate-to-large increases in naloxone pharmacy distribution. However, only three policies were expected to yield substantive decreases on fatal overdose: statewide standing/protocol order, over-the-counter supply, and statewide "free naloxone." Of these, experts rated only statewide standing/protocol orders as highly affordable and equitable, and unlikely to generate meaningful population-level effects on OUD or nonfatal opioid-related overdose. Across all policies, experts rated naloxone prescribing mandates relatively lower in acceptability, feasibility, affordability, and equitability. CONCLUSION Experts believe statewide standing/protocol orders are an effective, implementable, and equitable policy for addressing opioid-related overdose mortality. While experts believe many other broad policies are effective in reducing opioid-related harms, they also believe these policies face implementation challenges related to cost and reaching vulnerable populations.
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Affiliation(s)
- Rosanna Smart
- Economics, Sociology, and Statistics Department, RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, USA.
| | - Sean Grant
- Department of Social & Behavioral Sciences, Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, RG 6046, Indianapolis, IN 46202, USA
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15
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Conway A, Valerio H, Peacock A, Degenhardt L, Hayllar J, Harrod ME, Henderson C, Read P, Gilliver R, Christmass M, Dunlop A, Montebello M, Whitton G, Reid D, Lam T, Alavi M, Silk D, Marshall AD, Treloar C, Dore GJ, Grebely J. Non-fatal opioid overdose, naloxone access, and naloxone training among people who recently used opioids or received opioid agonist treatment in Australia: The ETHOS Engage study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103421. [PMID: 34452808 DOI: 10.1016/j.drugpo.2021.103421] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/07/2021] [Accepted: 08/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Overdose is a major cause of morbidity and mortality among people who use opioids. Naloxone can reverse opioid overdoses and can be distributed and administered with minimal training. People with experience of overdose are a key population to target for overdose prevention strategies. This study aims to understand if factors associated with recent non-fatal opioid overdose are the same as factors associated with naloxone access and naloxone training in people who recently used opioids or received opioid agonist treatment (OAT). METHODS ETHOS Engage is an observational study of people who inject drugs in Australia. Logistic regression models were used to estimate odds ratios for non-fatal opioid overdose, naloxone access and naloxone training. RESULTS Between May 2018-September 2019, 1280 participants who recently used opioids or received OAT were enrolled (62% aged >40 years; 35% female, 80% receiving OAT, 62% injected drugs in the preceding month). Recent opioid overdose (preceding 12 months) was reported by 7% of participants, lifetime naloxone access by 17%, and lifetime naloxone training by 14%. Compared to people receiving OAT with no additional opioid use, recent opioid, benzodiazepine (preceding six months), and hazardous alcohol use was associated with recent opioid overdose (aOR 3.91; 95%CI: 1.68-9.10) and lifetime naloxone access (aOR 2.12; 95%CI 1.29-3.48). Among 91 people who reported recent overdose, 65% had never received take-home naloxone or naloxone training. CONCLUSIONS Among people recently using opioids or receiving OAT, benzodiazepine and hazardous alcohol use is associated with non-fatal opioid overdose. Not all factors associated with non-fatal overdose correspond to factors associated with naloxone access. Naloxone access and training is low across all groups. Additional interventions are needed to scale up naloxone provision.
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Affiliation(s)
- A Conway
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia.
| | - H Valerio
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - A Peacock
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia; School of Psychology, University of Tasmania, Hobart, Tasmania, Australia
| | - L Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - J Hayllar
- Alcohol and Drug Service, Metro North Mental Health, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - M E Harrod
- NSW Users and AIDS Association, NSW, Australia
| | - C Henderson
- NSW Users and AIDS Association, NSW, Australia
| | - P Read
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; Kirketon Road Centre, Sydney, NSW, Australia
| | - R Gilliver
- Kirketon Road Centre, Sydney, NSW, Australia
| | - M Christmass
- Next Step Drug and Alcohol Services, Mental Health Commission, WA, Australia; National Drug Research Institute, Curtin University, WA, Australia
| | - A Dunlop
- Centre for Translational Neuroscience and Mental Health, Hunter Medical Research Institute & University of Newcastle, Newcastle, NSW, Australia; Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - M Montebello
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia; Drug and Alcohol Services, Northern Sydney Local Health District, Sydney, NSW, Australia; University of Sydney, Sydney, NSW, Australia
| | - G Whitton
- Drug Health Service, South West Sydney LHD, NSW, Australia
| | - D Reid
- Drug and Alcohol Service, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - T Lam
- Drug Health, Western Sydney Local Health District, Sydney, NSW, Australia
| | - M Alavi
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - D Silk
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - A D Marshall
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - C Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - G J Dore
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - J Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
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16
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Schneider KE, Urquhart GJ, Rouhani S, Park JN, Morris M, Allen ST, Sherman SG. Practical implications of naloxone knowledge among suburban people who use opioids. Harm Reduct J 2021; 18:47. [PMID: 33910565 PMCID: PMC8080996 DOI: 10.1186/s12954-021-00466-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Naloxone distribution programs have been a cornerstone of the public health response to the overdose crisis in the USA. Yet people who use opioids (PWUO) continue to face a number of barriers accessing naloxone, including not knowing where it is available. METHODS We used data from 173 PWUO from Anne Arundel County, Maryland, which is located between Baltimore City and Washington, DC. We assessed the prevalence of recently (past 6 months) receiving naloxone and currently having naloxone, the type(s) of the naloxone kits received, and the perceived ease/difficultly of accessing naloxone. We also assessed participants knowledge of where naloxone was available in the community. RESULTS One third (35.7%) of participants had recently received naloxone. Most who had received naloxone received two doses (72.1%), nasal naloxone (86.9%), and education about naloxone use (72.1%). Most currently had naloxone in their possession (either on their person or at home; 78.7%). One third (34.4%) believed naloxone was difficult to obtain in their community. Only half (56.7%) knew of multiple locations where they could get naloxone. The health department was the most commonly identified naloxone source (58.0%). Identifying multiple sources of naloxone was associated with being more likely to perceive that naloxone is easy to access. DISCUSSION Our results suggest that additional public health efforts are needed to make PWUO aware of the range of sources of naloxone in their communities in order to ensure easy and continued naloxone access to PWUO.
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Affiliation(s)
- Kristin E Schneider
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, HH886, Baltimore, MD, 21205, USA.
| | - Glenna J Urquhart
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Saba Rouhani
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Ju Nyeong Park
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Miles Morris
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Sean T Allen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
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17
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Prevalence and correlates of multiple non-fatal opioid overdoses among people who inject drugs who utilise needle syringe programs in Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103245. [PMID: 33840562 DOI: 10.1016/j.drugpo.2021.103245] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 03/15/2021] [Accepted: 03/21/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Non-fatal overdose (NFOD) is a major cause of morbidity among people who inject drugs (PWID) and multiple NFOD is associated with increased risk of fatal overdose. Despite this, few studies have examined the prevalence and correlates of drug-specific multiple NFOD. The current study aimed to determine the prevalence and correlates of recent multiple non-fatal opioid overdose (NFOOD) among PWID who access needle syringe programs (NSPs) in Australia. METHODS The Australian Needle and Syringe Program Survey is conducted annually and was conducted at 46 sites across Australia in 2019. Participation involves completion of a self-administered questionnaire and a capillary dried blood spot for HIV and hepatitis C virus testing. In 2019, respondents who reported a minimum of one NFOOD in the previous 12 months (recent NFOOD) were asked to complete supplementary questions regarding their last NFOOD. Bivariate and multivariate logistic regression were used to determine factors independently associated with multiple recent NFOOD. RESULTS A total of 222 respondents reported recent NFOOD. Respondents were predominantly male (59%), one third (39%) were aged less than 39 years and 73% reported last injecting heroin at their last NFOOD. One in two respondents (48%, n = 107) reported multiple opioid overdoses (median 3, interquartile range 2-5). The odds of reporting multiple NFOOD were higher among respondents who reported injecting in a public location at their last NFOOD (adjusted odds ratio [AOR] 2.10, 95% CI 1.14-3.90, p = 0.018) and benzodiazepine use in the 12 h prior to NFOOD (AOR 2.74, 95% CI 1.50-4.99, p = 0.001). CONCLUSIONS Multiple NFOOD was prevalent among PWID who utilised NSPs who reported recent NFOOD. Public injecting and benzodiazepine use were associated with increased risk of multiple NFOOD, and there is a need for interventions specifically targeting PWID who report these high risk injecting practices.
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18
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Schneider S, Richter C, Niethammer R, Beisel L. Fatal and Non-Fatal Heroin-Related Overdoses: Circumstances and Patterns. Subst Use Misuse 2021; 56:1997-2006. [PMID: 34470589 DOI: 10.1080/10826084.2021.1963986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Heroin overdose is a leading cause of mortality among drug users. This paper aims to identify individual and contextual factors associated with lethal and non-lethal heroin-related overdoses on the basis of case reports and semi-structured proxy interviews. Typical patterns within these cases are determined by means of cluster analysis. METHODS Within the CaRe (Case Reports of heroin-related overdoses) study, case reports (100 proxy reports of overdose events from 36 different facilities) were gathered and evaluated as part of a nationwide survey of experts conducted in Germany in 2019. Following initial descriptive analyses a two-step cluster analysis with the four binary variables of gender, age, time and place was conducted to identify patterns within the reported cases. RESULTS The case reports grouped into five clusters: 1) Younger male drug users, found in a public space during the daytime; 2) Female drug users; 3) Older male drug users, found in a public space during the daytime; 4) Drug users found at home at night; 5) Drug users found outside at night. Overdoses by female drug users and those which occurred at home and/or at night were significantly more likely to have a fatal outcome. CONCLUSION Future prevention and intervention measures should aim to consider the context, i.e. typical constellations of risk, and attempt to inhibit this through appropriate counter measures.
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Affiliation(s)
- Sven Schneider
- Mannheim Institute of Public Health, Social and Preventive Medicine, Heidelberg University, Mannheim, Germany
| | - Christian Richter
- Drug Counselling Centre "Abrigado", Drug Consumption Room, Hamburg, Germany
| | - Rainer Niethammer
- Clinic for Psychiatry and Psychotherapy, Hospital "Zum Guten Hirten", Ludwigshafen, Germany
| | - Larissa Beisel
- Mannheim Institute of Public Health, Social and Preventive Medicine, Heidelberg University, Mannheim, Germany
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19
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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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20
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Moradmand-Badie B, Tran L, Oikarainen N, Degenhardt L, Nielsen S, Roberts J, Ward S, Bowman J, Larney S. Feasibility and acceptability of take-home naloxone for people released from prison in New South Wales, Australia. Drug Alcohol Rev 2020; 40:98-108. [PMID: 32808357 DOI: 10.1111/dar.13144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 07/03/2020] [Accepted: 07/13/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND AIMS To assess the feasibility and acceptability of a take-home naloxone program for people with a history of opioid use released from prison in New South Wales, Australia. DESIGN AND METHODS Cross-sectional interviews with people with a history of opioid use who were recently released from prison (n = 105), and semi-structured interviews with key clinical and operational staff of Justice Health and Forensic Mental Health Network and Corrective Services NSW (n = 9). RESULTS Among people with a history of opioid use who had recently left prison, there was very high awareness of the elevated risk of overdose following release from prison (95%) and the potential for naloxone to reverse an opioid overdose (97%). Participants considered that their personal risk of overdose was low, despite ongoing opioid use being common. Participants were largely supportive of take-home naloxone, but the majority (83%) stated that proactively obtaining naloxone would be a low priority for them following release. Key informants were supportive of introducing naloxone training and supply and identified barriers to implementation, including adequate resourcing, identifying the population for training, and developing an appropriate model of training and implementation. DISCUSSION AND CONCLUSION There was widespread support for naloxone training in custody and distribution at release among people recently released from prison and key stakeholders in health-care provision and prisons administration. As proactively accessing naloxone is a low priority for patients, naloxone supply at release may be more effective than programs that refer releasees to local pharmacies, but developing a sustainable supply model requires consideration of several barriers.
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Affiliation(s)
| | - Lucy Tran
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Noora Oikarainen
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | - Jillian Roberts
- Drug and Alcohol Service, Justice Health and Forensic Mental Health Network, Sydney, Australia
| | - Stephen Ward
- Drug and Alcohol Strategic Operations, Justice Health and Forensic Mental Health Network, Sydney, Australia
| | - Julia Bowman
- Research Unit, Justice Health and Forensic Mental Health Network, Sydney, Australia.,School of Public Health, University of Technology Sydney, Sydney, Australia
| | - Sarah Larney
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montréal and Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Canada
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21
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Collins AB, Ndoye CD, Arene-Morley D, Marshall BDL. Addressing co-occurring public health emergencies: The importance of naloxone distribution in the era of COVID-19. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 83:102872. [PMID: 32713765 PMCID: PMC7373067 DOI: 10.1016/j.drugpo.2020.102872] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/06/2020] [Accepted: 07/20/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Alexandra B Collins
- Department of Epidemiology, School of Public Health, Brown University, 121 South Main Street, Providence, RI 02903, United States.
| | | | - Diego Arene-Morley
- Rhode Island Communities for Addiction Recovery Efforts, 134 Mathewson Street, Providence, RI 02903, United States
| | - Brandon D L Marshall
- Department of Epidemiology, School of Public Health, Brown University, 121 South Main Street, Providence, RI 02903, United States
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22
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Fomiatti R, Farrugia A, Fraser S, Dwyer R, Neale J, Strang J. Addiction stigma and the production of impediments to take-home naloxone uptake. Health (London) 2020; 26:139-161. [PMID: 32529843 DOI: 10.1177/1363459320925863] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Opioid overdose deaths are a major health issue in Australia and around the world. Programmes to provide opioid consumers with 'take-home' naloxone to reverse overdose exist internationally, but uptake by mainstream health services and consumers remains inconsistent. Researchers have identified a range of important educational, training and logistical impediments to take-home naloxone uptake and distribution, yet they have focused less on the social dynamics that can enhance or limit access, such as stigma. In this article, we also explore impediments to uptake, drawing on qualitative interview data gathered for an Australian research project on take-home naloxone. Mobilising a performative approach to stigma, we argue that overdose and prevention are shaped by the social dynamics of stigma and, as such, responsibility for dealing with overdose, as with take-home naloxone, should also be considered social (i.e. shared among peers, the public, communities and governments). Our interview data illuminate the various ways in which addiction stigma limits the possibilities and capacities of take-home naloxone and overdose prevention. First, we focus on how stigma may impede professional information provision about take-home naloxone by limiting the extent to which it is presented as a matter of interest for all opioid consumers, not just those who consume opioids illicitly. Second, we explore how stigma may limit the scale-up and expansion of programmes and access points. From here, we focus on how stigma co-constitutes the politics of overdose and prevention, rendering take-home naloxone ill-suited to many social settings of overdose. In closing, we point out that stigma is not just a post hoc impediment to access to and use of take-home naloxone but is central to opioid overdose production itself, and to effective prevention. While take-home naloxone is an excellent life-saving initiative, uncritically valorising it may divert attention from broader goals, such as the de-stigmatisation of drug consumption through decriminalisation, and other ambitious attempts to reduce overdose.
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Affiliation(s)
- Renae Fomiatti
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia
| | - Adrian Farrugia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia; National Drug Research Institute, Curtin University, Australia
| | - Suzanne Fraser
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia; Centre for Social Research in Health, Faculty of Arts and Social Sciences, University of New South Wales, Australia
| | - Robyn Dwyer
- Centre for Alcohol Policy Research, La Trobe University, Australia; National Drug Research Institute, Curtin University, Australia
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23
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Lintzeris N, Santo T, Nielsen S, Degenhardt L, Campbell G. Estimating Centre for Disease Control and Prevention-defined overdose risk in people prescribed opioids for chronic non-cancer pain: implications for take-home naloxone provision. Intern Med J 2020; 49:1054-1055. [PMID: 31387142 DOI: 10.1111/imj.14386] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/27/2019] [Accepted: 05/04/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Nicholas Lintzeris
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia.,Division Addiction Medicine, University of Sydney, Sydney, New South Wales, Australia.,National Drug and Alcohol Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Thomas Santo
- National Drug and Alcohol Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Suzanne Nielsen
- National Drug and Alcohol Centre, University of New South Wales, Sydney, New South Wales, Australia.,Monash Addiction Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Gabrielle Campbell
- National Drug and Alcohol Centre, University of New South Wales, Sydney, New South Wales, Australia
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24
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Lintzeris N. Providing take home naloxone needs to be improved to prevent opioid overdose deaths. Med J Aust 2020; 212:307-308. [DOI: 10.5694/mja2.50561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Nicholas Lintzeris
- The University of Sydney Sydney NSW
- Drug and Alcohol ServicesSouth Eastern Sydney Local Health DistrictSydneyNSW
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25
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Tse WC, Sanfilippo P, Lam T, Dietze P, Nielsen S. Community pharmacy naloxone supply, before and after rescheduling as an over‐the‐counter drug: sales and prescriptions data, 2014–2018. Med J Aust 2020; 212:314-320. [DOI: 10.5694/mja2.50524] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/26/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Wai Chung Tse
- Monash Addiction Research CentreMonash University Melbourne VIC
- Monash University Melbourne VIC
| | - Paul Sanfilippo
- Monash Addiction Research CentreMonash University Melbourne VIC
| | - Tina Lam
- Monash Addiction Research CentreMonash University Melbourne VIC
| | - Paul Dietze
- Monash Addiction Research CentreMonash University Melbourne VIC
- Centre for Epidemiology and Population Health ResearchBurnet Institute Melbourne VIC
| | - Suzanne Nielsen
- Monash Addiction Research CentreMonash University Melbourne VIC
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26
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Lam T, Kuhn L, Hayman J, Middleton M, Wilson J, Scott D, Lubman DI, Smith K, Nielsen S. Recent trends in heroin and pharmaceutical opioid-related harms in Victoria, Australia up to 2018. Addiction 2020; 115:261-269. [PMID: 31465131 DOI: 10.1111/add.14784] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/20/2019] [Accepted: 08/08/2019] [Indexed: 12/14/2022]
Abstract
AIMS To characterize the trajectory in the years leading up to 2018 in pharmaceutical opioid and heroin morbidity in Victoria, Australia, and to assess the effect on that trajectory of reformulation of oxycodone to a form that could not be easily snorted or injected. DESIGN Interrupted time-series analyses of population-level data before versus after reformulation of oxycodone, stratified by sex. SETTING Victoria, Australia. PARTICIPANTS The population of Victoria aged 12+ years. MEASUREMENTS Ambulance patient care and emergency department (ED) records were examined using both fixed-code and free-text fields, with each record manually cleaned and checked by trained coders. These were used to derive the output variables providing an index of harm: rates of opioid-related ambulance attendances and ED attendances for pharmaceutical opioids and heroin. The input variable was pre- versus post-oxycodone reformulation. FINDINGS There were 30 045 opioid-related ambulance attendances from January 2012 to October 2018 (54% heroin-related), and 10 113 ED attendances from July 2008 to June 2018 (39% heroin-related). There was an increase in the rate (events per 100 000 people per year) of all opioid ED attendances from 2008 to 2018 [increase = 0.063; 95% confidence interval (CI) = 0.049, 0.078]. Pharmaceutical opioid ED attendances decreased from 2014 onwards (slope change = -0.083; 95% CI = -0.108, -0.059). Heroin-related ED attendances increased from 2014 to 2018; 11 324 heroin-related ambulance attendances and 1980 ED attendances were observed from April 2014 to June 2018, compared with the respective estimates of 8176, and 1661 had the pre-April 2014 trend continued (ambulance slope change = 0.296, 95% CI = 0.104, 0.489; ED slope change = 0.026, 95% CI = 0.005, 0.046). The inflection point of 2014 coincided with the re-formulation of oxycodone. CONCLUSION In Victoria, Australia, there appears to have been a trend starting around mid-2014 of increasing heroin-related harm, and a flattening of the increase or a decrease of harms relating to pharmaceutical opioids. These changes may, in part, reflect reformulation of oxycodone to reduce the extent to which it can be injected or snorted.
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Affiliation(s)
- Tina Lam
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
| | - Lisa Kuhn
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia.,Monash Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Jane Hayman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia.,Victorian Injury Surveillance Unit, Monash University Accident Research Centre, Monash University, Clayton, Victoria, Australia
| | - Melissa Middleton
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
| | - James Wilson
- Turning Point, Eastern Health & Eastern Health Clinical School, Monash University, Richmond, Victoria, Australia
| | - Debbie Scott
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia.,Turning Point, Eastern Health & Eastern Health Clinical School, Monash University, Richmond, Victoria, Australia
| | - Dan I Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia.,Turning Point, Eastern Health & Eastern Health Clinical School, Monash University, Richmond, Victoria, Australia
| | - Karen Smith
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Ambulance Victoria, Victoria, Australia.,Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
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27
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Lintzeris N, Monds LA, Bravo M, Read P, Harrod ME, Gilliver R, Wood W, Nielsen S, Dietze PM, Lenton S, Shanahan M, Jauncey M, Jefferies M, Hazelwood S, Dunlop AJ, Greenaway M, Haber P, Ezard N, Malcom A. Designing, implementing and evaluating the overdose response with take-home naloxone model of care: An evaluation of client outcomes and perspectives. Drug Alcohol Rev 2019; 39:55-65. [PMID: 31774221 DOI: 10.1111/dar.13015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND DESIGNS Take-home naloxone (THN) interventions are an effective response to preventing overdose deaths, however uptake across Australia remains limited. This project designed, implemented and evaluated a model of care targeting opioid users attending alcohol and other drug (AOD) treatment, needle and syringe programs (NSP) and related health services targeting people who inject drugs. DESIGN AND METHODS Service providers, consumers and regulators collaboratively designed a THN brief intervention (ORTHN, Overdose Response with Take-Home Naloxone) involving client education and supply of naloxone in pre-filled syringes, delivered by nursing, allied health and NSP workers. ORTHN interventions were implemented in over 15 services across New South Wales, Australia. The evaluation included client knowledge, attitudes, substance use and overdose experiences immediately before and 3 months after ORTHN intervention in a subsample of participants. RESULTS Six hundred and sixteen interventions were delivered, with 145 participants recruited to the research subsample, of whom 95 completed the three-month follow up. Overdose-related attitudes amongst participants improved following ORTHN, with no evidence of increased substance use or failure to implement other 'first responses' (e.g. calling an ambulance). Nine participants (10%) reversed an overdose using THN in the follow-up period. Participants identified a willingness to access THN from a range of services. While a minority (16%) indicated they were unwilling to pay for THN, the median price that participants were willing to pay was $AUD20 (IQR $10.40). DISCUSSION AND CONCLUSIONS The ORTHN model of care for THN appears an effective way to disseminate THN to people who use opioids attending AOD, NSP and related health-care settings.
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Affiliation(s)
- Nicholas Lintzeris
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia.,Discipline of Addiction Medicine, Central Clinical School, The University of Sydney, Sydney, Australia.,NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia
| | - Lauren A Monds
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia.,Discipline of Addiction Medicine, Central Clinical School, The University of Sydney, Sydney, Australia.,NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia
| | - Maria Bravo
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia.,Discipline of Addiction Medicine, Central Clinical School, The University of Sydney, Sydney, Australia.,NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia
| | - Phillip Read
- Kirketon Road Centre, South Eastern Sydney Local Health District, Sydney, Australia.,The Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | - Rosie Gilliver
- Kirketon Road Centre, South Eastern Sydney Local Health District, Sydney, Australia
| | - William Wood
- Medically Supervised Injecting Centre, Sydney, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | - Paul M Dietze
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Australia
| | - Simon Lenton
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Marian Shanahan
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | | | - Meryem Jefferies
- NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia.,Drug Health, Western Sydney Local Health District, Sydney, Australia
| | - Susan Hazelwood
- NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia.,Drug and Alcohol Services, Hunter New England Local Health District, Newcastle, Australia
| | - Adrian J Dunlop
- NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia.,Drug and Alcohol Services, Hunter New England Local Health District, Newcastle, Australia
| | | | - Paul Haber
- Discipline of Addiction Medicine, Central Clinical School, The University of Sydney, Sydney, Australia.,NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia.,Drug Health Services, Sydney Local Health District, Sydney, Australia
| | - Nadine Ezard
- NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia.,Drug and Alcohol Services, St. Vincent's Local Health Network, Sydney, Australia.,National Centre for Clinical Research in Emerging Drugs, Sydney, Australia
| | - Annie Malcom
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia.,NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia
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28
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Farrugia A, Fraser S, Dwyer R, Fomiatti R, Neale J, Dietze P, Strang J. Take-home naloxone and the politics of care. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41:427-443. [PMID: 30710415 DOI: 10.1111/1467-9566.12848] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
'Take-home naloxone' refers to a life-saving intervention in which a drug (naloxone) is made available to nonmedically trained people for administration to other people experiencing an opioid overdose. In Australia, it has not been taken up as widely as would be expected, given its life-saving potential. We consider the actions of take-home naloxone, focusing on how care relations shape its uses and effects. Mobilising Science and Technology Studies insights, we suggest that the uses and effects of naloxone are co-produced within social relations and, therefore, this initiative 'affords' multiple outcomes. We argue that these affordances are shaped by a politics of care, and that these politics relate to uptake. We analyse two complementary case studies, drawn from an interview-based project, in which opioid consumers discussed take-home naloxone and its uses. Our analysis maps the ways take-home naloxone can afford (i) a regime of care within an intimate partnership (allowing a terminally ill man to more safely consume opioids) and (ii) a political process of care (in which a consumer takes care of others treated with the medication by administering it 'gently'). We conclude by exploring the political affordances of a politics of care approach for the uptake of take-home naloxone.
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Affiliation(s)
- Adrian Farrugia
- Social Studies of Addiction Concepts Research Program, Faculty of Health Sciences, National Drug Research Institute, Curtin University, Melbourne, Vic, Australia
| | - Suzanne Fraser
- Social Studies of Addiction Concepts Research Program, Faculty of Health Sciences, National Drug Research Institute, Curtin University, Melbourne, Vic, Australia
- Centre for Social Research in Health, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Robyn Dwyer
- Social Studies of Addiction Concepts Research Program, Faculty of Health Sciences, National Drug Research Institute, Curtin University, Melbourne, Vic, Australia
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University, Melbourne, Vic, Australia
| | - Renae Fomiatti
- Social Studies of Addiction Concepts Research Program, Faculty of Health Sciences, National Drug Research Institute, Curtin University, Melbourne, Vic, Australia
| | - Joanne Neale
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paul Dietze
- Behaviours and Health Risks Programs, Burnet Institute, Melbourne, Vic, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - John Strang
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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29
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Campbell G, Lintzeris N, Gisev N, Larance B, Pearson S, Degenhardt L. Regulatory and other responses to the pharmaceutical opioid problem. Med J Aust 2018; 210:6-8.e1. [PMID: 30636303 DOI: 10.5694/mja2.12047] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Gabrielle Campbell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
| | - Nicholas Lintzeris
- University of Sydney, Sydney, NSW.,Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
| | - Briony Larance
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW.,University of Wollongong, Wollongong, NSW
| | - Sallie Pearson
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW.,Menzies Centre for Health Policy, University of Sydney, Sydney, NSW
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
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30
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Stam NC, Gerostamoulos D, Smith K, Pilgrim JL, Drummer OH. Challenges with take-home naloxone in reducing heroin mortality: a review of fatal heroin overdose cases in Victoria, Australia. Clin Toxicol (Phila) 2018; 57:325-330. [PMID: 30451007 DOI: 10.1080/15563650.2018.1529319] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIM Take-home naloxone (THN) programs have been implemented in order to reduce the number of heroin-overdose deaths. Because of recent legislative changes in Australia, there is a provision for a greater distribution of naloxone in the community, however, the potential impact of these changes for reduced heroin mortality remains unclear. The aim of this study was to examine the characteristics of the entire cohort of fatal heroin overdose cases and assess whether there was an opportunity for bystander intervention had naloxone been available at the location and time of each of the fatal overdose events to potentially avert the fatal outcome in these cases. METHODS The circumstances related to the fatal overdose event for the cohort of heroin-overdose deaths in the state of Victoria, Australia between 1 January 2012 and 31 December 2013 were investigated. Coronial data were investigated for all cases and data linkage was performed to additionally investigate the Emergency Medical Services information about the circumstances of the fatal heroin overdose event for each of the decedents. RESULTS AND DISCUSSION There were 235 fatal heroin overdose cases identified over the study period. Data revealed that the majority of fatal heroin overdose cases occurred at a private residence (n = 186, 79%) and where the decedent was also alone at the time of the fatal overdose event (n = 192, 83%). There were only 38 cases (17%) where the decedent was with someone else or there was a witness to the overdose event, and in half of these cases the witness was significantly impaired, incapacitated or asleep at the time of the fatal heroin overdose. There were 19 fatal heroin overdose cases (8%) identified where there was the potential for appropriate and timely intervention by a bystander or witness. CONCLUSION This study demonstrated that THN introduction alone could have led to a very modest reduction in the number of fatal heroin overdose cases over the study period. A lack of supervision or a witness to provide meaningful and timely intervention was evident in most of the fatal heroin overdose cases.
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Affiliation(s)
- Nathan C Stam
- a Department of Forensic Medicine , Monash University , Melbourne , Australia.,b Department of Community Emergency Health and Paramedic Practice , Monash University , Melbourne , Australia
| | | | - Karen Smith
- b Department of Community Emergency Health and Paramedic Practice , Monash University , Melbourne , Australia.,d Centre for Research and Evaluation , Ambulance Victoria , Melbourne , Australia.,e Department of Epidemiology and Preventive Medicine , Monash University , Melbourne , Australia
| | - Jennifer L Pilgrim
- a Department of Forensic Medicine , Monash University , Melbourne , Australia
| | - Olaf H Drummer
- a Department of Forensic Medicine , Monash University , Melbourne , Australia
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31
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Olsen A, Dwyer R, Lenton S. Take-home naloxone in Australia and beyond. Drug Alcohol Rev 2018; 37:437-439. [PMID: 29744978 DOI: 10.1111/dar.12700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/20/2018] [Accepted: 03/22/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Anna Olsen
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Robyn Dwyer
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia.,Faculty of Health Sciences, National Drug Research Institute, Curtin University, Melbourne, Australia
| | - Simon Lenton
- National Drug Research Institute, Curtin University, Perth, Australia
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33
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Curtis M, Dietze P, Aitken C, Kirwan A, Kinner SA, Butler T, Stoové M. Acceptability of prison-based take-home naloxone programmes among a cohort of incarcerated men with a history of regular injecting drug use. Harm Reduct J 2018; 15:48. [PMID: 30241532 PMCID: PMC6497216 DOI: 10.1186/s12954-018-0255-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/07/2018] [Indexed: 01/18/2023] Open
Abstract
Background Take-home naloxone (THN) programmes are an evidence-based opioid overdose prevention initiative. Elevated opioid overdose risk following prison release means release from custody provides an ideal opportunity for THN initiatives. However, whether Australian prisoners would utilise such programmes is unknown. We examined the acceptability of THN in a cohort of male prisoners with histories of regular injecting drug use (IDU) in Victoria, Australia. Methods The sample comprised 380 men from the Prison and Transition Health (PATH) Cohort Study; all of whom reported regular IDU in the 6 months prior to incarceration. We asked four questions regarding THN during the pre-release baseline interview, including whether participants would be willing to participate in prison-based THN. We describe responses to these questions along with relationships between before- and during-incarceration factors and willingness to participate in THN training prior to release from prison. Results Most participants (81%) reported willingness to undertake THN training prior to release. Most were willing to resuscitate a friend using THN if they were trained (94%) and to be revived by a trained peer (91%) using THN. More than 10 years since first injection (adjusted odds ratio [AOR] 2.22, 95%CI 1.03–4.77), having witnessed an opioid overdose in the last 5 years (AOR 2.53, 95%CI 1.32–4.82), having ever received alcohol or other drug treatment in prison (AOR 2.41, 95%CI 1.14–5.07) and injecting drugs during the current prison sentence (AOR 4.45, 95%CI 1.73–11.43) were significantly associated with increased odds of willingness to participate in a prison THN programme. Not specifying whether they had injected during their prison sentence (AOR 0.37, 95%CI 0.18–0.77) was associated with decreased odds of willingness to participate in a prison THN training. Conclusion Our findings suggest that male prisoners in Victoria with a history of regular IDU are overwhelmingly willing to participate in THN training prior to release. Factors associated with willingness to participate in prison THN programmes offer insights to help support the implementation and uptake of THN programmes to reduce opioid-overdose deaths in the post-release period.
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Affiliation(s)
- Michael Curtis
- Behaviours and Health Risks, Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Australia.
| | - Paul Dietze
- Behaviours and Health Risks, Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Campbell Aitken
- Disease Elimination, Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Amy Kirwan
- Behaviours and Health Risks, Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Stuart A Kinner
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Tony Butler
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Mark Stoové
- Behaviours and Health Risks, Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Fraser S, Farrugia A, Dwyer R. Grievable lives? Death by opioid overdose in Australian newspaper coverage. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 59:28-35. [DOI: 10.1016/j.drugpo.2018.06.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/04/2018] [Accepted: 06/11/2018] [Indexed: 11/29/2022]
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