1
|
Michaud L, Kolla G, Rudzinski K, Guta A. Mapping a moral panic: News media narratives and medical expertise in public debates on safer supply, diversion, and youth drug use in Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 127:104423. [PMID: 38642543 DOI: 10.1016/j.drugpo.2024.104423] [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: 10/30/2023] [Revised: 02/26/2024] [Accepted: 04/06/2024] [Indexed: 04/22/2024]
Abstract
The ongoing overdose and drug toxicity crisis in North America has contributed momentum to the emergence of safer supply prescribing and programs in Canada as a means of providing an alternative to the highly volatile unregulated drug supply. The implementation and scale-up of safer supply have been met with a vocal reaction on the part of news media commentators, conservative politicians, recovery industry representatives, and some prominent addiction medicine physicians. This reaction has largely converged around several narratives, based on unsubstantiated claims and anecdotal evidence, alleging that safer supply programs are generating a "new opioid epidemic", reflecting an emerging alignment among key institutional and political actors. Employing situational analysis method, and drawing on the policy studies and social science scholarship on moral panics, this essay examines news media coverage from January to July 2023, bringing this into dialogue with other existing empirical sources on safer supply (e.g. Coroner's reports, program evaluations, debates among experts in medical journals). We employ eight previously established criteria delineating moral panics to critically appraise public dialogue regarding safer supply, diverted medication, and claims of increased youth initiation to drug use and youth overdose. In detailing the emergence of a moral panic regarding safer supply, we trace historic continuities with earlier drug scares in Canadian history mobilized as tools of racialized poverty governance, as well as previous backlashes towards healthcare interventions for people who use drugs (PWUD). The essay assesses the claims of moral entrepreneurs against the current landscape of opioid use, diversion, and overdose among youth, notes the key role played by medical expertise in this and previous moral panics, and identifies what the convergence of these narratives materialize for PWUD and healthcare access, as well as the broader policy responses such narratives activate.
Collapse
Affiliation(s)
- Liam Michaud
- Graduate Program in Socio-Legal Studies, York University, Toronto, ON, Canada; Nathanson Centre on Transnational Human Rights, Crime and Security, York University, Toronto, ON, Canada.
| | - Gillian Kolla
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada; Faculty of Medicine, Memorial University, St. John's, NL, Canada
| | | | - Adrian Guta
- School of Social Work, University of Windsor, ON, Canada
| |
Collapse
|
2
|
Messinger JC, Beletsky L, Kesselheim AS, Barenie RE. Moving Naloxone Over the Counter Is Necessary but Not Sufficient. Ann Intern Med 2023; 176:1109-1112. [PMID: 37459615 DOI: 10.7326/m23-0852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Abstract
Naloxone is an opioid antagonist that is available in numerous formulations and can be easily administered to avert death from opioid overdose. Amid a historic overdose crisis in the United States, naloxone has a crucial role in stemming the loss of life. However, it remains largely inaccessible to the public. Recently, the U.S. Food and Drug Administration announced the approval of the first over-the-counter formulation of naloxone. Although this historic change provides an important opportunity to increase distribution of naloxone, we must take careful steps during this transition so that it does not paradoxically threaten overall access to this life-saving medication. Specifically, we must ensure that a larger supply of naloxone will meet the newly increased demand at a sustainable price for consumers who are most in need. We must also continue to prioritize comprehensive methods of distribution, such as overdose education and naloxone distribution programs, that serve as important tools to reach the most vulnerable populations. In addition, simultaneous investment in harm-reduction strategies, such as supervised consumption spaces, is critical to ensure that naloxone is available in settings where its life-saving potential can be most fully realized.
Collapse
Affiliation(s)
- John C Messinger
- Harvard Medical School; The Action Lab, Northeastern University School of Law; and Program on Regulation, Therapeutics, and Law, Boston, Massachusetts (J.C.M.)
| | - Leo Beletsky
- The Action Lab, Northeastern University School of Law, and Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts (L.B.)
| | - Aaron S Kesselheim
- Harvard Medical School; Program on Regulation, Therapeutics, and Law; and Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts (A.S.K.)
| | - Rachel E Barenie
- The University of Tennessee Health Science Center, Memphis, Tennessee (R.E.B.)
| |
Collapse
|
3
|
Baumgart M, Chiarello E, Slay T. Reluctant Saviors: Professional ambivalence, cultural imaginaries, and deservingness construction in naloxone provision. Soc Sci Med 2022; 309:115230. [DOI: 10.1016/j.socscimed.2022.115230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 07/07/2022] [Accepted: 07/16/2022] [Indexed: 11/27/2022]
|
4
|
Quinn K, Kumar S, Hunter CT, O’Donnell J, Davis NL. Naloxone administration among opioid-involved overdose deaths in 38 United States jurisdictions in the State Unintentional Drug Overdose Reporting System, 2019. Drug Alcohol Depend 2022; 235:109467. [PMID: 35461083 PMCID: PMC9106898 DOI: 10.1016/j.drugalcdep.2022.109467] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/12/2022] [Accepted: 04/14/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND The majority of drug overdose deaths in the United States involve opioids, and synthetic opioid-involved overdose death rates are increasing. Naloxone is a key prevention strategy yet estimates of its administration are limited. METHODS We analyzed 2019 data from 37 states and the District of Columbia in CDC's State Unintentional Drug Overdose Reporting System to estimate the percentage of decedents, by sociodemographic subgroup, who experienced a fatal opioid-involved overdose and had no evidence of naloxone administration. RESULTS A total of 77.3% of 33,084 opioid-involved overdose deaths had no evidence of naloxone administration. Statistically significant subgroup differences were observed for all sociodemographic groups examined except housing status. The highest percentages of decedents lacking evidence of naloxone administration were those with highest educational attainment (doctorate or professional degree, 87.0%), oldest (55-64 years, 83.4%; ≥65 years, 87.3%) and youngest ages (<15 years, 87.5%), and single marital status (84.5%). The lowest percentages of no evidence of naloxone administration were observed for non-Hispanic American Indian/Alaskan Native persons (66.2%) and those ages 15-24 years (70.8%). CONCLUSIONS More than three-quarters of opioid-involved overdose deaths had no evidence of naloxone administration, underscoring the need to ensure sufficient naloxone access and capacity for utilization. While fatal overdose data cannot fully characterize sociodemographic disparities in naloxone administration, naloxone education and access efforts can be informed by apparent inequities. Public health partners can assist persons who use drugs (PWUD) by maintaining naloxone supply and amplifying messages about the high risk of using drugs alone among PWUD and their social networks.
Collapse
Affiliation(s)
- Kelly Quinn
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Overdose Prevention, 4770 Buford Hwy, Atlanta, GA 30341, USA.
| | - Sagar Kumar
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Overdose Prevention, 4770 Buford Hwy, Atlanta, GA 30341, USA.
| | | | | | | |
Collapse
|
5
|
Naloxone Training From Nonmedical Personnel: Benefits Before, During, and After Overdose Events. J Addict Med 2021; 14:e220-e225. [PMID: 32187113 DOI: 10.1097/adm.0000000000000645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Drug overdose death rates in the United States have increased exponentially over the past 2 decades, primarily driven by fatal opioid overdoses. To combat this epidemic, naloxone training programs have become prevalent, but still remain widely underutilized. The purpose of the current study was to assess the benefits of a brief training with differing educational approaches (individual training versus training in dyads) as well as the outcomes following overdose reversals. METHODS Persons who use opioids (N = 448) were recruited from 4 sites including treatment facilities, inpatient hospitals, and criminal justice locations over a 3-year period. Training was delivered by nonmedical personnel and focused on safe naloxone usage and recognizing overdose signs. Overdose and naloxone knowledge were assessed before and following training with a 10-item questionnaire. Participants were trained individually, in a dyad with a partner who used opioids (PO), or in a dyad with a partner who did not use opioids (PNO). RESULTS All training groups displayed an increased knowledge of naloxone and overdose situations following training. Approximately 11% of participants (n = 47) reported using their naloxone kit and 97.7% of those resulted in successful overdose reversals. Kits were primarily used by the trained participant on a third-party individual. CONCLUSIONS The results of the current study substantiate the effectiveness of naloxone in reversing overdose symptoms. A brief, 15-minute naloxone training delivered by nonmedical personnel enhanced overdose knowledge and led to positive reversal outcomes. Training persons who use opioids in dyads may offer additional benefits and improve follow-up reporting.
Collapse
|
6
|
Abstract
Abstract
This paper uses the lens of medical populism to analyze the impact of biocommunicability on COVID-19 testing through a case study approach. The political efficacy of testing is traced through two mini-case studies: the Philippines and the United States. The case studies follow the approach of populism scholars in drawing from various sources that ‘render the populist style visible’ from the tweets and press releases of government officials to media reportage. Using the framework of medical populism, the case studies pay attention to the ways in which coronavirus testing figured in (1) simplification of the pandemic; (2) spectacularization of the crisis; (3) forging of divisions; and (4) invocation of knowledge claims. Identifying and critically analyzing how knowledge is generated is an essential step to recognizing the impact that political styles have on the COVID pandemic. The political actors in each case study have shaped knowledge of the epidemic, in the way they construct the idea of ‘testing’, and in how they mobilize testing as an ‘evidence-making practice’. Their actions shaped how the pandemic—as well as their responses—is measured. This framework contributes to public policy debates by providing evidence of the impact of medical populism on pandemic response efforts.
Collapse
Affiliation(s)
- Kristin Hedges
- Department of Anthropology , Grand Valley State University , Allendale, MI 49401-9403, United States
| | - Gideon Lasco
- Department of Anthropology , University of the Philippines Diliman , Quezon City , 1101 , Philippines
| |
Collapse
|
7
|
Lai JT, Goldfine CE, Chapman BP, Taylor MM, Rosen RK, Carreiro SP, Babu KM. Nobody Wants to Be Narcan'd: A Pilot Qualitative Analysis of Drug Users' Perspectives on Naloxone. West J Emerg Med 2021; 22:339-345. [PMID: 33856321 PMCID: PMC7972385 DOI: 10.5811/westjem.2020.10.48768] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/29/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction Bystander naloxone distribution is an important component of public health initiatives to decrease opioid-related deaths. While there is evidence supporting naloxone distribution programs, the effects of increasing naloxone availability on the behavior of people who use drugs have not been adequately delineated. In this study we sought to 1) evaluate whether individuals’ drug use patterns have changed due to naloxone availability; and 2) explore individuals’ knowledge of, access to, experiences with, and perceptions of naloxone. Methods We conducted a pilot study of adults presenting to the emergency department whose medical history included non-medical opioid use. Semi-structured interviews were conducted with participants and thematic analysis was used to code and analyze interview transcripts. Results Ten participants completed the study. All were aware of naloxone by brand name (Narcan) and had been trained in its use, and all but one had either currently or previously possessed a kit. Barriers to naloxone administration included fear of legal repercussions, not having it available, and a desire to avoid interrupting another user’s “high.” Of the eight participants who reported being revived with naloxone at least once during their lifetime, all described experiencing a noxious physical response and expressed a desire to avoid receiving it again. Furthermore, participants did not report increasing their use of opioids when naloxone was available. Conclusions Participants were accepting of and knowledgeable about naloxone, and were willing to administer naloxone to save a life. Participants tended to use opioids more cautiously when naloxone was present due to fears of experiencing precipitated withdrawal. This study provides preliminary evidence countering the unsubstantiated narrative that increased naloxone availability begets more high-risk opioid use and further supports increasing naloxone access.
Collapse
Affiliation(s)
- Jeffrey T Lai
- University of Massachusetts Medical School, Department of Emergency Medicine, Worcester, Massachusetts
| | - Charlotte E Goldfine
- Brigham and Women's Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Brittany P Chapman
- University of Massachusetts Medical School, Department of Emergency Medicine, Worcester, Massachusetts
| | - Melissa M Taylor
- University of Massachusetts Medical School, Department of Emergency Medicine, Worcester, Massachusetts
| | - Rochelle K Rosen
- Brown University School of Public Health, Department of Behavioral and Social Sciences, Providence, Rhode Island
| | - Stephanie P Carreiro
- University of Massachusetts Medical School, Department of Emergency Medicine, Worcester, Massachusetts
| | - Kavita M Babu
- University of Massachusetts Medical School, Department of Emergency Medicine, Worcester, Massachusetts
| |
Collapse
|