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

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.

Physiological responses in high-P subjects during active and passive coping

There have been relatively few studies of the psychophysiological correlates of Eysenck's dimension of psychoticism (P) and those which do not exist report findings which cannot be readily integrated to isolate a distinctive physiological basis of P. The present study investigated differences between subjects scoring high and low on the P scale of the Eysenck Personality Questionnaire (EPQ) in relation to sympathetic and parasympathetic arousal following aversive stimulation. An active-passive coping paradigm using an aversive tone was selected to elicit responses and cardiovascular measures (heart period, heart period variance, T-wave amplitude) and a skin conductance measure (event-related skin conductance) were obtained. The findings show that differences between high- and low-P subjects are specific to the coping condition. Under active coping, high-P subjects exhibited greater sympathetic arousal following the aversive tone than low-P subjects. There was no significant difference between the high-P and low-P subjects on any physiological variable under the passive coping condition. It is suggested that if there is differential functioning of the divisions of the autonomic nervous system in subjects differing in P, that these differences may only manifest themselves under specific situations.