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Background: Naloxone is an opioid antagonist that can reverse an opioid overdose. Increased opioid-related mortality rates led to greater distribution of naloxone without a prescription and administration of naloxone by laypersons. This study fills a gap in knowledge of naloxone experiences among active users of opioids living in suburban communities. Purpose: The purpose of this article is to provide nurse practitioners with an in-depth understanding of current naloxone use practices among people who experience overdose events. The specific aims are to compare access to naloxone in diverse suburban towns, to examine administration differences across settings, and to understand perspectives on naloxone experiences from people who are actively using opioids. Methodological orientation: The data for this analysis were drawn from an ethnographic study in the suburban towns around Atlanta, Georgia; Boston, Massachusetts; and New Haven, Connecticut. Short surveys and in-depth interviews were collected. Inductive methods were used to compare data across settings. Sample: The sample of 106 included 48% female, 62% White, 24% African American/Black, 13% more than one race, and 21% Hispanic/Latinx. The mean age was 41.35 years. Conclusions: Differences between study settings in access to naloxone, administration frequency, and delivery systems were found. Findings suggest more education and training is needed in overdose prevention and harm reduction intervention. Studies on delivery systems need to address the increase in fentanyl-related overdoses. Implications for practice: Nurse practitioners can help to target distribution of naloxone in local communities, facilitate collaboration with harm reduction services, and provide evidence-based education and training to laypersons.

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Drug courts were established for criminal offenders whose primary offense is related to drug use. As an alternative to incarceration, the drug court incorporates drug treatment with close judicial supervision. A team approach includes the judge, public defender, case workers and/or treatment providers, and a coordinator. Traditional drug court treatment programs offer therapeutic approaches that include mandatory counseling, 12-step (self-help) group meetings, attendance at regular court sessions, random drug testing, and, in some cases, life skills training (Nolan 2003). Some drug courts place particular emphasis on furthering participants' education and their job skills. In these examples, employment and education are seen as important treatment outcomes (Leukefield 2007; Deschenes 2009). Adding services to drug court programs such as employment and educational resources and increasing the number of residential treatment beds also improves retention rates for participation and helps contain recidivism rates (Deschenes 2009). Most studies find drug court participants to have substantially lower re-arrest rates than comparison samples, with recidivism as low as 27 percent compared to 70 percent for drug offenders who did not participate in a drug court program (Belenko 1998; May 2008).

Women of childbearing age who misuse opioids are a particularly vulnerable population, and their barriers to treatment are unique because of their caregiver roles. Research on treatment for opioid use generally draws from urban and rural areas. This study fills a gap in research that focuses on barriers and motivators to opioid treatment in suburban areas. The aim of this study was to give voice to suburban pregnant women and mothers caring for children while using opioids. Ethnographic methods were used for recruitment, and 58 in-depth interviews were analyzed using a modified grounded theory approach. Barriers to medication-assisted treatment (MAT) included stigma, staff attitudes, and perceptions the women had about MAT treatment. Barriers associated with all types of treatment included structural factors and access difficulties. Relationships with partners, friends, family, and providers could be barriers as well as motivators, depending on the social context of the women’s situation. Our findings suggest increasing treatment-seeking motivators for mothers and pregnant women by identifying lack of resources, more empathetic consideration of social environments, and implementing structural changes to overcome barriers. Findings provide a contemporary understanding of how suburban landscapes affect mothers’ treatment-seeking for opioid dependence and suggest the need for more focus on emotional and structural resources rather than strict surveillance of women with opioid dependence who are pregnant or caring for children.