Addiction stigma and the production of impediments to take-home naloxone uptake

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.

Overdoselifesavers.org: a mixed-method evaluation of a public information website on experiences of overdose and using take-home naloxone to save lives

“…For example, Olsen et al (2018) argue, Politically [ … ] THN [take-home naloxone] advocacy and policy suffers from many of the same difficulties as other harm reduction initiatives for people who inject drugs: lack of general public awareness or support; concerns about the target population's capacity and disposition; and limited policy-maker resolve and funding. (Olsen et al, 2018, p. 437) Political impediments such as those listed by Olsen et al (2018) emphasise the importance of analysing the impact of social dynamics, for example stigma, on support for initiatives aimed at reducing opioid overdose deaths (Fomiatti et al, 2020). Detailed analysis of how stigma shapes uptake of take-home naloxone has only recently emerged.…”

“…Detailed analysis of how stigma shapes uptake of take-home naloxone has only recently emerged. Fomiatti et al (2020) argue that stigma impedes professional information provision about naloxone availability, limits the expansion of programs and access points and renders take-home naloxone ill-suited to many social settings of overdose (see also Fraser et al, 2018).…”

“…Aiming to support the uptake of take-home naloxone and address gaps in public and professional understandings of opioid overdose, the project that produced Overdoselifesavers.org began in 2017. Funded by the Australian Research Council (DP170101669) and drawing on the expertise of a national advisory panel, the project used a purposive data collection strategy to recruit and interview 46 opioid consumers and 36 health professionals across the Australian states of New South Wales and Victoria (for analyses of interview data see, Farrugia et al, 2019Farrugia et al, , 2020; Fomiatti et al, 2020). The study was approved by Curtin University's Human Research Ethics Committee (HRE2017-0168/2017) and La Trobe University's Human Ethics Committee (HEC19339).…”

“…Importantly, while the website contains many successful stories of revival, it does not present a naïve or overly positive account of the issue. In this way, Overdoselifesavers.org sought to provide balance in acknowledging the challenges of responding to overdose under prohibition and the influence of issues such as insecure housing, police harassment, and stigma, all known to shape incidence of overdose and reduce capacity to respond (Buchman et al, 2017;Fomiatti et al, 2020;Zigon, 2019).…”

“…Such responses can be understood to endorse the larger 'project' of Overdoselifesavers.org as a social intervention to reframe understandings of overdose. These responses also point to the continued importance of efforts to directly address the stigma and discrimination encountered by people who consume drugs and their impact on uptake and use of take-home naloxone (Fomiatti et al, 2020).…”