Barriers to naloxone use and acceptance among opioid users, first responders, and emergency department providers in New Hampshire, USA

Bessen, Sarah Y.; Metcalf, Stephen A.; Saunders, Elizabeth C.; Moore, Sarah K.; Meier, Andrea; McLeman, Bethany; Walsh, Olivia; Marsch, Lisa A.

doi:10.1016/j.drugpo.2019.09.008

Cited by 54 publications

(52 citation statements)

References 27 publications

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“…Participants cited 4 main barriers that may impede rates of naloxone acceptance, possession, and use: (1) stigma related to substance use, (2) indifference toward overdose, (3) fear of the negative consequences of carrying naloxone, and (4) fear of misrecognizing the need for naloxone. Some of these barriers have been identified by other researchers, including the fear of precipitating withdrawal sickness, stigma, and the fear of arrest [ 12 , 24 , 36 , 37 ]. Our study participants cited stigma toward drug users and concerns of being outed as a drug user as influencing naloxone-related practices, including decisions about whether or not to carry or prominently display naloxone when carrying it.…”

Section: Discussionmentioning

confidence: 99%

“…The size and distribution modalities of programs vary by state and city; however, these programs all typically provide no-cost naloxone to people who use opioids, along with training in how to identify an overdose, conduct rescue breathing and cardiopulmonary resuscitation (CPR), and administer naloxone [9,10]. Overdose training and naloxone are also provided to staff at many drug treatment programs and syringe service programs (SSPs), and to first responders such as law enforcement, Emergency Medical Services (EMS), and fire department personnel [11,12]. These efforts have resulted in greater access to naloxone for many individuals who might not otherwise receive the medication [13][14][15], and evaluations of THN programs have consistently found that these programs effectively reduce overdose mortality and lead to few adverse events [16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

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Reasons People Who Use Opioids Do Not Accept or Carry No-Cost Naloxone: Qualitative Interview Study

et al. 2020

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Background: Many people use opioids and are at risk of overdose. Naloxone is an opioid antagonist used to counter the effects of opioid overdose. There is an increased availability of naloxone in New York City; however, many who use opioids decline no-cost naloxone even when offered. Others may have the medication but opt not to carry it and report that they would be reluctant to administer it if they were to witness an overdose. Objective: We aim to better understand why people who use opioids may be reluctant to accept, carry, and administer naloxone, and to inform the development of messaging content that addresses barriers to its acceptance and use. Methods: We conducted formative qualitative interviews with 20 people who use opioids who are 18 years and older in New York City. Participants were recruited via key informants and chain referral. Results: Participants cited 4 main barriers that may impede rates of naloxone acceptance, possession, and use: (1) stigma related to substance use, (2) indifference toward overdose, (3) fear of negative consequences of carrying naloxone, and (4) fear of misrecognizing the need for naloxone. Participants also offered suggestions about messaging content to tackle the identified barriers, including messages designed to normalize naloxone possession and use, encourage shared responsibility for community health, and elicit empathy for people who use drugs. Taken together, participants' narratives hold implications for the following potential messaging content: (1) naloxone is short-acting, and withdrawal sickness does not have to be long-lasting; (2) it is critical to accurately identify an opioid-involved overdose; (3) anyone can overdose; (4) naloxone cannot do harm; and (5) the prompt administration of the medication can help ensure that someone can enjoy another day. Finally, participants suggested that messaging should also debunk myths and stereotypes about people who use drugs more generally; people who use opioids who reverse overdoses should be framed as lay public health advocates and not just "others" to be managed with stigmatizing practices and language. Conclusions: It must be made a public health priority to get naloxone to people who use opioids who are best positioned to reverse an overdose, and to increase the likelihood that they will carry naloxone and use it when needed. Developing, tailoring, and deploying messages to address stigma, indifference toward overdose, fear and trepidation about reversing an overdose, and fear of police involvement may help alleviate fears among some people who are reluctant to obtain naloxone and use the medication on someone in an overdose situation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reasons People Who Use Opioids Do Not Accept or Carry No-Cost Naloxone: Qualitative Interview Study

et al. 2020

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“…Quantitative evaluations of structured training sessions on OD response for law enforcement officers in the U.S. states of Connecticut and Rhode Island have demonstrated that such training can effectively equip first responders with the skills and knowledge needed to apply these new fatal OD prevention strategies when responding to calls for service ( Saucier et al, 2016 ). However, qualitative assessments have highlighted the emotional burden of implementing these new strategies (often resulting in compassion fatigue or “burnout”) among law enforcement ( Bessen et al, 2019 ) as well as growing concern among first responders that such strategies may enable riskier substance use ( Saunders et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Knowledge, preparedness, and compassion fatigue among law enforcement officers who respond to opioid overdose

Carroll

Mital

Wolff

et al. 2020

Drug and Alcohol Dependence

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Highlights Most patrol officers who respond to OD calls receive training and carry naloxone. One in three officers report making an arrest at an OD scene in the past 6 months. A minority of officers correctly described their state’s Good Samaritan Law. Officer endorsement of OD-prevention strategies decreases as OD response increases.

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“…That is, naloxone may be used unnecessarily when less aversive treatments might be administered by emergency medical personnel (Bledsoe, 2018). Finally, officers have argued that naloxone may enable opioid use by providing a safety net in the event of overdose (Bessen et al., 2019), though this has not been substantiated in prior research (Seal et al., 2005; Wagner et al., 2010).…”

mentioning

confidence: 99%

Two‐year outcomes following naloxone administration by police officers or emergency medical services personnel

Lowder

Lawson

O’Donnell

et al. 2020

Criminology & Public Policy

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We conducted a retrospective, quasi-experimental study of a police naloxone program to examine individual outcomes following nonfatal overdose where either police (n = 111) or emergency medical services (n = 1,229) provided a first response and administered naloxone. Individuals who received a police response were more likely to be arrested immediately following initial dispatch and had more instances of repeat nonfatal overdose two years following dispatch; there were no differences in rearrest or death rates. Findings suggest police naloxone programs may increase short-term incarceration risk, but we found little evidence overall of long-term adverse effects. Policy Implications: Naloxone is a tool to reduce fatal opioid-involved overdose. Its provision alone does not constitute a comprehensive agency response to the opioid epidemic. Findings support the need for standardized policies and procedures to guide emergency responses to nonfatal overdose events and ensure consistency across agencies.

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Barriers to naloxone use and acceptance among opioid users, first responders, and emergency department providers in New Hampshire, USA

Cited by 54 publications

References 27 publications

Reasons People Who Use Opioids Do Not Accept or Carry No-Cost Naloxone: Qualitative Interview Study

Reasons People Who Use Opioids Do Not Accept or Carry No-Cost Naloxone: Qualitative Interview Study

Knowledge, preparedness, and compassion fatigue among law enforcement officers who respond to opioid overdose

Two‐year outcomes following naloxone administration by police officers or emergency medical services personnel

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