Factors associated with withdrawal symptoms and anger among people resuscitated from an opioid overdose by take-home naloxone: Exploratory mixed methods analysis

Neale, Joanne; Kalk, Nicola J.; Parkin, Stephen; Brown, Caral; Brandt, Laura; Campbell, Aimee N.C.; Castillo, Felipe; Jones, Jermaine D.; Strang, John; Comer, Sandra D.

doi:10.1016/j.jsat.2020.108099

Cited by 11 publications

(6 citation statements)

References 62 publications

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“…Initial symptoms of anxiety, agitation, and restlessness are distressing to patients, which may lead to increased irritability and aggression. 58 Abstinence in alcohol users after treatment is different, as there is no evidence of urgency of use as is seen with substances such as heroin and crack-cocaine. This can be related to several factors, but those most described in the literature are emotional aspects linked to negative affects that trigger a craving for alcohol use.…”

Section: Discussionmentioning

confidence: 99%

Anger and substance abuse: a systematic review and meta-analysis

Laitano

Ely

Sordi

et al. 2022

Braz. J. Psychiatry

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Objective: Conduct a systematic review and meta-analysis to evaluate levels of anger among substance users compared to non-user controls and to analyze the possible association between anger and psychoactive substance use (PSU). Methods: The procedures of this review followed the Meta-Analyzes of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four electronic databases (MEDLINE, EMBASE, BIREME, PsycINFO) were searched. Results: Twelve studies were included in the meta-analysis; 10 used the State-Trait Anger Expression Inventory (STAXI) anger trait subscale and two used the Buss-Perry-Aggression Questionnaire (BPAQ) anger subscale. The sample included 2,294 users of psychoactive substances and 2,143 nonusers, all male. The mean difference in anger scale scores between users and non-users was 2.151 (95%CI 1.166-3.134, p p 0.00, inconsistency index [I 2 ] = 98.83) standard deviations. Age and abstinence duration did not moderate the difference in anger between substance users and non-users. Conclusion: Users of psychoactive substances had elevated anger scores compared to non-users, which represents a high risk of relapse. It is suggested that PSU treatment programs include intensive anger management modules, focusing on factors such as dealing with daily stressors, family conflicts, frustrations, and problems.

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Section: Discussionmentioning

confidence: 99%

Anger and substance abuse: a systematic review and meta-analysis

Laitano

Ely

Sordi

et al. 2022

Braz. J. Psychiatry

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“…At the start of the trial, intranasal naloxone was provided in the form of a multi-step atomized nasal naloxone spray assembled by combining a pre-filled luer-lock syringe with a nasal atomizer and spare vial. In August 2017, the trial changed from providing the multistep intranasal naloxone to the single step Narcan ® nasal spray, although participants were still offered the option of receiving the intramuscular device instead (for details see 38 ). Participants were followed up for one year to assess retention of overdose prevention knowledge and to obtain detailed information surrounding overdose events that were witnessed and/or experienced (for detailed information on the RCT see) 29 , 39 …”

Section: Methodsmentioning

confidence: 99%

Emotional Reactions of Trained Overdose Responders who use Opioids following Intervention in an Overdose Event

et al. 2022

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Background: Our aim was to explore emotional reactions to intervening in an overdose event from the perspective of individuals who use opioids (peer responders). In addition, we were interested in the impact this experience may have on peer responders’ feelings about helping in an overdose situation in the future. Methods: For this qualitative sub-study of a randomized controlled trial (RCT), data from 61 interviews were analyzed thematically using an inductive approach. Results: Peer responders had diverse emotional reactions to the overdose event. These ranged from a sense of pride and other positive feelings associated with their ability to help to ambivalence about being involved in situations perceived as challenging and burdensome. There were few reports of the overdose event as an exclusively negative experience. Many peer responders perceived it as their duty to use naloxone again if required. However, some had ambivalent feelings toward this responsibility, which may be related to negative experiences with previous intervention efforts. Conclusions: The capacity of people who use opioids to help reduce the harms associated with opioid overdose is experienced as empowering by some. Nonetheless, engaging peer responders in strategies to reduce opioid-related mortality should be coupled with appropriate resources to process their experiences and emotional responses.

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“…One example is the mooted possibility that the associated sense of safety may paradoxically lead to increased risky behaviour ("risk compensation"): little evidence of this theoretical risk has been found and specific examination of this possibility in a randomized trial found no such evidence [29]. A second example is the concern that excessive naloxone dosing could cause "over-antagonism" [56] with resulting hostility to the person resuscitating the victim alongside further drug-seeking to reverse the reversal: new studies between researchers in London, New York, and Melbourne [57][58][59][60] has explored this phenomenon and their implications for necessary revisions to policy and practice. A third recently identified concern is the reports of low carriage rates of take-home naloxone, a characteristic of possible importance if it leads to missed actions, and which seems to be very variable between settings (<10% in Scotland; >40% in Norway [61,62]), with recent survey comparing different European countries finding considerable variability (forthcoming).…”

Section: Fuller Understandingmentioning

confidence: 99%

“…Naloxone dose needs to be sufficient to reverse the opioid overdose that might cause death. But it is also important to avoid giving excess naloxone which might precipitate acute opioid withdrawal which, in addition to causing unnecessary distress and risk of hostility, might trigger further drug-seeking to reverse the naloxone-trig- gered reversal [56,59,82]. We also need to establish if dose titration can effectively be taught to this new intervention workforce: the principles are simple, as is the practice, requiring the administration of an initial dose, observation of its effect over the next few minutes, then a decision whether a repeat dose is required.…”

Section: Uncertainty About Naloxone Dosementioning

confidence: 99%

Take-Home Naloxone and the Prevention of Deaths from Heroin Overdose: Pursuing Strong Science, Fuller Understanding, Greater Impact

Strang

2021

Eur Addict Res

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Background and Context: Realization of the life-saving potential of “take-home naloxone” has been a personal journey, but it has also been a collective journey. It has been a story of individual exploration and growth, and also a story of changes at a societal level. “Take-home naloxone” has matured since its first conceptualization a quarter of a century ago. It required recognition of the enormous burden of deaths from drug overdose (particularly heroin and other opioids), and also realization of critical clusterings (such as post-release from prison). It also required realization that, since many overdose deaths are witnessed, we can potentially prevent many deaths by mobilizing drug users themselves, their families, and the wider caring community to act as intervention workforce to give life-saving interim emergency care. Summary of Scope: This article explores 5 areas (many illustrations UK-based where the author works): firstly, the need for strong science; secondly, our improved understanding of opioid overdose and deaths; thirdly, the search for greater impact from our policies and interventions; fourthly, developing better forms of naloxone; and fifthly, examining the challenges still to be addressed. Key Messages: “Take-home naloxone” is an exemplar of harm reduction with potential global impact – drug policy and practice for the public good. However, “having the potential” is not good enough – there needs to be actual implementation. This will be easier once the component parts of “take-home naloxone” are improved (better naloxone products, better training aids, revised legislation, and explicit funding support). Many improvements are already possible, but we hesitate about implementation. It is our responsibility to drive progress faster. With “take-home naloxone,” we can be proud of what we have achieved, but we must also be humble about how much more we still need to do.

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Factors associated with withdrawal symptoms and anger among people resuscitated from an opioid overdose by take-home naloxone: Exploratory mixed methods analysis

Cited by 11 publications

References 62 publications

Anger and substance abuse: a systematic review and meta-analysis

Anger and substance abuse: a systematic review and meta-analysis

Emotional Reactions of Trained Overdose Responders who use Opioids following Intervention in an Overdose Event

Take-Home Naloxone and the Prevention of Deaths from Heroin Overdose: Pursuing Strong Science, Fuller Understanding, Greater Impact

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