How competent are people who use opioids at responding to overdoses? Qualitative analyses of actions and decisions taken during overdose emergencies

Abstract

Background and Aims Providing take-home naloxone (THN) to people who use opioids is an increasingly common strategy for reversing opioid overdose. However, implementation is hindered by doubts regarding the ability of people who use opioids to administer naloxone and respond appropriately to overdoses. We aimed to increase understanding of the competencies required and demonstrated by opioid users who had recently participated in a THN programme and were subsequently confronted with an overdose emergency. Design Qualitative study designed to supplement findings from a randomized controlled trial of overdose education and naloxone distribution. Interviews were audio-recorded, transcribed, systematically coded and analysed via Iterative Categorization. Setting New York City, USA. Participants Thirty-nine people who used opioids (32 men, 7 women; aged 22-58 years). Intervention Trial participants received brief or extended overdose training and injectable or nasal naloxone. Measurements The systematic coding frame comprised deductive codes based on the topic guide and more inductive codes emerging from the data. Findings In 38 of 39 cases the victim was successfully resuscitated; the outcome of one overdose intervention was unknown. Analyses revealed five core overdose response 'tasks': (1) overdose identification; (2) mobilizing support; (3) following basic first aid instructions; (4) naloxone administration; and (5) post-resuscitation management. These tasks comprised actions and decisions that were themselves affected by diverse cognitive, emotional, experiential, interpersonal and social factors over which lay responders often had little control. Despite this, participants demonstrated high levels of competency. They had acquired new skills and knowledge through training and brought critical 'insider' understanding to overdose events and the resuscitation actions which they applied. Conclusions People who use opioids can be trained to respond appropriately to opioid overdoses and thus to save their peers' lives. Overdose response requires both practical competency (e.g. skills and knowledge in administering basic first aid and naloxone) and social competency (e.g. willingness to help others, having the confidence to be authoritative and make decisions, communicating effectively and demonstrating compassion and care to victims post-resuscitation).

Preventing opioid overdose with peer-administered naloxone: findings from a rural state

“…Overall, findings from the interviews highlight the feasibility of community-based overdose education and naloxone distribution, as participants reported high levels of accessibility and satisfaction as well as high perceived effectiveness of naloxone in reversing overdoses. These findings are consistent with other recent literature demonstrating the competence of peers in administering naloxone and reversing overdose [44] and also suggest that overdose education may be useful for overcoming opioid knowledge deficits experienced by rural individuals [45].…”

Fatal overdose prevention and experience with naloxone: A cross-sectional study from a community-based cohort of people who inject drugs in Baltimore, Maryland

“…As OEND programs continue to expand, research has consistently demonstrated their safety and effectiveness [4][5][6][7][8][9][10][11]. Most importantly, OEND participation is associated with improved ability of participants to respond appropriately to overdose and safely administer naloxone in order to prevent fatal overdoses [12].…”

Opioid users reflect on their experiences responding to suspected opioid overdoses using take-home naloxone

“…The stated aim of the study was to develop increased understanding of the knowledge and skills that opioid users require and use in overdose emergencies 2. This qualitative study supplements a randomised controlled trial in which people aged 21–65 years meeting the criteria for opioid use disorder within 6 months of the intervention were provided with THN.…”