“I've been to more of my friends’ funerals than I've been to my friends’ weddings”: Witnessing and responding to overdose in rural Northern New England

Abstract

Purpose Overdose is a leading cause of death among people who use drugs (PWUDs), but policies to reduce fatal overdose have had mixed results. Summaries of naloxone access and Good Samaritan Laws (GSLs) in prior studies provide limited information about local context. Witnessing overdoses may also be an important consideration in providing services to PWUDs, as it contributes to post traumatic stress disorder (PTSD) symptoms, which complicate substance use disorder treatment. Methods We aim to estimate the prevalence and correlates of witnessing and responding to an overdose, while exploring overdose context among rural PWUD. The Drug Injection Surveillance and Care Enhancement for Rural Northern New England (DISCERNNE) mixed‐methods study characterized substance use and risk behaviors in 11 rural Massachusetts, Vermont, and New Hampshire counties between 2018 and 2019. PWUD completed surveys (n = 589) and in‐depth interviews (n = 22). Findings Among the survey participants, 84% had ever witnessed an overdose, which was associated with probable PTSD symptoms. Overall, 51% had ever called 911 for an overdose, though some experienced criminal legal system consequences despite GSL. Although naloxone access varied, 43% had ever used naloxone to reverse an overdose. Conclusions PWUD in Northern New England commonly witnessed an overdose, which they experienced as traumatic. Participants were willing to respond to overdoses, but faced barriers to effective overdose response, including limited naloxone access and criminal legal system consequences. Equipping PWUDs with effective overdose response tools (education and naloxone) and enacting policies that further protect PWUDs from criminal legal system consequences could reduce overdose mortality.

HCV serostatus and injection sharing practices among those who obtain syringes from pharmacies and directly and indirectly from syringe services programs in rural New England

“…The overall goal of DISCERNNE was to characterize the risk environment and epidemiology of overdose and injection-mediated infectious diseases among rural PWID. Further study details and findings from the DISCERNNE study have been published elsewhere [19][20][21].…”

Overdose responses among rural people who use drugs: A multi-regional qualitative study

“…Studies focused on rural communities have similarly found that rural people who use drugs fear the legal consequences of reporting overdose, even in states with GSL [24]. As with urban communities, people who use drugs often report experiencing stigma related to drug use in rural communities [11,[25][26][27].…”

I Don’t Believe a Person Has to Die When Trying to Get High: Overdose Prevention and Response Strategies in Rural Illinois

“…Even where naloxone is readily available, there are considerable barriers limiting uptake, such as stigma and fear of police arrest, diminishing the potential value of this lifesaving evidence-based intervention [ 17 ]. Along with naloxone, research has also identified overdose response techniques such as injecting a person with water or with a salt solution [ 18 , 19 ] and immersing people in cold water [ 20 ].…”