“Narcan Encounters:” Overdose and Naloxone Rescue Experiences among People who use Opioids

Abstract

Background Communities across the United States are confronting the precipitous rise in opioid overdose fatalities that has occurred over the past decade. Naloxone, an opioid antagonist, is a safe rescue medication that laypeople can administer to reverse an overdose. Community naloxone training programs have been well-documented. Less is known about overdose survivors’ subjective experiences with naloxone reversal and its impacts on drug use behavior. Methods Semi-structured interviews were conducted with 35 community-dwelling adults who had been reversed at least once with naloxone. Inductive thematic content analysis incorporating Atlas.ti software was used to identify themes. Results Four broad thematic categories were identified. (1) Overdose experience and memory: Most participants remembered taking the drugs one minute and waking up the next—sometimes in different surroundings; (2) Naloxone rescue—waking up: Participants described acute withdrawal symptoms, disorientation, and volatile emotions; (3) Reasons for overdose: Polypharmacy; changes in opioid tolerance, or presence of fentanyl were the most common explanations. (4) Impacts of naloxone rescue: A variety of contextual factors influenced participants’ responses to naloxone rescue, especially acute withdrawal symptoms. While some participants altered or tempered their opioid use, others resumed opioid use—especially to mitigate withdrawal. Participants overwhelmingly emphasized that naloxone saved their lives. Conclusion Results suggest that a naloxone rescue may not be a wake-up call for many people who use opioids, but access to naloxone is an effective overdose harm reduction option, supporting its widespread implementation. The study findings underscore the importance of ongoing community overdose prevention and harm reduction initiatives, including take-home naloxone (THN) and medication assisted treatment in the Emergency Department.

The Role of the Social Network in Fatal Opioid Overdose Prevention: The Former Opioid User’s Perspective

“…Consistent with findings from other studies, the participants in the present study mentioned stigma as a perceived barrier to naloxone use (Bennett et al, 2020; Bowles et al, 2020; Kahn et al, 2020; Latkin et al, 2019; Rochester & Graboyes, 2020). There is also available literature regarding the need to better train pharmacists on opioid use disorder and the efficacy of naloxone to address stigma (Green et al, 2017).…”

“…Therefore, public health officials should aim their future work at decreasing the stigma associated with opioid use disorder and naloxone among individuals within the social network of PWUO and within the community at large. In addition, as has been reported in the literature, many of the participants in the present study identified cost as a perceived barrier to naloxone use among PWUO, in particular (Bowles et al, 2020; Davis et al, 2013; Kahn et al, 2020; Khatiwoda et al, 2018; Lankenau et al, 2013; Richert, 2015; Rochester & Graboyes, 2020; Wagner et al, 2014; Walley et al, 2013). To mitigate this issue, policymakers and medical professionals have proposed the re-classification of naloxone as an over-the-counter (OTC) medication (Evoy et al, 2021).…”

“…Very few participants in this study described using opioids with someone else or having naloxone present as a precautionary measure to overdose. More commonly, the participants described protective factors such as their awareness of opioid purity (i.e., the presence of fentanyl), as has been reported by other researchers (Bowles et al, 2020;Harris et al, 2021;Kahn et al, 2020). Therefore, public health officials should disseminate the harm reduction message among PWUO to never use alone in addition to being aware of the purity of opioids as protective measures against fatal overdose.…”

“…A convenience sample of N = 25 participants was selected with recruitment assistance from peer support individuals employed at five behavioral health treatment centers in Michigan and Ohio accessed in this study. Several researchers have used convenience sampling of small sample size (i.e., 18-52 participants) in other phenomenological studies among PWUO (Bennett et al, 2020;Bowles et al, 2020;Kahn et al, 2020;Rochester & Graboyes, 2020). Participants were excluded based on their self-reported opioid use history, where only those who reported not having used any opioid other than medication-assisted treatments such as methadone and buprenorphine by any route of administration within the past 6 months were eligible.…”

Treatment Experiences Among People Who Use Opioids: A Social Ecological Approach

“…The current study is part of a larger qualitative research project involving people who survived opioid overdose and naloxone rescue (Kahn et al, 2020). Following Sandelowski's methodological approach (Sandelowski & Boshamer, 2006), we divided the qualitative dataset derived from our interviews into two broad thematic categories: (1) opioid overdose and naloxone rescue (Kahn et al, 2020) and (2) treatment seeking and engagement. We have previously reported on overdose and naloxone rescue (Kahn et al, 2020).…”