Perceived Causes of Personal versus Witnessed Overdoses among People who Inject Opioids

Behar, Emily; Chang, Jamie; Countess, Kennedy; Matheson, Tim; Santos, Glenn-Milo; Coffin, Phillip O.

doi:10.1080/10826084.2019.1609988

Cited by 2 publications

(7 citation statements)

References 35 publications

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“…Our findings may have been affected by social desirability and selection biases [ 40 , 44 ]. Nonetheless, our findings are similar to those among other groups of people who use opioids [ 29 , 30 ]. The study was conducted in a single setting, limiting the generalizability of findings to other locations.…”

Section: Discussionsupporting

confidence: 91%

“…This was similar to our findings among REBOOT pilot participants, where participants who were older had lower odds of perceived overdose risk [ 29 ]. Pilot participants similarly described inexperience as a main contributor to overdose events that they witnessed in other people but not to overdoses that they personally experienced [ 30 ]. This finding led to a greater emphasis in the intervention on helping participants develop a realistic assessment of their risk for overdose.…”

Section: Discussionmentioning

confidence: 99%

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“There’s No Heroin Around Anymore. It’s All Fentanyl.” Adaptation of an Opioid Overdose Prevention Counseling Approach to Address Fentanyl Overdose: Formative Study

McMahan¹,

Arenander²,

Matheson³

et al. 2022

JMIR Form Res

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Background Drug overdose mortality continues to increase, now driven by fentanyl. Prevention tools such as naloxone and medications to treat opioid use disorder are not sufficient to control overdose rates; additional strategies are urgently needed. Objective We sought to adapt a behavioral intervention to prevent opioid overdose (repeated-dose behavioral intervention to reduce opioid overdose [REBOOT]) that had been successfully piloted in San Francisco, California, United States, to the setting of Boston, Massachusetts, United States, and the era of fentanyl for a full efficacy trial. Methods We used the assessment, decision, adaptation, production, topical experts, integration, training, and testing (ADAPT-ITT) framework for intervention adaptation. We first identified opioid overdose survivors who were actively using opioids as the population of interest and REBOOT as the intervention to be adapted. We then performed theater testing and elicited feedback with 2 focus groups (n=10) in Boston in 2018. All participants had used opioids that were not prescribed to them in the past year and experienced an opioid overdose during their lifetime. We incorporated focus group findings into our initial draft of the adapted REBOOT intervention. The adapted intervention was reviewed by 3 topical experts, and their feedback was integrated into a subsequent draft. We trained study staff on the intervention and made final refinements based on internal piloting. This paper describes the overall ADAPT-ITT process for intervention adaptation, as well as a qualitative analysis of the focus groups. Working independently, 2 authors (VMM and JA) reviewed the focus group transcripts and coded them for salient and common themes using the constant comparison method, meeting to discuss any discrepancies until consensus was reached. Codes and themes were then mapped onto the REBOOT counseling steps. Results Focus group findings contributed to substantial changes in the counseling intervention to better address fentanyl overdose risk. Participants described the widespread prevalence of fentanyl and said that, although they tried to avoid it, avoidance was becoming impossible. Using alone and lower opioid tolerance were identified as contributors to overdose risk. Slow shots or tester shots were acceptable and considered effective to reduce risk. Naloxone was considered an effective reversal strategy. Although calling emergency services was not ruled out, participants described techniques to prevent the arrival of police on the scene. Expert review and internal piloting improved the intervention manual through increased participant centeredness, clarity, and usability. Conclusions We successfully completed the ADAPT-ITT approach for an overdose prevention intervention, using theater testing with people who use opioids to incorporate the perspectives of people who use drugs into a substance use intervention. In the current crisis, overdose prevention strategies must be adapted to the context of fentanyl, and innovative strategies must be deployed, including behavioral interventions. Trial Registration ClinicalTrials.gov NCT03838510; https://clinicaltrials.gov/ct2/show/NCT03838510

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

“There’s No Heroin Around Anymore. It’s All Fentanyl.” Adaptation of an Opioid Overdose Prevention Counseling Approach to Address Fentanyl Overdose: Formative Study

McMahan¹,

Arenander²,

Matheson³

et al. 2022

JMIR Form Res

Self Cite

View full text Add to dashboard Cite

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“…Harm reduction education should also emphasize the importance of not using alone—especially given the heightened risks of fentanyl as well as inconsistencies in the drug supply 56 , 57 . Several study participants attributed their overdose to fentanyl.…”

Section: Discussionmentioning

confidence: 99%

“…[51][52][53][54][55] Harm reduction education should also emphasize the importance of not using alone-especially given the heightened risks of fentanyl as well as inconsistencies in the drug supply. 56,57 Several study participants attributed their overdose to fentanyl. In some cases, they were surprised to learn that the substance they thought was pure heroin or cocaine was laced with fentanyl.…”

Section: Public Health Implicationsmentioning

confidence: 99%

“…57,59,60 Behar and colleagues reported volatility in drug potency as a major contributing factor to overdose among people who inject drugs. 57 Reduced drug tolerance after a period of abstinence during hospital detoxification, residential treatment, or incarceration is another well-established overdose risk factor and noted by some of our participants. [65][66][67][68] Increased drug tolerance leading to overdose was also mentioned in our interviews.…”

Section: Public Health Implicationsmentioning

confidence: 99%

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

et al. 2022

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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.

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Perceived Causes of Personal versus Witnessed Overdoses among People who Inject Opioids

Cited by 2 publications

References 35 publications

“There’s No Heroin Around Anymore. It’s All Fentanyl.” Adaptation of an Opioid Overdose Prevention Counseling Approach to Address Fentanyl Overdose: Formative Study

“There’s No Heroin Around Anymore. It’s All Fentanyl.” Adaptation of an Opioid Overdose Prevention Counseling Approach to Address Fentanyl Overdose: Formative Study

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

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