Awareness and access to naloxone necessary but not sufficient: Examining gaps in the naloxone cascade

Tobin, Karin E.; Clyde, Catie; Davey‐Rothwell, Melissa; Latkin, Carl A.

doi:10.1016/j.drugpo.2018.07.003

Cited by 63 publications

(57 citation statements)

References 10 publications

(10 reference statements)

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“…In a community-based cohort of current and former PWID living in Baltimore, nearly half reported recently receiving naloxone training and many had recently received a supply of naloxone (38%), but recent use (9%) and regular possession (9%) of naloxone were much less frequently reported. These findings support prior research on lifetime engagement in the 'naloxone cascade' in Baltimore [18] and other settings [23], where awareness of naloxone was high (70-90%), but possession and use were low (20-30%). Unfortunately, the pervasiveness of fentanyl in the Baltimore drug supply [24] and the resulting rise in overdose mortality rates locally demonstrate that there is a dire need for not only OEND, but ready and consistent access to naloxone.…”

Section: Discussionsupporting

confidence: 85%

“…While Tobin et al [18] characterized lifetime experience with the naloxone cascade, potential overdose responders need continuous and consistent access to naloxone in order to effectively implement this life-saving intervention. To examine continuous and consistent access to naloxone in PWID, we characterized recent experience with naloxone, including receipt of training and naloxone supply, use of naloxone after a witnessed overdose, and regular possession of naloxone among PWID in Baltimore, Maryland.…”

Section: Plos Onementioning

confidence: 99%

“…Participants of OEND have been characterized as predominantly homeless PWID, who have commonly received drug treatment and witnessed overdoses [13][14][15][16][17], suggesting that training efforts may be adequately reaching vulnerable populations. In fact, in a recent study among persons who currently use or formerly used heroin in Baltimore in 2018, 90% had heard of naloxone and the majority had received naloxone training, but only one-third of those aware of naloxone reported regularly carrying it [18]. This suggests that despite good coverage of educational campaigns, additional work may be needed to ensure adequate supply and to encourage those most likely to experience an overdose to habitually carry naloxone.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

et al. 2020

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Introduction Overdose is a leading cause of death in the United States, especially among people who inject drugs (PWID). Improving naloxone access and carrying among PWID may offset recent increases in overdose mortality associated with the influx of synthetic opioids in the drug market. This study characterized prevalence and correlates of several naloxone outcomes among PWID. Methods During 2018, a survey to assess experience with naloxone was administered to 915 participants in the AIDS Linked to the IntraVenous Experience (ALIVE) study, an ongoing community-based observational cohort of people who currently inject or formerly injected drugs in Baltimore, Maryland. We examined the associations of naloxone outcomes (training, supply, use, and regular possession) with socio-demographic, substance use and healthcare utilization factors among PWID in order to characterize gaps in naloxone implementation among this high-risk population. Results Median age was 56 years, 34% were female, 85% were African American, and 31% recently injected. In the past six months, 46% (n = 421) reported receiving training in overdose prevention, 38% (n = 346) had received a supply of naloxone, 9% (n = 85) had administered naloxone, and 9% (n = 82) reported usually carrying a supply of naloxone. Recent non-fatal overdose was not associated with any naloxone outcomes in adjusted analysis. Active opioid use (aOR = 2.10, 95% CI: 1.03, 4.28) and recent treatment of alcohol or substance use disorder (aOR = 2.01, 95% CI: 1.13, 3.56) were associated with regularly carrying naloxone.

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Section: Discussionsupporting

confidence: 85%

Section: Plos Onementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…Along these lines, there has been interest in more clearly understanding ‘gaps in the naloxone cascade’ . In other words, researchers and experts in the substance abuse field recognize that awareness and access to naloxone is not sufficient to stem the tide of opiate deaths.…”

mentioning

confidence: 99%

Dying alone: the sad irrelevance of naloxone in the context of solitary opiate use

Wojcicki

2018

Addiction

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“…The effect of naloxone laws on its supply has been investigated . A study in the United States found that its availability increased and opioid‐related mortality declined after pharmacists were permitted to directly supply naloxone .…”

mentioning

confidence: 99%

Community pharmacy naloxone supply, before and after rescheduling as an over‐the‐counter drug: sales and prescriptions data, 2014–2018

Tse

Sanfilippo

Lam

et al. 2020

Medical Journal of Australia

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Objectives: To characterise the community pharmacy supply of naloxone by supply type -individual prescription, prescriber bag, and non-dispensed (supplied over the counter or expired) -during 2014-2018; to examine whether the 2016 rescheduling of naloxone as an over-the-counter drug influenced non-dispensed naloxone supply volume.Design, setting: Analysis of monthly naloxone prescriptions (Pharmaceutical Benefits Scheme) and sales data (IQVIA), 2014-2018, for Australia and by state and territory; time series analysis of non-dispensed naloxone supply to assess effect of rescheduling on naloxone supply. Major outcomes:Total naloxone supply to community pharmacies; prescribed and non-dispensed naloxone supply. Results:During 2014-2018, 372 351 400 μg units of naloxone were sold to community pharmacies: non-dispensed naloxone accounted for 205 866.5 units (55.3%), prescriber bags for 155 841 units (41.8%), and individual prescriptions for 10 643.5 units (2.9%). Populationadjusted national naloxone sales to community pharmacies increased between 2014 and 2018 (per year: incidence rate ratio [IRR], 1.15; 95% CI, 1.09-2.22). This increase was primarily attributable to increased volumes of prescriber bag naloxone (IRR, 1.63; 95% CI, 1.50-1.78) and, to a lesser extent, increased individual prescription supply (IRR, 2.04; 95% CI, 1.85-2.26). Non-dispensed naloxone supply volume was unchanged at the national level (IRR, 0.93; 95% CI, 0.85-1.01); changes in non-dispensed supply immediately following rescheduling and subsequently were not statistically significant in time series analyses for most jurisdictions. Conclusions:Total naloxone supply to community pharmacies in Australia increased between 2014 and 2018, but rescheduling that enabled over-the-counter access did not significantly influence the volume of non-dispensed naloxone.The known: Take home naloxone programs are effective for preventing opioid overdose deaths. Most overdoses in Australia involve pharmaceutical opioids, but little is known about how much naloxone is supplied in primary care, where most pharmaceutical opioids are prescribed.The new: The volume of naloxone supplied on individual prescriptions accounted for less than 3% of all naloxone supplied to pharmacies. Further, despite the 2016 scheduling change that permits naloxone supply without prescription, the over-thecounter supply of naloxone did not increase between 2014 and 2018.The implications: Although prescriptions are no longer a barrier to obtaining naloxone, further strategies are required to increase the supply of take home naloxone.

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Awareness and access to naloxone necessary but not sufficient: Examining gaps in the naloxone cascade

Abstract: This study identifies that consistent possession is a gap in the naloxone cascade. Future research is needed to understand reasons for not always carrying naloxone.

Cited by 63 publications

References 10 publications

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

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

Dying alone: the sad irrelevance of naloxone in the context of solitary opiate use

Community pharmacy naloxone supply, before and after rescheduling as an over‐the‐counter drug: sales and prescriptions data, 2014–2018

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