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

Abstract

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.

The health and social consequences during the initial period of the COVID-19 pandemic among current and former people who inject drugs: A rapid phone survey in Baltimore, Maryland

“…Those living with HIV who were unsuppressed at their last study visit were the most likely to report having naloxone on hand; however, this group may be the most stable due to their obvious engagement in care and adherence to ART. Reassuringly current PWID were most likely to report having a supply of both fentanyl strips and naloxone which reflects recent findings within our broader population ( Buresh et al, 2020 ). However, one-third of those actively injecting did not have a supply of naloxone on hand.…”

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“…While we cannot say definitively that the scheduling change allowing for over-the-counter naloxone access was the impetus for increased awareness and/or use of naloxone this is an important area of inquiry for future research. Naloxone research in the United States with majority-male samples, for instance, has shown current opioid use, witnessing an overdose, and recent non-fatal experience of overdose were associated with greater naloxone knowledge and possession of a kit [ 83 , 84 ]. The opportunity for peer-led support in this study population needs to be highlighted, as women often learned about naloxone through informal social networks, instead of through health care providers.…”

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“…If naloxone is needed for an overdose outside of the hospital setting, then in most cases emergency medical response systems should be activated for further support. [11][12][13][14]…”