Opiate users' knowledge about overdose prevention and naloxone in New York City: a focus group study

Abstract

BackgroundDrug-induced and drug-related deaths have been increasing for the past decade throughout the US. In NYC, drug overdose accounts for nearly 900 deaths per year, a figure that exceeds the number of deaths each year from homicide. Naloxone, a highly effective opiate antagonist, has for decades been used by doctors and paramedics during emergency resuscitation after an opiate overdose. Following the lead of programs in Europe and the US who have successfully distributed take-home naloxone, the Overdose Prevention and Reversal Program at the Lower East Side Harm Reduction Center (LESHRC) has started providing a similar resource for opiate users in NYC. Participants in the program receive a prescription for two doses of naloxone, with refills as needed, and comprehensive training to reduce overdose risk, administer naloxone, perform rescue breathing, and call 911. As of September 2005, 204 participants have received naloxone and been trained, and 40 have revived an overdosing friend or family member. While naloxone accessibility stands as a proven life-saving measure, some opiates users at LESHRC have expressed only minimal interest in naloxone use, due to past experiences and common misconceptions.MethodsIn order to improve the naloxone distribution program two focus groups were conducted in December 2004 with 13 opiate users at LESHRC to examine knowledge about overdose and overdose prevention. The focus groups assessed participants' (i) experiences with overdose response, specifically naloxone (ii) understanding and perceptions of naloxone, (iii) comfort level with naloxone administration and (iv) feedback about increasing the visibility and desirability of the naloxone distribution program.ResultsAnalyses suggest that there is both support for and resistance to take-home naloxone, marked by enthusiasm for its potential role in reviving an overdosing individual, numerous misconceptions and negative views of its impact and use.ConclusionFocus group results will be used to increase participation in the program and reshape perceptions about naloxone among opiate users, also targeting those already prescribed naloxone to increase their comfort using it. Since NYC is advancing toward a citywide naloxone distribution program, the LESHRC program will play an important role in establishing protocol for effective and wide-reaching naloxone availability.

Using a group approach to preventing heroin overdose in North London

“…It seems unlikely that the majority of drug users will feel comfortable in calling for ambulance help in overdose situations until this inconsistency has been resolved. This fear of police involvement has been found by Worthington, Markham Piper, Galea, and Rosenthal (2006), and is frequently cited as the reason ambulance help is either called late, or not at all. This anomaly should be addressed by public policy, which classifies these incidents as health emergencies as opposed to criminal justice incidents.…”

Twenty years of take-home naloxone for the prevention of overdose deaths from heroin and other opioids—Conception and maturation

“…Despite willingness to participate in THN training, opioid users also expressed concerns about THN, such as fear of experiencing withdrawal symptoms, enabling further drug use, risk of blood-borne virus infection, and potentially having to manage agitation and hostility in those revived (Kerr et al, 2008;Seal et al, 2003;Worthington et al, 2006). Service users also expressed concerns about the risk of confiscation of the antidote and its potential role in escalating already delicate relationships with law enforcement (Seal et al, 2003;Worthington et al, 2006).…”

“…Similarly, opioid users in New York and Los Angeles reported fear of withdrawal and police involvement as key concerns associated with THN distribution (Lankenau et al, 2013;Worthington et al, 2006), and continued use of folk remedies posed a barrier to THN use (Lankenau et al, 2013).…”

Attitudes of Australian Heroin Users to Peer Distribution of Naloxone for Heroin Overdose: Perspectives on Intranasal Administration

“…10,11 It has been estimated that the introduction of such programs had saved more than 900 lives by February 2006. 10 While IDU have generally been shown to have positive attitudes toward peer naloxone distribution, 2,6,[12][13][14] concerns have been raised about programs for a variety of reasons including a potential for increased heroin use and the promotion of drug use, 2,6,[15][16][17] questions about the competence of IDU to effectively administer the drug, 9,15 possible adverse reactions, 2,16 and a possible failure to seek subsequent emergency medical support after treatment. 6,12,18 There have been recommendations for the establishment of naloxone distribution programs in Australia.…”