Perspectives of Stakeholders of Equitable Access to Community Naloxone Programs: A Literature Review

Abstract

The purpose of this review is to examine the existing literature about facilitators and barriers influencing equitable access to naloxone programs by individuals who use opioids. A total of 49 published articles were examined, which generated four overarching themes:(1) Stigma as a barrier to access; (2) Lack of a wide range of stakeholder perspectives; (3) Need for a comprehensive understanding of factors affecting equitable access to naloxone programs; (4) Facilitators to increase the access of community naloxone programs. Our review highlighted the importance of advocacy in practice, education, administration, and policy to address the health inequities that exist in naloxone distribution programs. Advocacy activities involve the need for health care professionals to engage in social justice practice through evidence-based informed research about the facts of opioid use; challenging the stigma toward victim-blaming against naloxone users; as well as promoting program development and health policy to bring about equitable access to naloxone programs by marginalized and socially disadvantaged populations.

Implementation facilitators and barriers to the expansion of a peer-led overdose prevention program

“…In some cases, the importance of training PWUD had only recently been recognized, whereas for others, it was reported that some organizations were reluctant to become involved with a prevention program for opioid use because they did not want to make it known that they had PWUO within their clientele. Stigma toward PWUD and surrounding opioid use and interactions with healthcare workers has been identified as a main barrier to program access in many studies and has been found to negatively affect the acceptability of a program (Martignetti & Sun, 2022;Cid et al, 2021;Rudisill et al, 2021;Strang et al, 2019;Young et al, 2019;Holland et al, 2020). Raising awareness about the pertinence and importance of training PWUD could help to improve this situation, as well as promoting strategies to reduce social stigma and protect confidentiality (Salvador et al, 2020).…”

“…The main barrier that emerged from the review of literature on naloxone programs was stigma and discrimination toward PWUD (Rudisill et al, 2021;Dwyer et al, 2016, Winstanley et al, 2016Leece et al, 2019;Martignetti & Sun, 2022;Van hout & McElrath, 2012;Stanojlović & Davidson, 2021;Goodyear et al, 2020).…”

Opioid-Associated Emergencies

“…Although the utilization of naloxone in the emergency department and even out in the field by law enforcement officers may appear ubiquitous, barriers to access for patients persist. Unfortunately, the stigma around building robust and equitable naloxone access programs in the community still exists (Martignetti & Sun, 2022). More specifically, there is widespread belief that naloxone access programs would only facilitate continued and riskier opioid use in the future.…”

Bystanders Saving Lives with Naloxone: A Scoping Review on Methods to Estimate Overdose Reversals

“…While naloxone distribution is an effective, evidence-based intervention, and OTC formulations are approved, there is still pushback against highly visible and available naloxone distribution points from policymakers and community members due to the stigma associated with drug use and, by extension, the legal landscape. 2 , 3 In this study we sought to investigate methods of estimating and tracking opioid overdose reversals by community members with take-home naloxone (THN) to coalesce possible ways of characterizing THN reach with a metric that is useful for guiding both distribution of naloxone and advocacy of its benefits.…”