Practical implications of naloxone knowledge among suburban people who use opioids

Abstract

Background Naloxone distribution programs have been a cornerstone of the public health response to the overdose crisis in the USA. Yet people who use opioids (PWUO) continue to face a number of barriers accessing naloxone, including not knowing where it is available. Methods We used data from 173 PWUO from Anne Arundel County, Maryland, which is located between Baltimore City and Washington, DC. We assessed the prevalence of recently (past 6 months) receiving naloxone and currently having naloxone, the type(s) of the naloxone kits received, and the perceived ease/difficultly of accessing naloxone. We also assessed participants knowledge of where naloxone was available in the community. Results One third (35.7%) of participants had recently received naloxone. Most who had received naloxone received two doses (72.1%), nasal naloxone (86.9%), and education about naloxone use (72.1%). Most currently had naloxone in their possession (either on their person or at home; 78.7%). One third (34.4%) believed naloxone was difficult to obtain in their community. Only half (56.7%) knew of multiple locations where they could get naloxone. The health department was the most commonly identified naloxone source (58.0%). Identifying multiple sources of naloxone was associated with being more likely to perceive that naloxone is easy to access. Discussion Our results suggest that additional public health efforts are needed to make PWUO aware of the range of sources of naloxone in their communities in order to ensure easy and continued naloxone access to PWUO.

The Need for Multiple Naloxone Administrations for Opioid Overdose Reversals: A Review of the Literature

“…Overall, this literature review found that the reported rates of MNA varied widely and have occurred in up to 89% of opioid overdose encounters in the US, were exceptionally high in certain regions, and have increased significantly over time. Among studies that utilized EMS data, MNA rates ranged from 9% to 53%, 16 – 22 while studies based on bystander-reported data were notably higher, ranging from 16% to 89% 23 – 29 . The wide range in reported MNA rates overall is not surprising given the significant variation in study design and attributes, the different data sources utilized, the year and geography studied, and the difficulty and limitations in accurately capturing this data.…”

“…With the increase of synthetic opioids and the rapid onset of effect, evidence is emerging suggesting the need for increased doses of naloxone to reverse opioid toxicity. Numerous studies have been published examining the occurrence of multiple naloxone administrations (MNA) in opioid overdose reversals, [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] however, these studies have varied in study design, scientific rigor, sample size and geographic locations, making it difficult to obtain a comprehensive understanding of the frequency and trends of MNA occurrence in the US.…”

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

“…Our review revealed the lack of literature that focused on inequity associated with opioid-related health outcomes or strategies to minimize barriers and promote access by the vulnerable groups who are disproportionately experiencing opiate-related harms, including individuals with disabilities and without accessible means of transportation [67], as well as low-income individuals, particularly those without stable housing [36,74]. These vulnerable groups reported barriers related to the varying number of nearby community pharmacies with naloxone distribution programs in different areas [34,65] or the loss of naloxone kits during transient housing [74]. A study conducted by Mitchell et al (2017) underscored the need for the placement of naloxone kits in common spaces of low-income housing in order to facilitate better access to naloxone by the marginalized populations [16].…”

“…A study conducted by Mitchell et al (2017) underscored the need for the placement of naloxone kits in common spaces of low-income housing in order to facilitate better access to naloxone by the marginalized populations [16]. Not being aware of naloxone programs, not having previously accessed naloxone, and not having knowledge of multiple sources of naloxone were found to negatively impact access [65]. Furthermore, our review revealed various studies of naloxone programs in North America, including North Carolina [63,67], Massachusetts, and Rhode Island in the United States [46], as well as Alberta [41] and British Columbia in Canada [16,74].…”

‘It’s the same thing as giving them CPR training’: rural first responders’ perspectives on naloxone

“…Structural barriers such as inaccessibility and a lack of knowledge about where to obtain naloxone, particularly for rural residents [ 25 , 72 ], and the stigma ascribed to PWUOs deter people from obtaining naloxone [ 5 , 70 ]. Rural residents confront additional barriers because some pharmacists are unable or unwilling to stock naloxone, and rural residents who do obtain it have been found to receive less comprehensive administration instructions than urban residents [ 72 ].…”