The social logic of naloxone: Peer administration, harm reduction, and the transformation of social policy

Abstract

This paper examines overdose prevention programs based on peer administration of the opioid antagonist naloxone. The data for this study consist of 40 interviews and participant observation of 10 overdose prevention training sessions at harm reduction agencies in the Bronx, New York, conducted between 2010 and 2012. This paper contends that the social logic of peer administration is as central to the success of overdose prevention as is naloxone's pharmacological potency. Whereas prohibitionist drug policies seek to isolate drug users from the spaces and cultures of drug use, harm reduction strategies like peer-administered naloxone treat the social contexts of drug use as crucial resources for intervention. Such programs utilize the expertise, experience, and social connections gained by users in their careers as users. In revaluing the experience of drug users, naloxone facilitates a number of harm reduction goals. But it also raises complex questions about responsibility and risk. This paper concludes with a discussion of how naloxone's social logic illustrates the contradictions within broader neoliberal trends in social policy.

How competent are people who use opioids at responding to overdoses? Qualitative analyses of actions and decisions taken during overdose emergencies

“…We identified five core overdose response tasks: (1) overdose identification; (2) mobilizing support; (3) following basic first aid instructions; (4) naloxone administration; and (5) postresuscitation management. The data presented counter such perceptions by demonstrating how they can be skillful, knowledgeable and caring, as well as willing and able to save lives (see also [46,58,62]). skills and knowledge in administering first aid and naloxone) and social competency (e.g.…”

“…People who use opioids are routinely stigmatized and associated with incapacity and the harms they cause [55,[65][66][67][68]. The data presented counter such perceptions by demonstrating how they can be skillful, knowledgeable and caring, as well as willing and able to save lives (see also [46,58,62]).…”

“…This includes their ability to rapidly assess a scene for signs and symptoms of overdose, anticipate and empathize with a victim's withdrawal symptoms, withhold or titrate a naloxone dose depending on the drugs probably taken, communicate effectively with a confused victim and persuade a reluctant patient to accept professional medical care. Additionally, participants demonstrated how they had acquired new skills and knowledge from their training, were willing to prioritize this new formal knowledge above non-evidence-based strategies they had used in the past (contrary to [21]) and felt empowered by their ability to respond [36,44,61,62]. This is not to suggest that participants did not make errors or questionable judgements.…”

“…Additionally, participants demonstrated how they had acquired new skills and knowledge from their training, were willing to prioritize this new formal knowledge above non-evidence-based strategies they had used in the past (contrary to [21]) and felt empowered by their ability to respond [36,44,61,62]. This includes their ability to rapidly assess a scene for signs and symptoms of overdose, anticipate and empathize with a victim's withdrawal symptoms, withhold or titrate a naloxone dose depending on the drugs probably taken, communicate effectively with a confused victim and persuade a reluctant patient to accept professional medical care.…”

Take‐home naloxone and the politics of care

“…That is, the socially produced nature of opioid overdose and how take‐home naloxone operates within wider public health policies and interventions are issues rarely addressed in this area of research. A notable exception here is Faulkner‐Gurstein's () article in which she argues that, by harnessing social networks of people who consume opioids, this intervention has the scope to constitute their relationships as potentially health producing and protective. While the dynamic Faulkner‐Gurstein () identifies could be said to reposition people who consume opioids with positive social identities, and potentially alleviate stigma (see also Buchman et al .…”