Wasted, overdosed, or beyond saving – To act or not to act? Heroin users’ views, assessments, and responses to witnessed overdoses in Malmö, Sweden

Richert, Torkel

doi:10.1016/j.drugpo.2014.07.006

Cited by 33 publications

(31 citation statements)

References 53 publications

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“…For Dylan, the frustration and distress that take‐home naloxone administration can afford (e.g. Richert ) can be avoided, simply by administering naloxone with the right care.…”

Section: Discussionmentioning

confidence: 99%

Take‐home naloxone and the politics of care

Farrugia

Fraser

Dwyer

et al. 2019

Sociology Health & Illness

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Take-home naloxone' refers to a life-saving intervention in which a drug (naloxone) is made available to nonmedically trained people for administration to other people experiencing an opioid overdose. In Australia, it has not been taken up as widely as would be expected, given its life-saving potential. We consider the actions of take-home naloxone, focusing on how care relations shape its uses and effects. Mobilising Science and Technology Studies insights, we suggest that the uses and effects of naloxone are co-produced within social relations and, therefore, this initiative 'affords' multiple outcomes. We argue that these affordances are shaped by a politics of care, and that these politics relate to uptake. We analyse two complementary case studies, drawn from an interview-based project, in which opioid consumers discussed take-home naloxone and its uses. Our analysis maps the ways take-home naloxone can afford (i) a regime of care within an intimate partnership (allowing a terminally ill man to more safely consume opioids) and (ii) a political process of care (in which a consumer takes care of others treated with the medication by administering it 'gently'). We conclude by exploring the political affordances of a politics of care approach for the uptake of take-home naloxone.

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“…For Dylan, the frustration and distress that take‐home naloxone administration can afford (e.g. Richert ) can be avoided, simply by administering naloxone with the right care.…”

Section: Discussionmentioning

confidence: 99%

Take‐home naloxone and the politics of care

Farrugia

Fraser

Dwyer

et al. 2019

Sociology Health & Illness

View full text Add to dashboard Cite

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“…Other factors impeding THN implementation have been reported, and include negative public attitudes and the stigma associated with opioid consumption, which can discourage professionals from providing, and users from requesting, naloxone [28][29][30]. There have also been reports that people who use opioids are not able to recognize and respond to overdoses reliably [29][30][31][32][33][34] and may be reluctant to administer naloxone because they are anxious about police involvement, needle-stick injuries, being too intoxicated or intervening when a victim does not want help [30,35]. Research has additionally indicated that peers trained in overdose response may continue to use non-evidence-based strategies alongside recommended strategies [18,21,36] and that they may be deterred from using naloxone because it can prompt withdrawal symptoms which make victims aggressive ('over-antagonism') [37].…”

Section: Introductionmentioning

confidence: 99%

“…This is vital to inform the planning and provision of effective THN, particularly as new naloxone formulations and delivery systems are developed, laws expanding naloxone access are passed and interventions to safeguard individuals from certain criminal sanctions if they report an overdose 'in good faith' (known in the United States as Good Samaritan Laws) are increasingly implemented [43]. With few exceptions [35,[44][45][46], information on how people who use opioids respond when they witness an overdose derives from quantitative studies which provide limited insights into how and why specific actions were taken [20,33,39,[47][48][49][50]. This paper draws upon detailed first-hand accounts of how opioid users who had recently participated in a THN programme responded when confronted with an overdose emergency.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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Background and Aims Providing take-home naloxone (THN) to people who use opioids is an increasingly common strategy for reversing opioid overdose. However, implementation is hindered by doubts regarding the ability of people who use opioids to administer naloxone and respond appropriately to overdoses. We aimed to increase understanding of the competencies required and demonstrated by opioid users who had recently participated in a THN programme and were subsequently confronted with an overdose emergency. Design Qualitative study designed to supplement findings from a randomized controlled trial of overdose education and naloxone distribution. Interviews were audio-recorded, transcribed, systematically coded and analysed via Iterative Categorization. Setting New York City, USA. Participants Thirty-nine people who used opioids (32 men, 7 women; aged 22-58 years). Intervention Trial participants received brief or extended overdose training and injectable or nasal naloxone. Measurements The systematic coding frame comprised deductive codes based on the topic guide and more inductive codes emerging from the data. Findings In 38 of 39 cases the victim was successfully resuscitated; the outcome of one overdose intervention was unknown. Analyses revealed five core overdose response 'tasks': (1) overdose identification; (2) mobilizing support; (3) following basic first aid instructions; (4) naloxone administration; and (5) post-resuscitation management. These tasks comprised actions and decisions that were themselves affected by diverse cognitive, emotional, experiential, interpersonal and social factors over which lay responders often had little control. Despite this, participants demonstrated high levels of competency. They had acquired new skills and knowledge through training and brought critical 'insider' understanding to overdose events and the resuscitation actions which they applied. Conclusions People who use opioids can be trained to respond appropriately to opioid overdoses and thus to save their peers' lives. Overdose response requires both practical competency (e.g. skills and knowledge in administering basic first aid and naloxone) and social competency (e.g. willingness to help others, having the confidence to be authoritative and make decisions, communicating effectively and demonstrating compassion and care to victims post-resuscitation).

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“…Qualitative interviews with 35 heroin addicts who had witnessed at least one overdose were conducted in a study in Sweden [75]. Overall, the addicts had a positive attitude about assisting others who might have overdosed, but there were notable barriers.…”

Section: Community Respondersmentioning

confidence: 99%

The Place of Community Rescue Naloxone in a Public Health Crisis of Opioid Overdose

Pergolizzi¹,

LeQuang²,

Taylor³

et al. 2019

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The recent large increase in deaths involving opioids (whether prescription or illicit, pure or adulterated, alone or in combination with other drugs) is the manifestation of a complex, and multifaceted problem consisting of psychological, psychosocial, medical, legal, regulatory, economic, cultural, and political components, among others. Because the problem involves issues related to both supply and demand, the solution is not obvious, simple, or quick. There is no easy fix. Preventing and treating opioid misuse and abuse requires a comprehensive, time-intensive, and expensive intervention supported by public policy and support through coordinated medical, regulatory, legal, and financial guidelines and practice. But until the long-term problems can be fixed, the immediate crisis of overdose deaths can be ameliorated by making available an opioid receptor antagonist to reverse the respiratory depression that is the cause of death to those who are in the best position to administer it in time (professionals, untrained bystanders, and even fellow drug abusers). The statistics overwhelmingly demonstrate that this is a life-saving medical intervention. Yet, there is still uncertainty about this intervention, and even some opposition to it. We describe the scientific basis for the approach and the issues surrounding its use to treat accidental or intentional overdose by pain patients, recreational opioid users, and addicts. We also describe the calls to limit the number of times it should be available to a user and the limitations of its effectiveness-mainly that it only addresses the acute death crisis, not the underlying problems that led to it.

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Wasted, overdosed, or beyond saving – To act or not to act? Heroin users’ views, assessments, and responses to witnessed overdoses in Malmö, Sweden

Cited by 33 publications

References 53 publications

Take‐home naloxone and the politics of care

Take‐home naloxone and the politics of care

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

The Place of Community Rescue Naloxone in a Public Health Crisis of Opioid Overdose

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