TY - JOUR
T1 - A qualitative study of repeat naloxone administrations during opioid overdose intervention by people who use opioids in New York City.
AU - Parkin, Stephen
AU - Neale, Joanne
AU - Brown, Caral
AU - Jones, Jermaine D.
AU - Brandt, Laura
AU - Castillo, Felipe
AU - Campbell, Aimee N.C.
AU - Strang, John
AU - Comer, Sandra D.
N1 - Funding Information:
In the last 3 years, J.N. has received, through her University, research funding from Mundipharma Research Ltd and Camurus AB. J.S. is a researcher and clinician who has advocated for wider pre-provision of take-home naloxone, using several types of naloxone. He has also worked with pharmaceutical companies to seek to identify new or improved treatments (including forms of naloxone) from whom he and his employer (King's College London) have received honoraria, travel costs and/or consultancy payments. This includes work with, during past 3 years, Indivior, MundiPharma, Braeburn/Camurus and trial medication supply from iGen and from Camurus. His-employer (King's College London) has registered intellectual property on a novel buccal naloxone formulation and he has also been named in a patent registration by a Pharma company regarding a concentrated nasal naloxone spray. For a fuller account, see J.S.’s web-page at http://www.kcl.ac.uk/ioppn/depts/addictions/people/hod.aspx . Within the past three years, S.D.C. has received research funding from Alkermes, BioXcel, Braeburn Pharmaceuticals, Cerecor Inc., Corbus, Go Medical, Intra-cellular Therapies, and Lyndra. In addition, Dr. Comer has also consulted for: Alkermes, Charleston Labs, Clinilabs, Collegium, Daiichi Sankyo, Depomed, Egalet, Endo, Epiodyne, Inspirion Delivery Sciences, Janssen, KemPharm, Mallinckrodt, Nektar, Neurolixis, Newron, Opiant, Otsuka, Pfizer, and Sun Pharma. She also has received honoraria from the World Health Organization. Dr. Jones has received compensation - in the form of partial salary support - from a study partially supported by Cerecor Inc., and BioXcel is the recipient of an investigator-initiated grant from Merck Pharmaceuticals, and has worked as a consultant for Alkermes. S.P., C.B., L.B., A.N.C.C., and F.C. have no disclosures or conflicts of interest to report.
Funding Information:
This study was supported by the National Institute on Drug Abuse Grant R01DA035207 to Dr. Sandra Comer (Principal Investigator). J.N. is part-funded by, and J.S. is supported by, the NIHR (National Institute for Health Research) Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. J.N. S.P. and J.S acknowledge the Pilgrim Trust for supporting their involvement in the research. L.B. is funded by an Erwin Schroedinger Fellowship by the Austrian Science Fund (ASF). The authors would like to thank the National Institute on Drug Abuse (NIDA) for supporting this research (R01DA035207; Comer ? Principal Investigator); all study participants for agreeing to be interviewed; and Verena Metz, Gregory Cortorreal, Richard Eisenberg, Rebecca Abbott, Benjamin Foote, Claudia Tindall, and Janet Murray for their technical assistance.
Funding Information:
This study was supported by the National Institute on Drug Abuse Grant R01DA035207 to Dr. Sandra Comer (Principal Investigator). J.N. is part-funded by, and J.S. is supported by, the NIHR (National Institute for Health Research) Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. J.N., S.P. and J.S acknowledge the Pilgrim Trust for supporting their involvement in the research. L.B. is funded by an Erwin Schroedinger Fellowship by the Austrian Science Fund (ASF). The authors would like to thank the National Institute on Drug Abuse (NIDA) for supporting this research (R01DA035207; Comer – Principal Investigator); all study participants for agreeing to be interviewed; and Verena Metz, Gregory Cortorreal, Richard Eisenberg, Rebecca Abbott, Benjamin Foote, Claudia Tindall, and Janet Murray for their technical assistance.
Publisher Copyright:
© 2020 Elsevier B.V.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2021/1
Y1 - 2021/1
N2 - Background: Take-home naloxone (THN) kits have been designed to provide community members (including people who use drugs, their families and/or significant others) with the necessary resources to address out-of-hospital opioid overdose events. Kits typically include two doses of naloxone. This 'twin-pack' format means that lay responders need information on how to use each dose. Advice given tends to be based on dosage algorithms used by medical personnel. However, little is currently known about how and why people who use drugs, acting as lay responders, decide to administer the second dose contained within single THN kits. The aim of this article is to explore this issue. Methods: Data were generated from a qualitative semi-structured interview study that was embedded within a randomised controlled trial examining the risks and benefits of Overdose Education and Naloxone Distribution (OEND) training in New York City (NYC). Analysis for this article focuses upon the experiences of 22 people who use(d) opioids and who provided repeat naloxone administrations (RNA) during 24 separate overdose events. The framework method of analysis was used to compare the time participants believed had passed between each naloxone dose administered (‘subjective response interval’) with the ‘recommended response interval’ (2–4 minutes) given during OEND training. Framework analysis also charted the various reasons and rationale for providing RNA during overdose interventions. Results: When participants’ subjective response intervals were compared with the recommended response interval for naloxone dosing, three different time periods were reported for the 24 overdose events: i. ‘two doses administered in under 2 minutes’ (n = 10); ii. ‘two doses administered within 2–4 minutes’ (n = 7), and iii. ‘two doses administered more than 4 minutes apart’ (n = 7). A variety of reasons were identified for providing RNA within each of the three categories of response interval. Collectively, reasons for RNA included panic, recognition of urgency, delays in retrieving naloxone kit, perceptions of recipients’ responsiveness/non-responsiveness to naloxone, and avoidance of Emergency Response Teams (ERT). Conclusion: Findings suggest that decision-making processes by people who use opioids regarding how and when to provide RNA are influenced by factors that relate to the emergency event. In addition, the majority of RNA (17/24) occurred outside of the recommended response interval taught during OEND training. These findings are discussed in terms of evidence-based intervention and ‘evidence-making intervention’ with suggestions for how RNA guidance may be developed and included within future/existing models of OEND training.
AB - Background: Take-home naloxone (THN) kits have been designed to provide community members (including people who use drugs, their families and/or significant others) with the necessary resources to address out-of-hospital opioid overdose events. Kits typically include two doses of naloxone. This 'twin-pack' format means that lay responders need information on how to use each dose. Advice given tends to be based on dosage algorithms used by medical personnel. However, little is currently known about how and why people who use drugs, acting as lay responders, decide to administer the second dose contained within single THN kits. The aim of this article is to explore this issue. Methods: Data were generated from a qualitative semi-structured interview study that was embedded within a randomised controlled trial examining the risks and benefits of Overdose Education and Naloxone Distribution (OEND) training in New York City (NYC). Analysis for this article focuses upon the experiences of 22 people who use(d) opioids and who provided repeat naloxone administrations (RNA) during 24 separate overdose events. The framework method of analysis was used to compare the time participants believed had passed between each naloxone dose administered (‘subjective response interval’) with the ‘recommended response interval’ (2–4 minutes) given during OEND training. Framework analysis also charted the various reasons and rationale for providing RNA during overdose interventions. Results: When participants’ subjective response intervals were compared with the recommended response interval for naloxone dosing, three different time periods were reported for the 24 overdose events: i. ‘two doses administered in under 2 minutes’ (n = 10); ii. ‘two doses administered within 2–4 minutes’ (n = 7), and iii. ‘two doses administered more than 4 minutes apart’ (n = 7). A variety of reasons were identified for providing RNA within each of the three categories of response interval. Collectively, reasons for RNA included panic, recognition of urgency, delays in retrieving naloxone kit, perceptions of recipients’ responsiveness/non-responsiveness to naloxone, and avoidance of Emergency Response Teams (ERT). Conclusion: Findings suggest that decision-making processes by people who use opioids regarding how and when to provide RNA are influenced by factors that relate to the emergency event. In addition, the majority of RNA (17/24) occurred outside of the recommended response interval taught during OEND training. These findings are discussed in terms of evidence-based intervention and ‘evidence-making intervention’ with suggestions for how RNA guidance may be developed and included within future/existing models of OEND training.
KW - Framework analysis
KW - Harm Reduction
KW - Naloxone response intervals
KW - New York City
KW - People who use opioids
KW - Repeat naloxone administrations
KW - Take home naloxone
U2 - 10.1016/j.drugpo.2020.102968
DO - 10.1016/j.drugpo.2020.102968
M3 - Article
AN - SCOPUS:85092903769
SN - 0955-3959
VL - 87
JO - International Journal of Drug Policy
JF - International Journal of Drug Policy
M1 - 102968
ER -