Overdose risk and attitudes to take-home naloxone among opioid users in Prague and London: A survey comparison

TY - JOUR

T1 - Overdose risk and attitudes to take-home naloxone among opioid users in Prague and London

T2 - A survey comparison

AU - Sefranek, Martin

AU - McDonald, Rebecca

AU - Kelleher, Mike

AU - Breidahl, Sibella

AU - Pavlidis, Pollyanna

AU - Miovsky, Michal

AU - Strang, John

N1 - Funding Information: Sibella Breidahl, Michal Miovsky, Pollyanna Pavlidis, and Martin Sefranek: These authors have no conflicts of interest to declare. Mike Kelleher, in the past 3 years, has taken part in research funded by Indivior, Camurus and Mundipharma. He has received honoraria from Indivior, Gilead, and Abbvie. Rebecca McDonald received conference-related travel funding and an honorarium from IOTOD (Improving Opioid Outcomes in the Treatment of Opioid Dependence) in 2018. Rebecca McDonald’s employer (King’s College London) has received a research grant from Mundipharma Research Ltd for an observational cohort study of take-home naloxone provision in Europe. Separately, King’s College London registered intellectual property on a novel buccal naloxone formulation, naming Rebecca McDonald as co-inventor. Rebecca McDonald worked as a consultant on community-based naloxone access in Central Asia and Eastern Europe for the United Nations Office on Drugs and Crime (UNODC; 2016-17) John Strang, through his university, works with the pharmaceutical industry to identify new or improved treatments and his employer (King’s College London) has received grants, travel costs and/or consultancy payments; this includes investigation of new naloxone formulations and has included work, within the past 3 years, with Mundipharma and Accord (companies which have naloxone products). His employer (King’s College London) has also registered intellectual property on a novel buccal naloxone formulation, naming John Strang as co-inventor, and he was earlier named in a patent registration by a pharmaceutical company regarding a concentrated nasal naloxone spray. John Strang worked as a consultant on community-based naloxone access in Central Asia and Eastern Europe for the United Nations Office on Drugs and Crime (UNODC; 2016-17). John Strang's research is supported by the National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King's College London. John Strang is an NIHR Senior Investigator. For a fuller account, see John Strang’s webpage at http://www.kcl.ac.uk/ioppn/ depts/addictions/people/hod.aspx. Publisher Copyright: © 2021, Pacini Editore S.p.A./AU-CNS. All rights reserved.

PY - 2021/12

Y1 - 2021/12

N2 - Background: Take-home naloxone (THN) programmes have been introduced in many European countries. In the Czech Republic, where the incidence of the opioid-overdose deaths is below the European average, THN is not available. We assessed a) drug use and overdose history and b) attitudes regarding THN among people who use opioids (PWUO) in Prague and compare these outcomes with a reference sample of PWUO in London, where THN is available. Methods: This cross-sectional study was conducted in PWUO (age ≥18) attending three outpatient addiction clinics in Prague and one in London between April 2018 and June 2019. A purpose-developed questionnaire was administered in the local language. Results: In total, n=125 PWUO completed the questionnaire, consisting of 60 participants in Prague (37/60; 62.7% male) and 65 in London (59/65; 90.8% male). The Prague sample primarily used (diverted) buprenorphine (37/60; 62.7%), with significantly higher rates of lifetime injecting use (60/60, 100.0%; vs. London: 46/65; 70.8%; p<0.001) and personal overdose (38/60; 63.3%; vs. London: 29/65; 44.6%; p=0.036). Most participants across both samples had witnessed overdoses (Prague: 43/60, 71.7%; London: 51/65, 78.5%; p = n.s.). PWUO in Prague wished to have a THN kit (44/60; 74.6%) and considered naloxone training to be “extremely” or “very” important (43/60; 74.1%). Conclusions: PWUO in Prague are at least as likely to overdose themselves and witness opioid overdoses as their peers in London. They ex-pressed strong interest in THN and opioid-overdose management training, suggesting that THN should be made available to Czech PWUO.

AB - Background: Take-home naloxone (THN) programmes have been introduced in many European countries. In the Czech Republic, where the incidence of the opioid-overdose deaths is below the European average, THN is not available. We assessed a) drug use and overdose history and b) attitudes regarding THN among people who use opioids (PWUO) in Prague and compare these outcomes with a reference sample of PWUO in London, where THN is available. Methods: This cross-sectional study was conducted in PWUO (age ≥18) attending three outpatient addiction clinics in Prague and one in London between April 2018 and June 2019. A purpose-developed questionnaire was administered in the local language. Results: In total, n=125 PWUO completed the questionnaire, consisting of 60 participants in Prague (37/60; 62.7% male) and 65 in London (59/65; 90.8% male). The Prague sample primarily used (diverted) buprenorphine (37/60; 62.7%), with significantly higher rates of lifetime injecting use (60/60, 100.0%; vs. London: 46/65; 70.8%; p<0.001) and personal overdose (38/60; 63.3%; vs. London: 29/65; 44.6%; p=0.036). Most participants across both samples had witnessed overdoses (Prague: 43/60, 71.7%; London: 51/65, 78.5%; p = n.s.). PWUO in Prague wished to have a THN kit (44/60; 74.6%) and considered naloxone training to be “extremely” or “very” important (43/60; 74.1%). Conclusions: PWUO in Prague are at least as likely to overdose themselves and witness opioid overdoses as their peers in London. They ex-pressed strong interest in THN and opioid-overdose management training, suggesting that THN should be made available to Czech PWUO.

KW - Czech Republic

KW - drug-related deaths

KW - harm reduction

KW - opioid overdose

KW - Prevention

UR - http://www.scopus.com/inward/record.url?scp=85129567210&partnerID=8YFLogxK

M3 - Article

AN - SCOPUS:85129567210

SN - 1592-1638

VL - 23

SP - 33

EP - 39

JO - Heroin Addiction And Related Clinical Problems

JF - Heroin Addiction And Related Clinical Problems

IS - 6

ER -