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More than just availability: Who has access and who administers take-home naloxone in Baltimore, MD

Author

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  • Lauren Dayton
  • Rachel E Gicquelais
  • Karin Tobin
  • Melissa Davey-Rothwell
  • Oluwaseun Falade-Nwulia
  • Xiangrong Kong
  • Michael Fingerhood
  • Abenaa A Jones
  • Carl Latkin

Abstract

Background: Fatal opioid overdose is a pressing public health concern in the United States. Addressing barriers and augmenting facilitators to take-home naloxone (THN) access and administration could expand program reach in preventing fatal overdoses. Methods: THN access (i.e., being prescribed or receiving THN) was assessed in a Baltimore, Maryland-based sample of 577 people who use opioids (PWUO) and had a history of injecting drugs. A sub-analysis examined correlates of THN administration among those with THN access and who witnessed an overdose (N = 345). Logistic generalized estimating equations with robust standard errors were used to identify facilitators and barriers to accessing and using THN. Results: The majority of PWUO (66%) reported THN access. In the multivariable model, decreased THN access was associated with the fear that a person may become aggressive after being revived with THN (aOR: 0.55, 95% CI: 0.35–0.85), police threaten people at an overdose event (aOR: 0.68, 95% CI: 0.36–1.00), and insufficient overdose training (aOR: 0.43, 95% CI: 0.28–0.68). Enrollment in medication-assisted treatment, personally experiencing an overdose, and graduating from high school were associated with higher access. About half (49%) of PWUO with THN access and who had witnessed an overdose reported having administered THN. THN use was positively associated with “often” or “always” carrying THN (aOR: 3.47, 95% CI: 1.99–6.06), witnessing more overdoses (aOR:5.18, 95% CI: 2.22–12.07), experiencing recent homelessness, and injecting in the past year. THN use was reduced among participants who did not feel that they had sufficient overdose training (aOR: 0.56, 95% CI: 0.32–0.96). Conclusion: THN programs must bolster confidence in administering THN and address barriers to use, such as fear of a THN recipient becoming aggressive. Normative change around carrying THN is an important component in an overdose prevention strategy.

Suggested Citation

  • Lauren Dayton & Rachel E Gicquelais & Karin Tobin & Melissa Davey-Rothwell & Oluwaseun Falade-Nwulia & Xiangrong Kong & Michael Fingerhood & Abenaa A Jones & Carl Latkin, 2019. "More than just availability: Who has access and who administers take-home naloxone in Baltimore, MD," PLOS ONE, Public Library of Science, vol. 14(11), pages 1-11, November.
    • Handle: RePEc:plo:pone00:0224686
    DOI: 10.1371/journal.pone.0224686
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    References listed on IDEAS

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    1. Martins, S.S. & Sampson, L. & Cerdá, M. & Galea, S., 2015. "Worldwide prevalence and trends in unintentional drug overdose: A systematic review of the literature," American Journal of Public Health, American Public Health Association, vol. 105(11), pages 29-49.
    2. Martins, S.S. & Sampson, L. & Cerdá, M. & Galea, S., 2015. "Worldwide Prevalence and Trends in Unintentional Drug Overdose: A Systematic Review of the Literature," American Journal of Public Health, American Public Health Association, vol. 105(11), pages 2373-2373.
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