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Naloxone protection, social support, network characteristics, and overdose experiences among a cohort of people who use illicit opioids in New York City

BACKGROUND: Despite increased availability of take-home naloxone, many people who use opioids do so in unprotected contexts, with no other person who might administer naloxone present, increasing the likelihood that an overdose will result in death. Thus, there is a social nature to being “protected...

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Autores principales: Bennett, Alex S., Scheidell, Joy, Bowles, Jeanette M., Khan, Maria, Roth, Alexis, Hoff, Lee, Marini, Christina, Elliott, Luther
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8894821/
https://www.ncbi.nlm.nih.gov/pubmed/35246165
http://dx.doi.org/10.1186/s12954-022-00604-w
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author Bennett, Alex S.
Scheidell, Joy
Bowles, Jeanette M.
Khan, Maria
Roth, Alexis
Hoff, Lee
Marini, Christina
Elliott, Luther
author_facet Bennett, Alex S.
Scheidell, Joy
Bowles, Jeanette M.
Khan, Maria
Roth, Alexis
Hoff, Lee
Marini, Christina
Elliott, Luther
author_sort Bennett, Alex S.
collection PubMed
description BACKGROUND: Despite increased availability of take-home naloxone, many people who use opioids do so in unprotected contexts, with no other person who might administer naloxone present, increasing the likelihood that an overdose will result in death. Thus, there is a social nature to being “protected” from overdose mortality, which highlights the importance of identifying background factors that promote access to protective social networks among people who use opioids. METHODS: We used respondent-driven sampling to recruit adults residing in New York City who reported recent (past 3-day) nonmedical opioid use (n = 575). Participants completed a baseline assessment that included past 30-day measures of substance use, overdose experiences, and number of “protected” opioid use events, defined as involving naloxone and the presence of another person who could administer it, as well as measures of network characteristics and social support. We used modified Poisson regression with robust variance to estimate unadjusted and adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs). RESULTS: 66% of participants had ever been trained to administer naloxone, 18% had used it in the past three months, and 32% had experienced a recent overdose (past 30 days). During recent opioid use events, 64% reported never having naloxone and a person to administer present. This was more common among those: aged ≥ 50 years (PR: 1.18 (CI 1.03, 1.34); who identified as non-Hispanic Black (PR: 1.27 (CI 1.05, 1.53); experienced higher levels of stigma consciousness (PR: 1.13 (CI 1.00, 1.28); and with small social networks (< 5 persons) (APR: 1.14 (CI 0.98, 1.31). Having a recent overdose experience was associated with severe opioid use disorder (PR: 2.45 (CI 1.49, 4.04), suicidality (PR: 1.72 (CI 1.19, 2.49), depression (PR: 1.54 (CI 1.20, 1.98) and positive urinalysis result for benzodiazepines (PR: 1.56 (CI 1.23, 1.96), but not with network size. CONCLUSIONS: Results show considerable gaps in naloxone protection among people who use opioids, with more vulnerable and historically disadvantaged subpopulations less likely to be protected. Larger social networks of people who use opioids may be an important resource to curtail overdose mortality, but more effort is needed to harness the protective aspects of social networks.
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spelling pubmed-88948212022-03-04 Naloxone protection, social support, network characteristics, and overdose experiences among a cohort of people who use illicit opioids in New York City Bennett, Alex S. Scheidell, Joy Bowles, Jeanette M. Khan, Maria Roth, Alexis Hoff, Lee Marini, Christina Elliott, Luther Harm Reduct J Research BACKGROUND: Despite increased availability of take-home naloxone, many people who use opioids do so in unprotected contexts, with no other person who might administer naloxone present, increasing the likelihood that an overdose will result in death. Thus, there is a social nature to being “protected” from overdose mortality, which highlights the importance of identifying background factors that promote access to protective social networks among people who use opioids. METHODS: We used respondent-driven sampling to recruit adults residing in New York City who reported recent (past 3-day) nonmedical opioid use (n = 575). Participants completed a baseline assessment that included past 30-day measures of substance use, overdose experiences, and number of “protected” opioid use events, defined as involving naloxone and the presence of another person who could administer it, as well as measures of network characteristics and social support. We used modified Poisson regression with robust variance to estimate unadjusted and adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs). RESULTS: 66% of participants had ever been trained to administer naloxone, 18% had used it in the past three months, and 32% had experienced a recent overdose (past 30 days). During recent opioid use events, 64% reported never having naloxone and a person to administer present. This was more common among those: aged ≥ 50 years (PR: 1.18 (CI 1.03, 1.34); who identified as non-Hispanic Black (PR: 1.27 (CI 1.05, 1.53); experienced higher levels of stigma consciousness (PR: 1.13 (CI 1.00, 1.28); and with small social networks (< 5 persons) (APR: 1.14 (CI 0.98, 1.31). Having a recent overdose experience was associated with severe opioid use disorder (PR: 2.45 (CI 1.49, 4.04), suicidality (PR: 1.72 (CI 1.19, 2.49), depression (PR: 1.54 (CI 1.20, 1.98) and positive urinalysis result for benzodiazepines (PR: 1.56 (CI 1.23, 1.96), but not with network size. CONCLUSIONS: Results show considerable gaps in naloxone protection among people who use opioids, with more vulnerable and historically disadvantaged subpopulations less likely to be protected. Larger social networks of people who use opioids may be an important resource to curtail overdose mortality, but more effort is needed to harness the protective aspects of social networks. BioMed Central 2022-03-04 /pmc/articles/PMC8894821/ /pubmed/35246165 http://dx.doi.org/10.1186/s12954-022-00604-w Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Bennett, Alex S.
Scheidell, Joy
Bowles, Jeanette M.
Khan, Maria
Roth, Alexis
Hoff, Lee
Marini, Christina
Elliott, Luther
Naloxone protection, social support, network characteristics, and overdose experiences among a cohort of people who use illicit opioids in New York City
title Naloxone protection, social support, network characteristics, and overdose experiences among a cohort of people who use illicit opioids in New York City
title_full Naloxone protection, social support, network characteristics, and overdose experiences among a cohort of people who use illicit opioids in New York City
title_fullStr Naloxone protection, social support, network characteristics, and overdose experiences among a cohort of people who use illicit opioids in New York City
title_full_unstemmed Naloxone protection, social support, network characteristics, and overdose experiences among a cohort of people who use illicit opioids in New York City
title_short Naloxone protection, social support, network characteristics, and overdose experiences among a cohort of people who use illicit opioids in New York City
title_sort naloxone protection, social support, network characteristics, and overdose experiences among a cohort of people who use illicit opioids in new york city
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8894821/
https://www.ncbi.nlm.nih.gov/pubmed/35246165
http://dx.doi.org/10.1186/s12954-022-00604-w
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