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Naloxone Knowledge and Attitudes Towards Overdose Response Among Family Members of People who Misuse Opioids

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Abstract

Providing family members of individuals with opioid use disorders (OUD) naloxone is a cost-effective way to prevent overdose deaths. However, misconceptions and negative attitudes towards naloxone hinder family engagement with naloxone programs. This study examines factors associated with knowledge and attitudes toward naloxone among adults with close family members who misused opioids. Adults with family members (parent, step-parent, child, spouse, sibling, or step-sibling) who misused opioids (N = 299) completed a web-based survey. Participants were recruited through treatment providers, community groups, and social media. Surveys assessed naloxone knowledge, attitudes toward overdose response, demographics, completion of naloxone training, attitude toward medications for OUD, and family members’ overdose history. Multiple regression was used to identify factors associated with naloxone knowledge (Model 1) and attitudes toward overdose response (Model 2). A graduate degree (B = .35, p < .003) and a history of overdose (B = 0.21, p = .032) were associated with greater naloxone knowledge. Age (B = .11, p < .001), race/ethnicity (B = -1.39, p = .037), naloxone training (B = 2.70, p < .001), and more positive attitude toward medications for OUD (B = 1.50, p = .003) were associated with attitudes toward overdose response. Family members are potential allies in reducing drug overdose deaths, and families may need broader education about naloxone. Awareness of previous overdose was associated with greater naloxone knowledge. Findings related to race/ethnicity suggest the need to reach family members of minoritized racial groups to provide access to naloxone training. Findings point to where education and distribution efforts may focus on increasing knowledge and improving attitudes among those closest to people with OUD.

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The data that support the findings of this study are available from the corresponding author upon request.

References

  1. Ahmad, F. B., Rossen, L. M., & Sutton, P. (2021). Vital statistics rapid release: Provisional drug overdose death counts. National Center for Health Statistics. Centers for Disease Control and Preventionhttps://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm.

  2. National Institute on Drug Abuse (2022, January). Naloxone drugfacts. National Institutes of Health. Retrieved [May 26, 2023], from https://www.drugabuse.gov/publications/drugfacts/naloxone.

  3. Holland, T. J., Penm, J., Johnson, J., Sarantou, M., & Chaar, B. B. (2020). Stakeholders’ perceptions of factors influencing the use of take-home-naloxone. Pharmacy, 8(4), https://doi.org/10.3390/pharmacy8040232.

  4. Smart, R., Pardo, B., & Davis, C. S. (2021). Systematic review of the emerging literature on the effectiveness of naloxone access laws in the United States. Addiction, 116(1), 6–17. https://doi.org/10.1111/add.15163.

    Article  PubMed  Google Scholar 

  5. Kerensky, T., & Walley, A. Y. (2017). Opioid overdose prevention and naloxone rescue kits: What we know and what we don’t know. Addiction Science & Clinical Practice, 12(1), https://doi.org/10.1186/s13722-016-0068-3.

  6. Wheeler, E., Jones, T. S., Gilbert, M. K., & Davidson, P. J. (2015). Opioid overdose prevention programs providing naloxone to laypersons—United States, 2014. Morbidity and Mortality Weekly Report, 64(23), 631–635. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4584734/.

    PubMed  PubMed Central  Google Scholar 

  7. Clark, A. K., Wilder, C. M., & Winstanley, E. L. (2014). A systematic review of community opioid overdose prevention and naloxone distribution programs. Journal of Addiction Medicine, 8(3), 153–163. https://doi.org/10.1097/ADM.0000000000000034.

    Article  CAS  PubMed  Google Scholar 

  8. Dietze, P. M., Draper, B., Olsen, A., Chronister, K. J., van Beek, I., Lintzeris, N., Dwyer, R., Nelson, M., & Lenton, S. (2018). Does training people to administer take-home naloxone increase their knowledge? Evidence from australian programs. Drug and Alcohol Review, 37(4), 472–479. https://doi.org/10.1111/dar.12680.

    Article  PubMed  Google Scholar 

  9. Lott, D. C., & Rhodes, J. (2016). Opioid overdose and naloxone education in a substance use disorder treatment program. The American Journal on Addictions, 25(3), 221–226. https://doi.org/10.1111/ajad.12364.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Naumann, R. B., Durrance, C. P., Ranapurwala, S. I., Austin, A. E., Proescholdbell, S., Childs, R., Marshall, S. W., Kansagra, S., & Shanahan, M. E. (2019). Impact of a community-based naloxone distribution program on opioid overdose death rates. Drug and Alcohol Dependence, 204, 107536. https://doi.org/10.1016/j.drugalcdep.2019.06.038.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Purviance, D., Ray, B., Tracy, A., & Southard, E. (2017). Law enforcement attitudes towards naloxone following opioid overdose training. Substance Abuse, 38(2), 177–182. https://doi.org/10.1080/08897077.2016.1219439.

    Article  PubMed  Google Scholar 

  12. Simmons, J., Rajan, S., Goldsamt, L. A., & Elliott, L. (2018). Implementation of online opioid prevention, recognition and response trainings for laypeople: Year 1 survey results. Substance Use & Misuse, 53(12), 1997–2002. https://doi.org/10.1080/10826084.2018.1451891.

    Article  Google Scholar 

  13. Wagner, K. D., Bovet, L. J., Haynes, B., Joshua, A., & Davidson, P. J. (2016). Training law enforcement to respond to opioid overdose with naloxone: Impact on knowledge, attitudes, and interactions with community members. Drug and Alcohol Dependence, 165, 22–28. https://doi.org/10.1016/j.drugalcdep.2016.05.008.

    Article  PubMed  Google Scholar 

  14. Walley, A. Y., Xuan, Z., Hackman, H. H., Quinn, E., Doe-Simkins, M., Sorensen-Alawad, A., Ruiz, S., & Ozonoff, A. (2013). Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: Interrupted time series analysis. Bmj, 346, https://doi.org/10.1136/bmj.f174. Article f174.

  15. Wilder, C. M., Miller, S. C., Tiffany, E., Winhusen, T., Winstanley, E. L., & Stein, M. D. (2016). Risk factors for opioid overdose and awareness of overdose risk among veterans prescribed chronic opioids for addiction or pain. Journal of Addictive Diseases, 35(1), 42–51. https://doi.org/10.1080/10550887.2016.1107264.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Williams, A. V., Marsden, J., & Strang, J. (2014). Training family members to manage heroin overdose and administer naloxone: Randomized trial of effects on knowledge and attitudes. Addiction, 109(2), 250–259. https://doi.org/10.1111/add.12360.

    Article  PubMed  Google Scholar 

  17. Heavey, S. C., Burstein, G., Moore, C., & Homish, G. G. (2018). Overdose education and naloxone distribution program attendees: Who attends, what do they know, and how do they feel? Journal of Public Health Management and Practice, 24(1), 63–68. https://doi.org/10.1097/PHH.0000000000000538.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Bardwell, G., Collins, A. B., McNeil, R., & Boyd, J. (2017). Housing and overdose: An opportunity for the scale-up of overdose prevention interventions? Harm Reduction Journal, 14, Article 77. https://doi.org/10.1186/s12954-017-0203-9.

  19. Gallaway, M. S., Tasnim, L., Reamer, M., Davidson, S., & Erhart, L. (2022). Annual report on opioid overdoses in Arizona, 2020–2021 Arizona Department of Health Services. Retrieved [May 26, 2023], from https://www.azdhs.gov/opioid/documents/opioid-surveillance-report-2020-2021.pdf.

  20. Adams, J. M. (2018). Increasing naloxone awareness and use: The role of health care practitioners. Journal Of The American Medical Association, 319(20), 2073–2074. https://doi.org/10.1001/jama.2018.4867.

    Article  PubMed  Google Scholar 

  21. Ogeil, R. P., Dwyer, J., Bugeja, L., Heilbronn, C., Lubman, D. I., & Lloyd, B. (2018). Pharmaceutical opioid overdose deaths and the presence of witnesses. International Journal of Drug Policy, 55, 8–13. https://doi.org/10.1016/j.drugpo.2017.12.020.

    Article  PubMed  Google Scholar 

  22. Bagley, S. M., Peterson, J., Cheng, D. M., Jose, C., Quinn, E., O’Connor, P. G., & Walley, A. Y. (2015). Overdose education and naloxone rescue kits for family members of individuals who use opioids: Characteristics, motivations, and naloxone use. Substance Abuse, 36(2), 149–154. https://doi.org/10.1080/08897077.2014.989352.

    Article  PubMed  Google Scholar 

  23. Bagley, S. M., Forman, L. S., Ruiz, S., Cranston, K., & Walley, A. Y. (2018). Expanding access to naloxone for family members: The Massachusetts experience. Drug and Alcohol Review, 37(4), 480–486. https://doi.org/10.1111/dar.12551.

    Article  PubMed  Google Scholar 

  24. Strang, J., Manning, V., Mayet, S., Titherington, E., Offor, L., Semmler, C., & Williams, A. (2008). Family carers and the prevention of heroin overdose deaths: Unmet training need and overlooked intervention opportunity of resuscitation training and supply of naloxone. Drugs: Education Prevention and Policy, 15(2), 211–218. https://doi.org/10.1080/09687630701731205.

    Article  Google Scholar 

  25. Slocum, S., Ozga, J. E., Joyce, R., Walley, A. Y., & Pollini, R. A. (2022). If we build it, will they come? Perspectives on pharmacy-based naloxone among family and friends of people who use opioids: A mixed methods study. Bmc Public Health, 22, 735. https://doi.org/10.1186/s12889-022-13078-z.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Lowenstein, M., Feuerstein-Simon, R., Dupuis, R., Herens, A., Hom, J., Sharma, M., Sheni, R., Encarnacion, L., Flaherty, C., Cueller, M., & Cannuscio, C. (2021). Overdose awareness and reversal trainings at Philadelphia public libraries. American Journal of Health Promotion, 35(2), 250–254. https://doi.org/10.1177/0890117120937909.

    Article  PubMed  Google Scholar 

  27. Dunn, K. E., Barrett, F. S., Yepez-Laubach, C., Meyer, A. C., Hruska, B. J., Petrush, K., Berman, S., Sigmon, S. C., Fingerhood, M., & Bigelow, G. E. (2016). Opioid overdose experience, risk behaviors, and knowledge in drug users from a rural versus an urban setting. Journal of Substance Abuse Treatment, 71, 1–7. https://doi.org/10.1016/j.jsat.2016.08.006.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kelly, J., Fallah-Sohy, N., Cristello, J., & Bergman, B. (2017). Coping with the enduring unpredictability of opioid addiction: An investigation of a novel family-focused peer-support organization. Journal of Substance Abuse Treatment, 77, P193–200. https://doi.org/10.1016/j.jsat.2017.02.010.

    Article  Google Scholar 

  29. Flanagin, A., Frey, T., Christiansen, S. L., & AMA Manual of Style Committee. (2021). Updated guidance on the reporting of race and ethnicity in medical and science journals. Journal Of The American Medical Association, 326(7), 621–627. https://doi.org/10.1001/jama.2021.13304.

    Article  PubMed  Google Scholar 

  30. Williams, A. V., Strang, J., & Marsden, J. (2013). Development of opioid overdose knowledge (OOKS) and attitudes (OOAS) scales for take-home naloxone training evaluation. Drug and Alcohol Dependence, 132(1–2), 383–386. https://doi.org/10.1016/j.drugalcdep.2013.02.007.

    Article  PubMed  Google Scholar 

  31. Watson, D. P., Ray, B., Robison, L., Huynh, P., Sightes, E., Walker, S., Brucker, K., & Duwve, J. (2018). Lay responder naloxone access and good samaritan law compliance: Postcard survey results from 20 Indiana counties. Harm Reduction Journal, 15(1), https://doi.org/10.1186/s12954-018-0226-x. Article 18.

  32. Beaulac, M., Richardson, L., Tobias, S., Lysyshyn, M., Grant, C., & Ti, L. (2022). Changes in the unregulated opioid drug supply during income assistance payment weeks in Vancouver, Canada: An exploratory analysis. International Journal of Drug Policy, 105, 103707. https://doi.org/10.1016/j.drugpo.2022.103707.

    Article  PubMed  Google Scholar 

  33. Fomiatti, R., Farrugia, A., Fraser, S., Dwyer, R., Neale, J., & Strang, J. (2020). Addiction stigma and the production of impediments to take-home naloxone uptake. Health: An Interdisciplinary Journal for the Social Study of Health Illness and Medicine, 26(2), 139–161. https://doi.org/10.1177/1363459320925863.

    Article  Google Scholar 

  34. Szalavitz, M. (2021). Undoing drugs: The untold story of harm reduction and the future of addiction. Hachette Books.

  35. Pasman, E. (2023). Stigma toward harm reduction interventions for opioid use disorder. [Doctoral dissertation, Wayne State University].

  36. Bennett, A. S., Freeman, R., Jarlais, D. C. D., & Aronson, I. D. (2020). Reasons people who use opioids do not accept or carry no-cost naloxone: Qualitative interview study. JMIR Formative Research, 4(12), https://doi.org/10.2196/22411. Article e22411.

  37. Camplain, R., Camplain, C., Trotter, I. I., Pro, R. T., Sabo, G., Eaves, S., Peoples, E., M., & Baldwin, J. A. (2020). Racial/ethnic differences in drug- and alcohol-related arrest outcomes in a southwest county from 2009 to 2018. American Journal of Public Health, 110, S85–S92. https://doi.org/10.2105/AJPH.2019.305409.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Friedman, J., & Hansen, H. (2022). Evaluation of increases in drug overdose mortality rates in the US by race and ethnicity before and during the COVID-19 pandemic. JAMA Psychiatry, 79(4), 379–381. https://doi.org/10.1001/jamapsychiatry.2022.0004.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Hedegaard, H., Minino, A. M., Spencer, M. R., & Warner, M. (2021). Drug overdose deaths in the United States, 1999–2020 (NCHS data brief no. 428). National Center for Health Statistics, Centers for Disease Control and Prevention. Retrieved [May, 26, https://doi.org/10.15620/cdc:112340. 2023].

  40. Friedman, J., Godvin, M., Shover, C. L., Gone, J. P., Hansen, H., & Schriger, D. L. (2022). Trends in drug overdose deaths among US adolescents, January 2010 to June 2021. Journal Of The American Medical Association, 327(14), 1398–1400. https://doi.org/10.1001/jama.2022.2847.

    Article  PubMed  Google Scholar 

  41. Windle, M. (2000). Parental, sibling, and peer influences on adolescent substance use and alcohol problems. Applied Developmental Science, 4(2), 98–110. https://doi.org/10.1207/S1532480XADS0402_5.

    Article  Google Scholar 

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Funding

This study was funded by Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, Rockville, MD (grant number 6H79TI080228-02 M001, Recipient: State of Michigan Department of Health and Human Services).

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Authors and Affiliations

  1. School of Social Work, Wayne State University, Detroit, MI, US

    Stella M. Resko, Emily Pasman, Danielle L. Hicks, Suzanne Brown & Elizabeth Agius

  2. Wayne State University, Merrill Palmer Skillman Institute, Detroit, MI, US

    Stella M. Resko

  3. School of Public Health, University of Memphis, Memphis, TN, US

    Guijin Lee

  4. School of Medicine, Johns Hopkins University, Baltimore, MD, US

    Jennifer D. Ellis

  5. Communication Studies and Philosophy, Utah State University, Logan, UT, US

    Sydney O’Shay

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  1. Stella M. Resko
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Correspondence to Stella M. Resko.

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Resko, S.M., Pasman, E., Hicks, D.L. et al. Naloxone Knowledge and Attitudes Towards Overdose Response Among Family Members of People who Misuse Opioids. J Community Health 49, 70–77 (2024). https://doi.org/10.1007/s10900-023-01257-x

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