Journal of Urban Health

, Volume 80, Issue 2, pp 291–301 | Cite as

Attitudes about prescribing take-home naloxone to injection drug users for the management of heroin overdose: a survey of street-recruited injectors in the San Francisco Bay Area

  • Karen H. Seal
  • Moher Downing
  • Alex H. Kral
  • Shannon Singleton-Banks
  • Jon-Paul Hammond
  • Jennifer Lorvick
  • Dan Ciccarone
  • Brian R. Edlin
Article

Abstract

Naloxone, an injectable opiate antagonist, can immediately reverse an opiate overdose and prevent overdose death. We sought to determine injection drug users’ (IDUs) attitudes about being prescribed take-home naloxone. During November 1999 to February 2000, we surveyed 82 street-recruited IDUs from the San Francisco Bay Area of California who had experienced one or more heroin overdose events. We used a questiomaire that included structured and open-ended questions. Most respondents (89%) had witnessed an overdose, and 90% reported initially attempting lay remedies in an effort to help companions survive. Only 51% reported soliciting emergency assistance (calling 911) for the last witnessed overdose, with most hesitating due to fear of police involvement. Of IDUs surveyed, 87% were strongly in favor of participating in an overdose management training program to receive take-home naloxone and training in resuscitation techniques. Nevertheless, respontdents expressed a variety of concerning attitudes. If provided naloxone, 35% predicted that they might feel comfortable using greater amounts of heroin, 62% might be less inclined to call 911 for an overdose, 30% might leave an overdose victim after naloxone resuscitation, and 46% might not be able to dissuade the victim from using heroin again to alleviate with drawal symptoms induced by naloxone. Prescribing take-home naloxone to IDUs with training in its use and in resuscitation techniques may represent a life-saving, peer-based adjunct to accessing emergency services. Nevertheless, strategies for overcoming potential risks associated with the use of take-home naloxone would need to be emphasized in an overdose management training program.

References

  1. 1.
    Office of National Drug Control Policy. What America’s Users Spend on Illegal Drugs. Washington, DC: Executive Office of the President.; 1997.Google Scholar
  2. 2.
    Drucker E, Garfield J. Overdose trends in five US citres: 1988–1997. Paper presented at: Preventing Heroin Overdose: Pragmatic Approaches; January 13–14, 2000; Seattle, WA.Google Scholar
  3. 3.
    Office of Applied Studies (OAS). Year-end Emergency Department Data From the Drug Abuse Warning Network (DAWN). Rockville, MD: Dept of Health and Human Services, Substance Abuse and Mental Health Services Administration; 1999.Google Scholar
  4. 4.
    San Francisco Medical Examiner. Annual Report. San Francisco, CA: San Francisco Department of Public Health, 1998–1999.Google Scholar
  5. 5.
    Seal KH, Kral AH, Gee L, et al. Predictors and prevention of nonfatal overdose among street-recruited injection heroin users in the San Francisco Bay Area, 1998–1999. Ann J Public Health. 2001;91:1842–1846.CrossRefGoogle Scholar
  6. 6.
    Darke S, Ross J, Hall W. Overdose among heroin users in Sydney, Australia: I. Pprevalence and correlates of non-fatal overdose. Addiction. 1996;91:405–411.CrossRefPubMedGoogle Scholar
  7. 7.
    Darke S, Zador D. Fatal heroin “overdose”: a review. Addiction. 1996;91:1765–1772.CrossRefPubMedGoogle Scholar
  8. 8.
    Zador D, Sunjic S, Darke S. Herbin-related deaths in New South Wales, 1992: toxicological findings and circumstances. Med J Aust. 1996;164:204–207.PubMedGoogle Scholar
  9. 9.
    Levine B, Green D, Smialek JE. The role of ethanol in heroin deaths. J Forensic Sci. 1995;40:808–810.PubMedGoogle Scholar
  10. 10.
    Powis B, Strang J, Griffiths P, et al. Self-reported overdose among injecting drug users in London: extent and nature of the problem. Addiction. 1999;94:471–478.CrossRefPubMedGoogle Scholar
  11. 11.
    Taylor A, Frischer M, Goldberg D. Non-tatal overdosing is related to polydrug use in Glasgow [letter; comment]. BMJ. 1996;313:1400–1401.PubMedGoogle Scholar
  12. 12.
    Darke S, Hall W. The distribution of naloxone to heroin users. Addiction. 1997;92:1195–1199.CrossRefPubMedGoogle Scholar
  13. 13.
    Sporer KA. Acute heroin overdose. Ann Intern Med. 1999;130:584–590.PubMedGoogle Scholar
  14. 14.
    Darke S, Ross J, Hall W. Overdose among heroin users in Sydney, Australia: II. responses to overdose. Addiction. 1996;91:413–417.CrossRefPubMedGoogle Scholar
  15. 15.
    Strang J, Best D, Man L, Noble A, Gossop M. Peer-mitiated overdose resuscitation: fellow drug users could be mobilized to implement resuscitation. Int J Drug Policy. 2000;11:437–445.CrossRefPubMedGoogle Scholar
  16. 16.
    Giuliano R. Drug users’ tools of the trade: naloxone and Narcan. Harm Reduction Commun. 1999;9:18–19.Google Scholar
  17. 17.
    Physician’s Desk Reference. Montevale, NJ: Medical Economics; 2000.Google Scholar
  18. 18.
    Shulgin A. Controlled Substances: Chemical and Legal Guide to Federal drug Laws. Berkeley, CA: Ronin Publishing, Inc.; 1992.Google Scholar
  19. 19.
    Goldfrank LR, Hoffman RS. The poisoned patient with altered consciousness. Controversies in the use of a “coma cocktail”. JAMA. 1995;274:562–569.CrossRefPubMedGoogle Scholar
  20. 20.
    Dettmer K, Naloxone distribution to drug addicts as a contribution to the prevention of opiate overdose fatalities. Paper presented at: Preventing Heroin overdose: Pragmatic Approaches; January 13–14, 2000; Seattle, WA.Google Scholar
  21. 21.
    Ronconi S. Prevention of overdoses among current heroin users in Torino, Italy, for the period 1995–1998. Paper presented at: Preventing Heroin Overdose: Pragmatic Approaches; January 13–14, 2000; Seattle, WA.Google Scholar
  22. 22.
    Bigg D.. Dats on take home naloxone are unclear but not condemnatory [letter]. BMJ. 2002;324:678.CrossRefPubMedGoogle Scholar
  23. 23.
    Strang J, Powis B, Best D, et al. Preventing opiate overdose fatalities with take-home naloxone: pre-launch study of possible impact and acceptability. Addiction, 1999;94:199–204.CrossRefPubMedGoogle Scholar
  24. 24.
    Lenton SR, Hargreaves KM. Should we conduct a trial of distributing naloxone to heroin users for peer administration to prevent fatal overdose? Med J Aust. 2000;173:260–263.PubMedGoogle Scholar
  25. 25.
    Watters JK. Trends in risk behavior and HIV seroprevalence in heterosexual injection drug users in San Francisco, 1986–1992. J Acquir Immune Defic Syndr. 1994;7:1276–1281.PubMedGoogle Scholar
  26. 26.
    Kral AH, Bluthenthal RN, Lorvick J, Gee L, Bacchetti P, Edlin BR. Sexual transmission of HIV-1 among injection drug users in San Francisco, USA: risk-factor analysis. Lancet. 2001;357:1397–1401.CrossRefPubMedGoogle Scholar
  27. 27.
    Watters JK, Biernacki P. Targeted sampling: options for the study of hidden populations. Soc Problems. 1989;36:416–430.Google Scholar
  28. 28.
    Bluthenthal RN, Watters JK. Multimethod research: from targeted sampling to HIV risk behaviors. In: Lambert EY, Ashery RS, Needle RH, eds. Qualitative Methods in the Prevention of Drug Abuse and HIV Research. Vol. 157. Rockville, MD: National Institute on Drug Abuse; 1995:212–230.Google Scholar
  29. 29.
    Darke S, Hall W, Weatherburn D, Lind B. Fluctuations in heroin purity and the incidence of fatal heroin overdose. Drug Alcohol Depend. 1999;54:155–161.CrossRefPubMedGoogle Scholar
  30. 30.
    Bammer G, Sengoz A. Non-fatal heroin overdoses [letter]. Med J Aust 1994;161:572–573.PubMedGoogle Scholar
  31. 31.
    Gossop M, Griffiths P, Powis B, Williamson S, Strang J. Frequency of non-fatal heroin overdose: survey of heroin users recruited in non-clinical settings. BMJ. 1996;313:402.PubMedGoogle Scholar
  32. 32.
    Levy JA, Gallmeier CP, Weibel WW. The outreach assisted peer-support model for controlling drug dependency. J Drug Issues. 1995;25:507–529.Google Scholar
  33. 33.
    Hawkins WE, Latkin C, Mandel W, Oziemkowska M. Do actions speak louder than words? Perceived peer influences on needle sharing and cleaning in a sample of injection drug users. AIDS Educ Prev. 1999;11:122–131.PubMedGoogle Scholar
  34. 34.
    Broadhead RS, Heckathorn DD, Weakliem DL, et al.. Hernessing peer networks as an instrument for AIDS prevention: results from a peer-driven intervention. Public Health Rep. 1998;113(Suppl 1):42–57.PubMedGoogle Scholar
  35. 35.
    Burris S, Noreland J, Edlin B. Legal aspects of providing naloxone to heroin users in the United States. Int J Drug Policy. 2001;12:237–248.CrossRefGoogle Scholar
  36. 36.
    Sporer KA, Firestone J, Isaacs SM. Out of-hospital treatment of opioid overdoses in an urban setting. Acad Emerg Med. 1996;3:660–667.PubMedCrossRefGoogle Scholar
  37. 37.
    Smith DA, Leake L, Loflin JR, Yealy DM. Is admission after intravenous heroin overdose necessary? Ann Emerg Med. 1992;21:1326–1330.CrossRefPubMedGoogle Scholar
  38. 38.
    Vilke GM, Buchanan J, Dunford JV, Chan TC. Are heroin overdose deaths related to patient release after prehospital treatment with naloxone? Prehosp Emerg Care. 1999;3:183–186.PubMedGoogle Scholar
  39. 39.
    Centers for Disease Control and Prevention. Unintentional overdose in King County, Washington, 1990–1999. MMWR Morb Mortal Wkly Rep. 2000;49:633–636.Google Scholar
  40. 40.
    Centers for Disease Control and Prevention. Herbin overdose deaths—Multnomah County, Oregon, 1993–1999. MMWR Morb Mortal Wkly Rep. 2000;49:633–636.Google Scholar
  41. 41.
    Watters JK, Needle R, Brown BS, Weatherby N, Booth R, Williams M. The self-reporting of cocaine use. JAMA. 1992;268:2374–2375; [discussion], 2375–2376.CrossRefPubMedGoogle Scholar
  42. 42.
    Dowling-Guyer S, Johnson ME, Fisher DG, et al. Relability of drug user’s self-reported HIV risk behaviors and validity of self-reported recent drug use. Assessment. 1994;1:383–392.Google Scholar

Copyright information

© The New York Academy of Medicine 2003

Authors and Affiliations

  • Karen H. Seal
    • 1
  • Moher Downing
    • 1
  • Alex H. Kral
    • 1
  • Shannon Singleton-Banks
    • 1
  • Jon-Paul Hammond
    • 1
  • Jennifer Lorvick
    • 1
  • Dan Ciccarone
    • 1
  • Brian R. Edlin
    • 1
  1. 1.Urban Health Study, Department of Family and Community MedicineUniversity of California, San FranciscoSan Francisco

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