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 |
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Authors: | Karen H Seal Moher Downing Alex H Kral Shannon Singleton-Banks Jon-Paul Hammond Jennifer Lorvick Dan Ciccarone Brian R Edlin |
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Institution: | (1) Urban Health Study, Department of Family and Community Medicine, University of California, San Francisco, 3180 18th Street, Suite 302, 94110 San Francisco, CA |
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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. |
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