Accepted for/Published in: JMIR Formative Research
Date Submitted: Jul 10, 2020
Date Accepted: Dec 3, 2020
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
“You could save a life or two you know?”: Reasons for declining no-cost naloxone and implications for messaging to increase uptake
ABSTRACT
Background:
Abstract Background. Despite the increased availability of naloxone in New York City, there are many people who use opioids (PWUO) who are at risk of OD yet, even when offered, decline no-cost naloxone. Others may have the medication but opt not to carry it and report that they would be reluctant to administer it if they were to witness an overdose.
Objective:
Objective. To better understand reasons why PWUO may be reluctant to administer or carry the medication, and how we can develop messaging to address barriers to acceptance and use.
Methods:
Methods. Formative qualitative interviews with 20 people who use opioids, age 18 years and older, were conducted in New York City. Participants were recruited via key informants and chain referral.
Results:
Results. In qualitative interviews conducted in New York City, participants who report using naloxone consider themselves community heroes, health champions, and advocates for the health and well-being of their peers. Participants report several barriers that may limit naloxone uptake and use among people who use opioids: indifference toward overdose/lack of altruism; fear of negative consequences of carrying naloxone; stigma related to substance use and naloxone possession; and fears of misrecognizing an overdose and the need for naloxone. Efforts to normalize naloxone can complement other messages designed to encourage shared responsibility for community health and to elicit empathy for people who use drugs. Participants suggest that messaging should also debunk myths and stereotypes about people who use drugs more generally, and frame PWUO who reverse overdoses as lay public health advocates, and not just an “other” to be managed with stigmatizing practices and language.
Conclusions:
Conclusion. Getting naloxone to PWUO who are best positioned to reverse an overdose, and increasing the likelihood they will use it when needed, is a public health priority. Developing, tailoring, and deploying messages to address fear and trepidation about reversing an OD may alleviate fears among some people who may be hesitant to use the medication on someone in an overdose situation.
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