Background: Community distribution of naloxone, a medication that reverses opioid overdose, is an effective public health strategy to prevent overdose deaths. However, data are limited on who has naloxone during the current fentanyl wave of the opioid overdose epidemic in the United States. We aim to determine correlates of naloxone ownership among a community sample of people who inject drugs (PWID) from New York City (NYC). Methods: Data were drawn from the National HIV Behavioral Surveillance Study among PWID. Participants were recruited via respondent-driven sampling. Eligible participants completed an interviewer-administered survey. Log-linked Poisson regression was used to determine adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs) current naloxone ownership. Results: Of 503 PWID, 60% currently owned naloxone. In the past 12 months, 74% witnessed an opioid overdose and 25% experienced one. Those who experienced current homelessness were less likely to own naloxone (aPR: 0.79; 95% CI: 0.68, 0.91), as were those who had been recently incarcerated (aPR: 0.83; 95% CI: 0.71, 0.97). Respondents who reported recent known or possible fentanyl use were more likely to own naloxone (aPR: 1.23; 95% CI: 1.07, 1.43) as were those who experienced an opioid overdose in the past 12 months (aPR: 1.33; 95% CI: 1.15, 1.53). Conclusions: The prevalence of naloxone ownership among PWID in NYC was high, potentially due to widespread community naloxone distribution programs; however, gaps in naloxone ownership existed. Interventions that further ease access to naloxone, such as reclassifying naloxone as an over-the-counter medication and making it available “off the shelf,” should be considered. More research is needed to identify barriers to access, uptake, and sustained possession within this group to maximize the impact of naloxone distribution during the ongoing fentanyl wave of the opioid overdose epidemic.
MattsonCL, TanzLJ, QuinnK, KariisaM, PatelP, DavisNL.Trends and geographic patterns in drug and synthetic opioid overdose deaths – United States, 2013–2019. MMWR Morb Mortal Wkly Rep.2021;70(6):1172–207.
2.
Centers for Disease Control and Prevention. Rising numbers of deaths involving fentanyl and fentanyl analogs, including carfentanil, and increased usage and mixing with non-opioids. Health Alert Network2018; https://emergency.cdc.gov/han/HAN00413.asp.
Colon-BerezinC, NolanML, Blachman-ForshayJ, PaoneD.Overdose deaths involving fentanyl and fentanyl analogs – New York City, 2000–2017. MMWR Morb Mortal Wkly Rep.2019;68(2):37–40.
5.
NolanML, TuazonE, PaoneD.Unintentional Drug Poisoning (Overdose) Deaths in New York City in 2019. New York City: Department of Health and Mental Hygiene; 2020.
SmartR, PardoB, DavisCS.Systematic review of the emerging literature on the effectiveness of naloxone access laws in the United States. Addiction.2021;116(1):6–17.
8.
CataifeG, DongJ, DavisCS.Regional and temporal effects of naloxone access laws on opioid overdose mortality. Subst Abus2020;17:1–10.
9.
YouH, HaJ, KangCRegional variation in states’ naloxone accessibility laws in association with opioid overdose death rates-Observational study (STROBE compliant). Medicine.2020;99(22):e20033.
10.
JonesAA, ParkJN, AllenSTRacial differences in overdose training, naloxone possession, and naloxone administration among clients and nonclients of a syringe services program. J Subst Abuse Treat.2021;129:108412.
11.
KinnardEN, BluthenthalRN, KralAH, WengerLD, LambdinBH.The naloxone delivery cascade: identifying disparities in access to naloxone among people who inject drugs in Los Angeles and San Francisco, CA. Drug Alcohol Depend.2021;225:108759.
12.
AllenST, WhiteRH, O'RourkeA, GriebSM, KilkennyME, ShermanSG.Take-home naloxone possession among people who inject drugs in rural West Virginia. Drug Alcohol Depend.2019;204:107581.
13.
LipiraL, LeichtlingG, CookRRPredictors of having naloxone in urban and rural Oregon findings from NHBS and the OR-HOPE study. Drug Alcohol Depend.2021;227:108912.
14.
ShresthaS, StopkaTJ, HughtoJMWPrevalence and correlates of non-fatal overdose among people who use drugs: findings from rapid assessments in Massachusetts, 2017–2019. Harm Reduct J.2021;18(1):93.
15.
BureshM, GicquelaisRE, AstemborskiJ, KirkGD, MehtaSH, GenbergBL.Fatal overdose prevention and experience with naloxone: a cross-sectional study from a community-based cohort of people who inject drugs in Baltimore, Maryland. PLoS One.2020;15(3):e0230127.
16.
DaytonL, GicquelaisRE, TobinKMore than just availability: who has access and who administers take-home naloxone in Baltimore, MD. PLoS One.2019;14(11):e0224686.
17.
OngAR, LeeS, BonarEE.Understanding disparities in access to naloxone among people who inject drugs in Southeast Michigan using respondent driven sampling. Drug Alcohol Depend.2020;206:107743.
18.
NaumannRB, DurranceCP, RanapurwalaSIImpact of a community-based naloxone distribution program on opioid overdose death rates. Drug Alcohol Depend2019;2014:107356.
19.
WalleyAY, XuanZ, HackmanHHOpioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis. BMJ.2013; 346:f174.
20.
LambdinBH, BluthenthalRN, WengerLDOverdose education and naloxone distribution within syringe service programs – United States, 2019. MMWR Morb Mortal Wkly Rep.2020;69(33):1117–1121.
ShermanSG, MoralesKB, ParkJN, McKenzieM, MarshallBDL, GreenTC.Acceptability of implementing community-based drug checking services for people who use drugs in three United States cities: Baltimore, Boston and Providence. Int J Drug Policy.2019;68:46–53.
23.
BaggettTP, HwangSW, O'ConnellJJMortality among homeless adults in Boston: shifts in causes of death over a 15-year period. JAMA Intern Med.2013;173(3):189–195.
24.
van DraanenJ, TsangC, MitraS, KaramouzianM, RichardsonL.Socioeconomic marginalization and opioid-related overdose: a systematic review. Drug Alcohol Depend.2020;214:108127.
25.
YamamotoA, NeedlemanJ, GelbergL, KominskiG, ShoptawS, TsugawaY.Association between homelessness and opioid overdose and opioid-related hospital admissions/emergency department visits. Soc Sci Med.2019;242:112585.
26.
MitalS, WolffJ, CarrollJJ.The relationship between incarceration history and overdose in North America: a scoping review of the evidence. Drug Alcohol Depend.2020;213:108088.
27.
SugarmanOK, BachhuberMA, WennerstromA, BrunoT, SpringgateBF.Interventions for incarcerated adults with opioid use disorder in the United States: a systematic review with a focus on social determinants of health. PLoS One.2020;15(1):e0227968.
28.
LimS, SeligsonAL, ParvezFMRisks of drug-related death, suicide, and homicide during the immediate post-release period among people released from New York City jails, 2001–2005. Am J Epidemiol.2012;175(6):519–526.
29.
FineDR, YuL, TriantVA, BaggettTP, MetlayJP.Baseline factors associated with mortality in patients who engaged in buprenorphine treatment for opioid use disorder: a cohort study. J Gen Intern Med.2020;35(8):2375–2382.
30.
MarshallJR, GassnerSF, AndersonCL, CooperRJ, LotfipourS, ChakravarthyB.Socioeconomic and geographical disparities in prescription and illicit opioid-related overdose deaths in Orange County, California, from 2010 to 2014. Subst Abus.2019;40(1):80–86.
31.
McKnightC, Des JarlaisDC.Being “hooked up” during a sharp increase in the availability of illicitly manufactured fentanyl: adaptations of drug using practices among people who use drugs (PWUD) in New York City. Int J Drug Policy.2018;60:82–88.
32.
ReedM, WagnerKD, TranNK, BradyKA, ShinefeldJ, RothA.Prevalence and correlates of carrying naloxone among a community-based sample of opioid-using people who inject drugs. Int J Drug Policy.2019;73:32–35.
33.
McDonaldR, ParkinS, EideDRethinking ‘carriage’ of take-home naloxone. Int J Drug Policy.2021;95:103253.
34.
JoudreyPJ, KhanMR, WangEAA conceptual model for understanding post-release opioid-related overdose risk. Addict Sci Clin Pract.2019;14(1):17.
35.
Brinkley-RubinsteinL, CloudDH, DavisCAddressing excess risk of overdose among recently incarcerated people in the USA: Harm reduction interventions in correctional settings. Int J Prison Health.2017;13(1):25–31.
36.
Huxley-ReicherZ, MaldjianL, WinkelsteinEWitnessed overdoses and naloxone use among visitors to Rikers Island jails trained in overdose rescue. Addict Behav.2018;86:73–78.
37.
WengerLD, ShowalterD, LambdinBOverdose education and naloxone distribution in the San Francisco county jail. J Correct Health Care.2019;25(4):394–404.
38.
ZuckerH, AnnucciAJ, StancliffS, CataniaH.Overdose prevention for prisoners in New York: a novel program and collaboration. Harm Reduct J.2015;12:51.
TobinK, ClydeC, Davey-RothwellM, LatkinC.Awareness and access to naloxone necessary but not sufficient: examining gaps in the naloxone cascade. Int J Drug Policy.2018;59:94–97.
41.
GreenTC, DonovanE, KlugBRevisiting pharmacy-based naloxone with pharmacists and naloxone consumers in 2 states: 2017 perspectives and evolving approaches. J Am Pharm Assoc.2020;60(5):740–749.
42.
DonovanE, CaseP, BratbergJPBeliefs associated with pharmacy-based naloxone: a qualitative study of pharmacy-based naloxone purchasers and people at risk for opioid overdose. J Urban Health.2019;96(3):367–378.
43.
GreenTC, CaseP, FiskeHPerpetuating stigma or reducing risk? Perspectives from naloxone consumers and pharmacists on pharmacy-based naloxone in 2 states. J Am Pharm Assoc. 2017;57(2S):S19–S27.
44.
KrieterP, ChiangN, GyawS,et al. Pharmacokinetic properties and human use characteristics of an FDA-approved intranasal naloxone product for the treatment of opioid overdose. J Clin Pharmacol.2016;56(10):1243–1253.
45.
RhodesB, CostenbaderB, WilsonLUrban, individuals of color are impacted by fentanyl-contaminated heroin. Int J Drug Policy.2019;73:1–6.
46.
SteinMD, KenneySR, AndersonBJ, BaileyGL.Perceptions about fentanyl-adulterated heroin and overdose risk reduction behaviors among persons seeking treatment for heroin use. J Subst Abuse Treat.2019;104:144–147.
OlfsonM, WallM, WangS, CrystalS, BlancoC.Risks of fatal opioid overdose during the first year following nonfatal overdose. Drug Alcohol Depend.2018;190:112–119.
51.
LowderEM, AmlungJ, RayBR.Individual and county-level variation in outcomes following non-fatal opioid-involved overdose. J Epidemiol Community Health.2020;74(4):369–376.
52.
KarmaliRN, RayGT, RubinsteinAL, SterlingSA, WeisnerCM, CampbellCI.The role of substance use disorders in experiencing a repeat opioid overdose, and substance use treatment patterns among patients with a non-fatal opioid overdose. Drug Alcohol Depend.2020;209:107923.
53.
WarfieldS, PolliniR, StokesCM, BossarteR.Opioid-related outcomes in West Virginia, 2008–2016. Am J Public Health.2019;109(2):303–305.
54.
WelchAE, JeffersA, AllenB, PaoneD, KuninsHV.Relay: a peer-delivered emergency department-based response to nonfatal opioid overdose. Am J Public Health.2019;109(10):1392–1395.
55.
BurtonG, McAuleyA, SchofieldJ, YeungA, MathesonC, ParkesT.A systematic review and meta-analysis of the prevalence of take-home naloxone (THN) ownership and carriage. Int J Drug Policy.2021;96:103298.
56.
TseWC, DjordjevicF, BorjaVDoes naloxone provision lead to increased substance use? A systematic review to assess if there is evidence of a ‘moral hazard’ associated with naloxone supply. Int J Drug Policy.2022;100:103513.
57.
Centers for Disease Control and Prevention.Influx of fentanyl-laced counterfeit pills and toxic fentanyl-related compounds further increases risk of fentanyl-related overdose and fatalities. Health Alert Network2016; https://emergency.cdc.gov/han/han00395.asp.
