Now they're sober and they're broke: A qualitative study of how people who use drugs' naloxone experiences are shaped by rural risk environment & overdose education/naloxone distribution intervention Público
Kesich, Zora (Spring 2023)
Abstract
Background
People who use drugs (PWUD) are highly likely to witness overdose. Overdose education and naloxone distribution (OEND) programs are recommended as an evidence-based approach to reducing fatal overdose rates. Despite the growing presence of OEND programs, PWUD experience barriers to accessing, carrying, and administering naloxone, shaped by their risk environments. Rural risk environments pose unique challenges minimally explored in the literature. We investigated how PWUDs’ naloxone experiences are shaped both by features of a rural risk environment and an OEND intervention.
Methods
29 one-on-one, semi-structured qualitative interviews were conducted with PWUD in rural Kentucky via Zoom software. All participants were enrolled in the CARE2HOPE (C2H) OEND intervention and recruited via phone calls, texts, and Facebook messages. Audio-recorded interviews were transcribed verbatim. Thematic analysis was conducted, guided by the Risk Environment Framework. NVivo 14.0 software (QSR International) was used for data management and coding.
Results
The OEND intervention altered participants’ healthcare environments by providing access to naloxone, increasing participant knowledge, and increasing participant confidence in naloxone administration. Over half of participants gained knowledge on naloxone through the intervention related to the healthcare environment (how to access naloxone, administration technique) and political/law enforcement environment (medical amnesty policies). Through knowledge and skills gained in the intervention, participants became a part of their local healthcare environment. Over half of participants had recent experience administering intervention-provided naloxone.
Participants’ experiences carrying and administering naloxone were indirectly shaped by the OEND intervention with added influence of other risk environment domains. Most participants opted to carry naloxone, citing factors related to the social environment (sense of responsibility to their community) and physical/healthcare environments (unpredictable nature of overdose, high overdose prevalence, suboptimal emergency response systems). Participants’ experiences administering naloxone to peers was largely shaped by social environment barriers (anticipated negative reaction from recipients attributable to physiological withdrawal, loss of high, and economic loss). Participants who felt a strong social ties to their community often administered naloxone despite anticipated consequences.
Conclusions
By providing naloxone paired with non-stigmatizing health and policy information, the OEND intervention both altered participants’ healthcare environments and enabled them to become a part of the healthcare environment themselves. PWUDs’ naloxone experiences are further shaped by other risk environment domains. Features of the rural physical environment contribute to many participants feeling safer when carrying naloxone. When PWUD administer naloxone to a peer, they are often acting against the recipient’s preference, adding a layer of social environment considerations. Although many override this barrier to administer naloxone, the event can be traumatic for all involved parties.
Table of Contents
CHAPTER 1: INTRODUCTION.........................................................................................1
CHAPTER 2: LITERATURE REVIEW.................................................................................5
Overview.......................................................................................................................5
Opioid Overdose............................................................................................................6
Harm reduction & naloxone............................................................................................7
Rural risk environment...................................................................................................8
Rural-REF Context: Healthcare, Physical, Law Enforcement, Political Environments...........9
Naloxone Experiences: Healthcare, Physical, Law Enforcement, Political Environments......11
Rural-REF Context: Economic Environment....................................................................13
Naloxone Experiences: Economic environment................................................................14
Rural-REF Context: Social Environment..........................................................................15
Naloxone Experiences: Social environment.....................................................................15
Rural Environment-specific Studies................................................................................17
Gaps in the literature, problem statement, & research aim...............................................18
CHAPTER 3: STUDENT CONTRIBUTION.........................................................................20
CHAPTER 4: MANUSCRIPT............................................................................................24
Chapter 4: Abstract........................................................................................................25
Chapter 4: Introduction..................................................................................................26
Chapter 4: Methods........................................................................................................29
Chapter 4: Results..........................................................................................................34
Accessing/accepting Narcan............................................................................................36
Carrying Narcan.............................................................................................................39
Administering Narcan.....................................................................................................45
Chapter 4: Discussion.....................................................................................................51
Strengths.......................................................................................................................54
Limitations....................................................................................................................55
CHAPTER 5: PUBLIC HEALTH IMPLICATIONS..................................................................57
References.....................................................................................................................58
Tables and Figures..........................................................................................................76
Table 1: Description of Sample........................................................................................76
Table 2: Interview Guide naloxone/Narcan Questions........................................................77
Table 3: Sub-set of Codebook Pertaining to naloxone/Narcan.............................................78
Figure 1: Results Visual Model.........................................................................................80
Table 4: Intervention component mapped to participant experience & impact.....................81
About this Master's Thesis
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