“Narcan encounters:” overdose and naloxone rescue experiences among people who use opioids

Abstract

Background

Communities across the United States are confronting the precipitous rise in opioid overdose fatalities that has occurred over the past decade. Naloxone, an opioid antagonist, is a safe rescue medication that laypeople can administer to reverse an overdose. Community naloxone training programs have been well-documented. Less is known about overdose survivors’ subjective experiences with naloxone reversal and its impacts on drug use behavior.

Methods: Semi-structured interviews were conducted with 35 community-dwelling adults who had been reversed at least once with naloxone. Inductive thematic content analysis incorporating Atlas.ti software was used to identify themes.

Results: Four broad thematic categories were identified. (1) Overdose experience and memory: Most participants remembered taking the drugs one minute and waking up the next—sometimes in different surroundings; (2) Naloxone rescue—waking up: Participants described acute withdrawal symptoms, disorientation, and volatile emotions; (3) Reasons for overdose: Polypharmacy; changes in opioid tolerance, or presence of fentanyl were the most common explanations. (4) Impacts of naloxone rescue: A variety of contextual factors influenced participants’ responses to naloxone rescue, especially acute withdrawal symptoms. While some participants altered or tempered their opioid use, others resumed opioid use—especially to mitigate withdrawal. Participants overwhelmingly emphasized that naloxone saved their lives.

Conclusion: Results suggest that a naloxone rescue may not be a wake-up call for many people who use opioids, but access to naloxone is an effective overdose harm reduction option, supporting its widespread implementation. The study findings underscore the importance of ongoing community overdose prevention and harm reduction initiatives, including take-home naloxone (THN) and medication assisted treatment in the Emergency Department.

Keywords:

• Naloxone
• opioid overdose
• opioid use disorder
• qualitative research

Acknowledgment

The researchers would like to acknowledge the help of Marc Ruszaj and Christine Toufexis, MD Candidates, Class of 2021. Both medical students assisted with the study during the summer of 2018.

Disclosure statement

No potential conflict of interest was reported by the author(s).

CRediT author statement

Linda Kahn: Conceptualization, Methodology, Formal Analysis, Investigation, Writing-Original Draft, Writing-Review & Editing, Supervision, Funding Acquisition.

Monika Wozniak: Formal Analysis, Investigation, Data Curation, Writing—Original Draft, Writing—Review & Editing, Project Administration.

Bonnie Vest: Writing—Original Draft, Writing—Review & Editing, Methodology.

Cheryll Moore: Conceptualization, Methodology, Writing—Review & Editing, Project Administration.

Additional information

Funding

This study was supported in part by the SUNY Buffalo State Institute for Community Health Promotion Collaborative Research Initiative which provided a stipend for a part-time graduate research assistant (MW). This research was not supported by any grant funding.