https://doi.org/10.4081/qrmh.2023.10868
It can save your life, that’s all I know. Barriers and facilitators for engagement in take-home naloxone for people receiving opioid substitution treatment in regional Australia: An explorative study
Submitted: 12 September 2022
Accepted: 7 May 2023
Published: 19 July 2023
Accepted: 7 May 2023
Abstract Views: 1545
PDF: 375
Supplementary Materials: 28
Supplementary Materials: 28
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Engagement in take-home naloxone (THN) programs by people receiving opioid substitution treatment (OST) in Australia is low despite methadone being a significant contributor to opioid overdose deaths. Our aim was to explore barriers and facilitators for OST patients to engage in THN. We used a descriptive qualitative design with thematic analysis to gain insight into naloxone uptake by people engaged in an OST program in regional Australia. Eleven participants were interviewed; eight had previously engaged with THN. Barriers to THN included limited knowledge and understanding, lack of information, and not personally experiencing an overdose. Facilitators included having a traumatic experience of overdose, knowledge and understanding of THN and overdose, empowerment in carrying naloxone, and expanding THN programs. Support for the expansion of THN programs is desired among participants, and widespread peer distribution is understood to be the key to success. This study found that prior traumatic experience of overdose facilitates acceptance of THN, and being offered THN was the most important factor in engagement. Less clear is how to engage people who lack a traumatic overdose experience.
Australian Government. (2022, 30 August 2022). Take home naloxone program. Accessed 5 September, 2022. Available from: https://www.health.gov.au/initiatives-and-programs/take-home-naloxone-program
Australian Institute of Health and Welfare. (2020). National opioid pharmacotherapy statistics annual data (NOPSAD) collection. Available from: https://www.aihw.gov.au/reports/alcohol-other-drug-treatment-services/national-opioid-pharmacotherapy-statistics/contents/about
Boyes, A. P. (1994). Repetition of overdose: A retrospective 5‐year study. Journal of Advanced Nursing, 20(3), 462-468.
DOI: https://doi.org/10.1111/j.1365-2648.1994.tb02382.x
Campbell, N. D. (2019). Naloxone as a technology of solidarity: history of opioid overdose prevention. Canadian Medical Association Journal, 191(34), E945-E946.
DOI: https://doi.org/10.1503/cmaj.190257
Choremis, B., Campbell, T., Tadrous, M., Martins, D., Antoniou, T., & Gomes, T. (2019). The uptake of the pharmacy-dispensed naloxone kit program in Ontario: A population-based study. PloS One, 14(10), e0223589.
DOI: https://doi.org/10.1371/journal.pone.0223589
Daley, D. C., Smith, E., Balogh, D., & Toscaloni, J. (2018). Forgotten but not gone: The impact of the opioid epidemic and other substance use disorders on families and children. Commonwealth, 20(2-3).
DOI: https://doi.org/10.15367/com.v20i2-3.189
Deering, D. E. A., Adamson, S. J., Sellman, J. D., Henderson, C., Sheridan, J., Pooley, S., Robertson, R. M., Noller, G., & Frampton, C. M. A. (2018). Potential risk for fatal drug overdose perceived by people using opioid drugs. Drug and Alcohol Review, 37, S309-S313.
DOI: https://doi.org/10.1111/dar.12635
Dietze, P. M., Draper, B., Olsen, A., Chronister, K. J., van Beek, I., Lintzeris, N., Dwyer, R., Nelson, M., & Lenton, S. (2018). Does training people to administer take‐home naloxone increase their knowledge? Evidence from Australian programs. Drug and Alcohol Review, 37(4), 472-479.
DOI: https://doi.org/10.1111/dar.12680
Dietze, P. M., Stare, M., Cogger, S., Nambiar, D., Olsen, A., Burns, L., & Lenton, S. (2018). Knowledge of naloxone and take‐home naloxone programs among a sample of people who inject drugs in Australia: Variations across capital cities. Drug and Alcohol Review, 37(4), 457-463.
DOI: https://doi.org/10.1111/dar.12644
Dwyer, R., Olsen, A., Fowlie, C., Gough, C., van Beek, I., Jauncey, M., Lintzeris, N., Oh, G., Dicka, J., & Fry, C. L. (2018). An overview of take‐home naloxone programs in Australia. Drug and Alcohol Review, 37(4), 440-449.
DOI: https://doi.org/10.1111/dar.12812
Foley, M. (2020, 11 November 2020). Naloxone to save more lives under amended drug law. Available from: https://www.premier.vic.gov.au/sites/default/files/2020-11/201111%20-%20Naloxone%20To%20Save%20More%20Lives%20Under%20Amended%20Drug%20Law.pdf
Fomiatti, R., Farrugia, A., Fraser, S., Dwyer, R., Neale, J., & Strang, J. (2022). Addiction stigma and the production of impediments to take-home naloxone uptake. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 26(2), 139-161.
DOI: https://doi.org/10.1177/1363459320925863
Fusch , P. I., & Ness, L. R. (2015). Are we there yet? Data saturation in qualitative research. Walden Faculty and Staff Publications. 455. Available from: https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=1466&context=facpubs
DOI: https://doi.org/10.46743/2160-3715/2015.2281
Green, T. C., Case, P., Fiske, H., Baird, J., Cabral, S., Burstein, D., Schwartz, V., Potter, N., Walley, A. Y., & Bratberg, J. (2017). Perpetuating stigma or reducing risk? Perspectives from naloxone consumers and pharmacists on pharmacy-based naloxone in 2 states. Journal of the American Pharmacists Association, 57(2), S19-S27. e14.
DOI: https://doi.org/10.1016/j.japh.2017.01.013
Jamieson, A. (2020). Data summary: Overdose deaths, Victoria 2010-2019 (COR 2018 5754).
Lavrakas, P. J. (2008). Encyclopedia of survey research methods. Sage publications.
DOI: https://doi.org/10.4135/9781412963947
Lenton, S., Dietze, P., Olsen, A., Wiggins, N., McDonald, D., & Fowlie, C. (2015). Working together: Expanding the availability of naloxone for peer administration to prevent opioid overdose deaths in the Australian Capital Territory and beyond. Drug and alcohol review, 34(4), 404-411.
DOI: https://doi.org/10.1111/dar.12198
Liamputtong, P. (2009). Qualitative data analysis: Conceptual and practical considerations. Health Promotion Journal of Australia, 20(2), 133-139.
DOI: https://doi.org/10.1071/HE09133
Lintzeris, N., Monds, L. A., Bravo, M., Read, P., Harrod, M. E., Gilliver, R., Wood, W., Nielsen, S., Dietze, P. M., & Lenton, S. (2020). Designing, implementing and evaluating the overdose response with take‐home naloxone model of care: An evaluation of client outcomes and perspectives. Drug and alcohol review, 39(1), 55-65.
DOI: https://doi.org/10.1111/dar.13015
McAuley, A., Best, D., Taylor, A., Hunter, C., & Robertson, R. (2012). From evidence to policy: The Scottish national naloxone programme. Drugs: Education, Prevention and Policy, 19(4), 309-319.
DOI: https://doi.org/10.3109/09687637.2012.682232
McAuley, A., Munro, A., & Taylor, A. (2018). “Once I’d done it once it was like writing your name”: lived experience of take-home naloxone administration by people who inject drugs. International Journal of Drug Policy, 58, 46-54.
DOI: https://doi.org/10.1016/j.drugpo.2018.05.002
McDonald, R., & Strang, J. (2016). Are take‐home naloxone programmes effective? Systematic review utilizing application of the Bradford Hill criteria. Addiction, 111(7), 1177-1187.
DOI: https://doi.org/10.1111/add.13326
Nelson, M., Lenton, S., Dietze, P., Olsen, A., & Agramunt, S. (2016). Evaluation of the WA peer naloxone project–final report. Perth: National Drug Research Institute, Curtin University. Available from: https://www.researchgate.net/profile/Anna-Olsen-3/publication/307605397_Evaluation_of_the_WA_Peer_Naloxone_Project_-_Final_Report/links/58ce0370aca27233551623db/Evaluation-of-the-WA-Peer-Naloxone-Project-Final-Report.pdf
Nielsen, S., Sanfilippo, P., Picco, L., Bruno, R., Kowalski, M., Wood, P., & Larney, S. (2021). What predicts pharmacists’ engagement with opioid-outcome screening? Secondary analysis from an implementation study in community pharmacy. International Journal of Clinical Pharmacy, 43(2), 420-429.
DOI: https://doi.org/10.1007/s11096-020-01074-5
Olsen, A., McDonald, D., Lenton, S., & Dietze, P. (2015). Evaluation of the "Implementing Expanded Naloxone Availability in the ACT (I-ENAACT) Program" 2011-2014.
Penington Institute. (2022). Australia’s annual overdose report 2022. Melbourne: Penington Institute.
Pricolo, A., & Nielsen, S. (2018). Naloxone rescheduling in Australia: Processes, implementation and challenges with supply of naloxone as a ‘pharmacist only’over‐the‐counter medicine. Drug and Alcohol Review, (4), 450-453.
DOI: https://doi.org/10.1111/dar.12547
Sandelowski, M. (2010). What's in a name? Qualitative description revisited. Research in Nursing and Health, 33(1), 77-84.
DOI: https://doi.org/10.1002/nur.20362
Strang, J., McDonald, R., Campbell, G., Degenhardt, L., Nielsen, S., Ritter, A., & Dale, O. (2019). Take-home naloxone for the emergency interim management of opioid overdose: the public health application of an emergency medicine. Drugs, 79(13), 1395-1418.
DOI: https://doi.org/10.1007/s40265-019-01154-5
Strang, J. S., & McDonald, R. (2016). Preventing opioid overdose deaths with take-home naloxone. Publications Office.
Van Boekel, L. C., Brouwers, E. P., Van Weeghel, J., & Garretsen, H. F. (2013). Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review. Drug and Alcohol Dependence, 131(1-2), 23-35.
DOI: https://doi.org/10.1016/j.drugalcdep.2013.02.018
Wagner, K. D., Davidson, P. J., Iverson, E., Washburn, R., Burke, E., Kral, A. H., McNeeley, M., Bloom, J. J., & Lankenau, S. E. (2014). “I felt like a superhero”: The experience of responding to drug overdose among individuals trained in overdose prevention. International Journal of Drug Policy, 25(1), 157-165.
DOI: https://doi.org/10.1016/j.drugpo.2013.07.003
Walley, A. Y., Doe-Simkins, M., Quinn, E., Pierce, C., Xuan, Z., & Ozonoff, A. (2013). Opioid overdose prevention with intranasal naloxone among people who take methadone. Journal of Substance Abuse Treatment, 44(2), 241-247.
DOI: https://doi.org/10.1016/j.jsat.2012.07.004
Williams, A. V., Marsden, J., & Strang, J. (2014). Training family members to manage heroin overdose and administer naloxone: Randomized trial of effects on knowledge and attitudes. Addiction, 109(2), 250-259.
DOI: https://doi.org/10.1111/add.12360
World Health Organization. (2014). Community management of opioid overdose. Available from_ https://apps.who.int/iris/bitstream/handle/10665/137462/?sequence=1
How to Cite
Natale, Isabella, Craig Harvey, Pene Wood, and Karen Anderson. 2023. “<i>It Can Save Your Life, that’s All I know</I>. Barriers and Facilitators for Engagement in Take-Home Naloxone for People Receiving Opioid Substitution Treatment in Regional Australia: An Explorative Study”. Qualitative Research in Medicine and Healthcare 7 (2). https://doi.org/10.4081/qrmh.2023.10868.
Copyright (c) 2023 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.