Willingness of Persons Who Inject Drugs to Have Naloxone Administered to Them By a Peer: Implications for Overdose Prevention

Introduction: Overdose deaths due to heroin have increased sharply over the last few years. The increasing heroin overdose rate is interconnected with the overdose rate from prescription opioid pain relievers, which has increased fourfold from 1999 to 2010. The increasing opioid overdose death rates are troubling. However, access to the opioid antagonist naloxone can reverse potentially fatal respiratory depression in persons who have overdosed. We sought to examine recent non-fatal overdose experiences among persons who inject drugs (PWID) to better characterize those most likely to benefit from naloxone.

Methods: Between July and December 2012, PWID were recruited using respondent-driven sampling as part of the National HIV Behavioral Surveillance system in Denver, Colorado. Persons were eligible if they were 18 years or older and reported injection drug use in the preceding 12 months. Participants completed a behavioral survey which included questions regarding recent overdose experiences and willingness to allow naloxone to be administered by another PWID.

Results: Of the 512 eligible participants, 96 (18.8%) had experienced at least one overdose in the preceding 12 months. A total of 320 (62.5%) participants reported heroin as their most frequently injected drug, while 75 (14.7%) reported injecting prescription opioids at least once in the past 12 months. Overdose in the past 12 months was most strongly associated with having been in jail or prison in the past 12 months (prevalence odds ratio (POR) = 1.86, 95% confidence interval (CI): 1.25, 2.75), reporting daily injection (POR=2.26, 95% CI: 1.46, 3.52), being currently homeless (POR=1.54, 95% CI: 1.01, 2.27), use of suboxone (POR=1.92, 95% CI: 1.34, 2.75), and use of downers or benzodiazapines in the past 12 months (POR=1.89, 95% CI: 1.26, 2.85). Three quarters (75%) of participants said they would be willing to have another PWID administer naloxone to them in the event of an overdose.

Conclusions: The United States Food and Drug Administration recently approved the first naloxone treatment specifically designed to be administered by a family member or peer. The hand-held auto-injector delivers a single dose of naloxone with a retractable needle system to prevent accidental needle exposure. A nasal spray formulation is currently being fast-tracked. Identifying those most likely to benefit from this life-saving intervention and knowing that the majority of those are amenable to having naloxone administered to them in the event of an overdose, when they are unable to provide consent, is critical to ending the opioid overdose epidemic.