title: Attitudes about prescribing take-home naloxone to injection drug users for the management of heroin overdose: a survey of street-recruited injectors in the San Francisco Bay Area.
abstract: Naloxone, an injectable opiate antagonist, can immediately reverse an opiate overdose and prevent overdose death. We sought to determine injection drug users' (IDUs) attitudes about being prescribed take-home naloxone. During November 1999 to February 2000, we surveyed 82 street-recruited IDUs from the San Francisco Bay Area of California who had experienced one or more heroin overdose events. We used a questionnaire that included structured and open-ended questions. Most respondents (89%) had witnessed an overdose, and 90% reported initially attempting lay remedies in an effort to help companions survive. Only 51% reported soliciting emergency assistance (calling 911) for the last witnessed overdose, with most hesitating due to fear of police involvement. Of IDUs surveyed, 87% were strongly in favor of participating in an overdose management training program to receive take-home naloxone and training in resuscitation techniques. Nevertheless, respondents expressed a variety of concerning attitudes. If provided naloxone, 35% predicted that they might feel comfortable using greater amounts of heroin, 62% might be less inclined to call 911 for an overdose, 30% might leave an overdose victim after naloxone resuscitation, and 46% might not be able to dissuade the victim from using heroin again to alleviate withdrawal symptoms induced by naloxone. Prescribing take-home naloxone to IDUs with training in its use and in resuscitation techniques may represent a life-saving, peer-based adjunct to accessing emergency services. Nevertheless, strategies for overcoming potential risks associated with the use of take-home naloxone would need to be emphasized in an overdose management training program.
authors.affiliation: Department of Family and Community Medicine, University of California, San Francisco, CA 94110, USA. karens@itsa.ucsf.edu
authors.forename: Karen H
authors.initials: KH
authors.lastname: Seal
authors.forename: Moher
authors.initials: M
authors.lastname: Downing
authors.forename: Alex H
authors.initials: AH
authors.lastname: Kral
authors.forename: Shannon
authors.initials: S
authors.lastname: Singleton-Banks
authors.forename: Jon-Paul
authors.initials: JP
authors.lastname: Hammond
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lorvick
authors.forename: Dan
authors.initials: D
authors.lastname: Ciccarone
authors.forename: Brian R
authors.initials: BR
authors.lastname: Edlin
mesh_terms: D000328:Adult; D001294:Attitude to Health; D062787:Drug Overdose / Q000188:drug therapy / Q000517:prevention & control*; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006556:Heroin Dependence / Q000188:drug therapy / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D012495:San Francisco; D015819:Substance Abuse, Intravenous / Q000523:psychology*; D011795:Surveys and Questionnaires; D014504:Urban Health
chemical_list: D009292:Narcotic Antagonists; D009270:Naloxone