Predictors of participant engagement and naloxone utilization in a community-based naloxone distribution program.
OBJECTIVE
To describe characteristics of participants and overdose reversals associated with a community-based naloxone distribution program and identify predictors of obtaining naloxone refills and using naloxone for overdose reversal.


METHODS
Bivariate statistical tests were used to compare characteristics of participants who obtained refills and reported overdose reversals versus those who did not. We fitted multiple logistic regression models to identify predictors of refills and reversals; zero-inflated multiple Poisson regression models were used to identify predictors of number of refills and reversals.


METHODS
San Francisco, California, USA.


METHODS
Naloxone program participants registered and reversals reported from 2010 to 2013.


METHODS
Baseline characteristics of participants and reported characteristics of reversals.


RESULTS
A total of 2500 participants were registered and 702 reversals were reported from 2010 to 2013. Participants who had witnessed an overdose [adjusted odds ratio (AOR)=2.02, 95% confidence interval (CI)= 1.53-2.66; AOR = 2.73, 95% CI = 1.73-4.30] or used heroin (AOR = 1.85, 95% CI =  1.44-2.37; AOR = 2.19, 95% CI = 1.54-3.13) or methamphetamine (AOR=1.71, 95% CI=1.37-2.15; AOR=1.61, 95% CI=1.18-2.19) had higher odds of obtaining a refill and reporting a reversal, respectively. African American (AOR = 0.63, 95% CI = 0.45-0.88) and Latino (AOR = 0.65, 95% CI =  0.43-1.00) participants had lower odds of obtaining a naloxone refill, whereas Latino participants who obtained at least one refill reported a higher number of refills [incidence rate ratio (IRR) = 1.33 (1.05-1.69)].


CONCLUSIONS
Community naloxone distribution programs are capable of reaching sizeable populations of high-risk individuals and facilitating large numbers of overdose reversals. Community members most likely to engage with a naloxone program and use naloxone to reverse an overdose are active drug users.
University of California, Berkeley, School of Public Health, Division of Epidemiology, Berkeley, CA, USA.
Christopher
C
Rowe
San Francisco Department of Public Health, San Francisco, CA, USA.|University of California, San Francisco, San Francisco, CA, USA.
Glenn-Milo
GM
Santos
University of California, San Francisco, San Francisco, CA, USA.
Eric
E
Vittinghoff
Drug Overdose Prevention and Education Project, Harm Reduction Coalition, Oakland, CA, USA.
Eliza
E
Wheeler
University of California, San Diego, La Jolla, CA, USA.
Peter
P
Davidson
San Francisco Department of Public Health, San Francisco, CA, USA.|University of California, San Francisco, San Francisco, CA, USA.
Philip O
PO
Coffin
D000328:Adult; D000701:Analgesics, Opioid / Q000506:poisoning*; D003156:Community Mental Health Services / Q000706:statistics & numerical data; D062787:Drug Overdose / Q000517:prevention & control; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000706:statistics & numerical data; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012495:San Francisco; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data
D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D009270:Naloxone
Harm reduction; heroin; methamphetamine; naloxone; opiates; overdose; substance use