Naloxone-access programs miss many opioid users

(Reuters Health) - Some opioid users are more likely than others to know about and use naloxone, a medication designed to rapidly reverse opioid overdoses, suggests a study conducted in Chicago.

People who inject heroin tend to be much more aware of naloxone than those who snort or smoke heroin or take prescription pills, the study team reports in the American Journal of Emergency Medicine.

“From my experience with patients, the users who seem to be the most informed about the problem and naloxone are the ones who are the most seriously into their addiction,” said lead author Dr. Jenna Nikolaides of the Cook County Health and Hospital System in Chicago.

Opioids were involved in more than 33,000 deaths in 2015, according to the Centers for Disease Control and Prevention, and overdoses have quadrupled since 1999. The Cook County health system hosts one of the oldest naloxone distribution programs in the country, the authors note.

“We wondered if these programs were giving naloxone to the same group of people or dispensing to a wider public,” Nikolaides said in a telephone interview. “We’re finding that some opioid users don’t know what it is in the first place, let alone where to find it.”

The researchers surveyed 101 patients who went to the emergency department at the John H. Stroger Jr. Hospital of Cook County in 2016 and were identified by doctors as opioid users. The survey asked which opioids the patients used, their history of IV heroin use, awareness of naloxone, access to naloxone, how they obtained naloxone and if they had ever used it.

Patients ranged in age from 22 to 72 years old, and 38 percent injected heroin, 72 percent snorted heroin and 8 percent used prescription pills. Researchers found that 55 percent of patients had heard of naloxone and 22 had access to it at some point.

Among those who injected heroin, 76 percent had heard of naloxone and 39 percent had access to it. However, among those who had never injected heroin, 32 percent had heard of naloxone and 2 percent had access to it.

“Even people who are open and honest about their drug use are not being reached by naloxone,” Nikolaides said. “There’s great potential that we’re missing those who aren’t open about their drug use, too.”

Of the 22 people who had used naloxone in the study, 7 used it on themselves, 10 used it on someone else and 9 had used it more than once. These uses had resulted in 43 overdose reversals.

Although doctors have started prescribing naloxone, and Illinois passed a law making it available in pharmacies without a prescription, none of the study participants had acquired it through those routes. All who had it in the past got their naloxone through a harm-reduction program, the study team notes.

The researchers couldn’t determine why naloxone awareness and access differed so much between the groups. Since most patients snorted heroin in this group, the study authors speculate, they may not have used needles or needed to go to needle-exchange programs.

Snorting heroin could also be perceived to be safer, and the users may be less worried about overdosing, Nikolaides added.

“This shows how we can’t attack the opioid problem in one way. There are different groups of users, even among the illicit drug category,” said Dr. Dennis Watson of Indiana University in Indianapolis, who wasn’t involved in the study.

“We need to think about the best way we can distribute naloxone and inform doctors,” Watson said in a telephone interview. “We’re trying to understand what the barriers are and how to get this into the hands of people who need it.”

Nikolaides and colleagues are training emergency department physicians in how to talk to opioid users, understand their medical history and counsel them on naloxone availability and use. The research team is also developing programs for family and friends of users who may need to know how to administer naloxone during an overdose.

“With epidemic numbers of opioid overdoses, opioid users, healthcare providers, and laypeople must have easy access to naloxone and be educated on how and when to use it during an opioid overdose,” said Dr. Alan Kaye of the Louisiana State University School of Medicine in New Orleans, who wasn’t involved in the study.

“Making naloxone available over the counter is a smart solution,” Kaye said in an email. “However, much work needs to be done to tell everyone that naloxone can save lives.”

SOURCE: American Journal of Emergency Medicine, online March 26, 2018.