Non-fatal opioid overdose, naloxone access, and naloxone training among people who recently used opioids or received opioid agonist treatment in Australia: The ETHOS Engage study

A Conway; H Valerio; A Peacock; L Degenhardt; J Hayllar; M E Harrod; C Henderson; P Read; R Gilliver; M Christmass; A Dunlop; M Montebello; G Whitton; D Reid; T Lam; M Alavi; D Silk; A D Marshall; C Treloar; G J Dore; J Grebely; ETHOS Engage Study Group

doi:10.1016/j.drugpo.2021.103421

Non-fatal opioid overdose, naloxone access, and naloxone training among people who recently used opioids or received opioid agonist treatment in Australia: The ETHOS Engage study

Int J Drug Policy. 2021 Oct:96:103421. doi: 10.1016/j.drugpo.2021.103421. Epub 2021 Aug 25.

Authors

A Conway¹, H Valerio², A Peacock³, L Degenhardt⁴, J Hayllar⁵, M E Harrod⁶, C Henderson⁶, P Read⁷, R Gilliver⁸, M Christmass⁹, A Dunlop¹⁰, M Montebello¹¹, G Whitton¹², D Reid¹³, T Lam¹⁴, M Alavi², D Silk², A D Marshall¹⁵, C Treloar¹⁶, G J Dore², J Grebely²; ETHOS Engage Study Group

Affiliations

¹ The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia. Electronic address: [email protected].
² The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
³ National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia; School of Psychology, University of Tasmania, Hobart, Tasmania, Australia.
⁴ National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia.
⁵ Alcohol and Drug Service, Metro North Mental Health, Metro North Hospital and Health Service, Brisbane, QLD, Australia.
⁶ NSW Users and AIDS Association, NSW, Australia.
⁷ The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; Kirketon Road Centre, Sydney, NSW, Australia.
⁸ Kirketon Road Centre, Sydney, NSW, Australia.
⁹ Next Step Drug and Alcohol Services, Mental Health Commission, WA, Australia; National Drug Research Institute, Curtin University, WA, Australia.
¹⁰ Centre for Translational Neuroscience and Mental Health, Hunter Medical Research Institute & University of Newcastle, Newcastle, NSW, Australia; Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia.
¹¹ National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia; Drug and Alcohol Services, Northern Sydney Local Health District, Sydney, NSW, Australia; University of Sydney, Sydney, NSW, Australia.
¹² Drug Health Service, South West Sydney LHD, NSW, Australia.
¹³ Drug and Alcohol Service, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia.
¹⁴ Drug Health, Western Sydney Local Health District, Sydney, NSW, Australia.
¹⁵ The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia.
¹⁶ Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia.

PMID: 34452808
DOI: 10.1016/j.drugpo.2021.103421

Abstract

Background: Overdose is a major cause of morbidity and mortality among people who use opioids. Naloxone can reverse opioid overdoses and can be distributed and administered with minimal training. People with experience of overdose are a key population to target for overdose prevention strategies. This study aims to understand if factors associated with recent non-fatal opioid overdose are the same as factors associated with naloxone access and naloxone training in people who recently used opioids or received opioid agonist treatment (OAT).

Methods: ETHOS Engage is an observational study of people who inject drugs in Australia. Logistic regression models were used to estimate odds ratios for non-fatal opioid overdose, naloxone access and naloxone training.

Results: Between May 2018-September 2019, 1280 participants who recently used opioids or received OAT were enrolled (62% aged >40 years; 35% female, 80% receiving OAT, 62% injected drugs in the preceding month). Recent opioid overdose (preceding 12 months) was reported by 7% of participants, lifetime naloxone access by 17%, and lifetime naloxone training by 14%. Compared to people receiving OAT with no additional opioid use, recent opioid, benzodiazepine (preceding six months), and hazardous alcohol use was associated with recent opioid overdose (aOR 3.91; 95%CI: 1.68-9.10) and lifetime naloxone access (aOR 2.12; 95%CI 1.29-3.48). Among 91 people who reported recent overdose, 65% had never received take-home naloxone or naloxone training.

Conclusions: Among people recently using opioids or receiving OAT, benzodiazepine and hazardous alcohol use is associated with non-fatal opioid overdose. Not all factors associated with non-fatal overdose correspond to factors associated with naloxone access. Naloxone access and training is low across all groups. Additional interventions are needed to scale up naloxone provision.

Keywords: Australia; Naloxone; Opioids; Overdose.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Analgesics, Opioid / therapeutic use
Drug Overdose* / drug therapy
Drug Overdose* / epidemiology
Female
Humans
Male
Naloxone / therapeutic use
Narcotic Antagonists / therapeutic use
Opiate Overdose*
Opioid-Related Disorders* / drug therapy
Opioid-Related Disorders* / epidemiology

Substances

Analgesics, Opioid
Narcotic Antagonists
Naloxone