A new study explores for the first time the relationship between non-medical prescription opioid (PO) use in young adults, their knowledge and experience of overdose, and the likelihood of overdose.
Opioid-involved overdoses have become a growing public health concern in the last decade. The number of accidental opioid-involved overdose deaths in 2011 was nearly triple the number of deaths in 2000, according to the New York City Department of Health and Mental Hygiene.
This is attributed to a significant increase in nonmedical prescription PO use among teens and young adults, and, more recently, in heroin use among youth who transitioned from POs to heroin.
The study involved NYC participants between the ages of 18 and 32, who had engaged in nonmedical PO use in the past 30 days.
The study used a series of in-depth, semi-structured interviews to explore the group’s overdose experiences, as well as their knowledge of and experience with opioid safety/overdose prevention services and practices. The researchers also measured participants’ knowledge of naloxone, a specific opioid receptor antagonist used to reverse an opioid overdose.
“We found that despite significant overdose experiences, nonmedical PO users were uninformed about overdose awareness, avoidance, and response strategies, especially the use of naloxone. Prevention efforts should provide education about overdose prevention and access to naloxone to young PO misusers,” said researcher Pedro Mateu-Gelabert, Ph.D.
The lack of knowledge in this high risk group was disturbing. In most cases, when asked about their experience with overdose, participants described their use of folk methods, such as slapping the individual or placing them in a cold shower, to revive an opioid user who appeared to have experienced an overdose.
In fact, many participants mentioned the popular film “Pulp Fiction,” which includes a fictionalized and inaccurate overdose reversal scene, highlighting the extent to which mass media depictions often function as significant sources of drug-related knowledge for this population.
In an effort to understand this knowledge deficit, researchers reviewed a variety of educational resources—such as harm reduction organizations and syringe exchange programs (SEPs)—and why these programs had failed to educate. It appears that study participants were of a different subpopulation from those traditionally served by these organizations.
“Many participants drew clear distinctions between nonmedical PO use and heroin use, and even those who transitioned to heroin tended to maintain identity-based distinctions between themselves and those they perceived as ‘junkies,’ said co-author David Frank, a graduate student at the City University of New York.
“Their desire to uphold this distinction affected their willingness to utilize such services, which are often stigmatized.”
Furthermore, many participants were opioid dependent, yet did not engage in injection drug use; therefore, despite being at risk for overdose, they were outside of the realm of influence of these organizations.
The researchers emphasize the need to expand existing resources outside the realm of the traditional centers. This would better address the less marginalized/stigmatized group of drug users studied.
“Given that every participant in the study had attended at least some high school, with half having attended at least some college, we believe the development of high school and college education programs that offer harm reduction training and distribute naloxone could contribute to overdose prevention efforts,” said Mateu-Gelabert.
The findings are published in the International Journal of Drug Policy.
Source: New York University