Abstract

Little is known about differences in bystander behavior among people who use drugs, trained and untrained in opioid overdose prevention. We examined three types of recommended overdose response – a 911 call, rescue breathing/CPR, and naloxone administration—among Philadelphia-based, predominantly street-involved women with a history of illicit drug use. The study utilized a convergent mixed methods approach integrating data from 186 quantitative survey responses and 38 semi-structured qualitative interviews. Quantitative findings revealed that compared to untrained women, trained women were more likely to administer naloxone (32.9% vs. 5.2%) and use two recommended responses (20.0% vs. 9.5%). No significant differences were found between the two groups in calling 911 or using rescue breathing/CPR. Qualitative findings indicated that barriers to enacting recommended overdose response were either structural or situational and included the avoidance of police, inability to carry naloxone or phone due to unstable housing, and perceived lack of safety on the streets and when interacting with strangers. Our study demonstrated that overdose training improved the frequency of naloxone administration among this sample of predominantly street-involved women. Future efforts need to focus on avoiding intrusive policing, scaling-up naloxone refill sites, and providing secondary naloxone distribution via drug user networks.

摘要

人们对吸毒者、接受过和未接受过阿片类药物过量预防培训的人在旁观者行为上的差异知之甚少。我们在费城有非法药物使用史的主要街头涉案妇女中检查了三种推荐的过量反应——911 电话、人工呼吸/CPR 和纳洛酮给药。该研究采用了一种融合混合方法，整合了来自 186 份定量调查回复和 38 份半结构化定性访谈的数据。定量结果显示，与未受过训练的女性相比，受过训练的女性更有可能使用纳洛酮（32.9% 对 5.2%）并使用两种推荐的反应（20.0% 对 9.5%）。两组在拨打 911 或使用人工呼吸/CPR 方面没有发现显着差异。定性调查结果表明，制定建议的过量反应的障碍是结构性或情境性的，包括避开警察、由于住房不稳定而无法携带纳洛酮或电话，以及在街上和与陌生人互动时感到缺乏安全性。我们的研究表明，在这个主要出街妇女的样本中，过量训练提高了纳洛酮给药的频率。未来的努力需要集中在避免侵入性警务、扩大纳洛酮补充站点的规模以及通过吸毒者网络提供二级纳洛酮分发。以及在街上和与陌生人互动时感到缺乏安全感。我们的研究表明，在这个主要出街妇女的样本中，过量训练提高了纳洛酮给药的频率。未来的努力需要集中在避免侵入性警务、扩大纳洛酮补充站点的规模以及通过吸毒者网络提供二级纳洛酮分发。以及在街上和与陌生人互动时感到缺乏安全感。我们的研究表明，在这个主要出街妇女的样本中，过量训练提高了纳洛酮给药的频率。未来的努力需要集中在避免侵入性警务、扩大纳洛酮补充站点的规模以及通过吸毒者网络提供二级纳洛酮分发。