An Exploration of Narcan as a Harm Reduction Strategy and User's Attitudes toward Law Enforcement Involvement in Overdose Cases.

Jared Durieux,Andrew Curtis,Chaz Felix,Eric Jefferis,Baaba Essel,Melissa Mirka

doi:10.3390/ijerph19063149

Abstract

The street homeless, those who spend their nights either in shelters or unofficial camps, whether in tents on a street or in society’s hidden spaces such as beneath an overpass, face multiple challenges beyond finding a safe place to sleep. Of further concern is how official actions can worsen these situations, through day-to-day activities or planned intervention strategies. In this paper we explore how a planned intervention may be negatively perceived—even as a form of “structural violence”—and may prevent Narcan (naloxone) use to stop an overdose related death in the Skid Row of Los Angeles. Data for this study consisted of a combination of Spatial Video Geonarratives (SVGs) and 325 incident reports from the Homeless Health Care Los Angeles Center for Harm Reduction (HHCLA-HRC) between November 2014 and December 2015. Chi-square and simple logistic regression models were used to examine the association between fear-of-arrest and other covariates of interest. Mapping results are presented with different sets of shapefiles created for (1) all Narcan uses, (2) all homeless, (3) all homeless with a worry about being arrested, (4) all Narcan uses where an ambulance attended, (5) and the same as 4 but also with police attendance. In the multivariable model, the estimated adjusted odds of fear-of-arrest is over three times higher among Narcan users ages 30–39 when compared to users under the age of 30. Analyzing the association of calling 9-1-1 on Narcan user demographics, socio-contextual characteristics, and overdose victim demographics, the crude estimated probability of calling 9-1-1 for Narcan users aged 50 and older is nearly three times higher when compared to Narcan users aged 19–29. Conclusion: Results suggest that the fear-of-arrest and calling 9-1-1 during an overdose is still a concern among Narcan users despite protective legislation and access to harm reduction resources.

Highlights

One of the tenets of harm reduction theory is that exposures resulting in dangerous or generally poor health situations is a function of individual behavior, choices, and the settings and situations that frame those decisions [1]
We were not able to answer each of these inquires with the available data, our analysis indicated that in a predominantly homeless population, that age, gender, and ethnicity of Narcan. Naloxone (Narcan) users and ethnicity of overdose victim are factors of fear-of-arrest, and that the effects of age, ethnicity, and housing status of Narcan users are factors of calling 9-1-1 in response to an opiate overdose
Independent of ethnicity, housing status of Narcan users, and relationship with the overdose victim, the influence of the overdose victim’s age and gender were factors of fear-of-arrest

Summary

Introduction

One of the tenets of harm reduction theory is that exposures resulting in dangerous or generally poor health situations is a function of individual behavior, choices, and the settings and situations that frame those decisions [1]. A good example in the United States is the street homeless, and their high rates of substance abuse and overdoses. The street homeless, those who spend their nights either in shelters or unofficial camps, whether they be tents on a street or in society’s hidden spaces such as beneath an overpass, face multiple challenges beyond finding a safe place to sleep.

Methods

Results

Discussion

Conclusion