Abstract
BackgroundPersons in addiction treatment are likely to experience and/or witness drug overdoses following treatment and thus could benefit from overdose education and naloxone distribution (OEND) programs. Diverting individuals from the criminal justice system to addiction treatment represents one treatment engagement pathway, yet OEND needs among these individuals have not been fully described.MethodsWe characterized justice involvement patterns among 514 people who use opioids (PWUO) participating in a criminal justice diversion addiction treatment program during 2014–2016 using a gender-stratified latent class analysis. We described prevalence and correlates of naloxone knowledge using quasi-Poisson regression models with robust standard errors.ResultsOnly 56% of participants correctly identified naloxone as an opioid overdose treatment despite that 68% had experienced an overdose and 79% had witnessed another person overdose. We identified two latent justice involvement classes: low involvement (20.3% of men, 46.5% of women), characterized by older age at first arrest, more past-year arrests, and less time incarcerated; and high involvement (79.7% of men, 53.5% of women), characterized by younger age at first arrest and more lifetime arrests and time incarcerated. Justice involvement was not associated with naloxone knowledge. Male participants who had personally overdosed more commonly identified naloxone as an overdose treatment after adjustment for age, race, education level, housing status, heroin use, and injection drug use (prevalence ratio [95% confidence interval]: men 1.5 [1.1–2.0]).ConclusionsAll PWUO in criminal justice diversion programs could benefit from OEND given the high propensity to experience and witness overdoses and low naloxone knowledge across justice involvement backgrounds and genders.
Highlights
Persons in addiction treatment are likely to experience and/or witness drug overdoses following treatment and could benefit from overdose education and naloxone distribution (OEND) programs
Correlates of overdose experience, witnessed overdose, and naloxone knowledge We examined whether the prevalence of experiencing or witnessing an overdose differed by justice involvement class
56.2% of participants had naloxone knowledge (62.1% had heard of naloxone and 90.6% of those who had heard of it correctly identified it as an overdose treatment)
Summary
Persons in addiction treatment are likely to experience and/or witness drug overdoses following treatment and could benefit from overdose education and naloxone distribution (OEND) programs. There is a critical need for overdose education and naloxone distribution (OEND) programs to identify, engage, and train people who use opioids (PWUO), as they are both potential overdose victims and bystanders who could respond [3,4,5]. OEND programs train potential overdose bystanders to identify and respond to an opioid overdose and equip participants with naloxone, an opioid antagonist that reverses the respiratory depression caused by high doses of opioids [6, 7]. As highlighted recently by the US Surgeon General [11], there remains an urgent need to maximize the number of PWUO who are wellpositioned to respond to an overdose or benefit from receipt of naloxone
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