Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, 809 E. 9th St., Bloomington, IN, 47405, USA.
Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA.
BMC Public Health. 2022 May 10;22(1):924. doi: 10.1186/s12889-022-13298-3.
Overdose education and naloxone distribution (OEND) to laypersons are key approaches to reduce the incidence of opioid-involved overdoses. While some research has examined attitudes toward OEND, especially among pharmacists and first responders, our understanding of what laypersons believe about overdose and naloxone is surprisingly limited. Further, some scholars have expressed concerns about the prevalence of non-evidence-based beliefs about overdose and naloxone. We designed this study to analyze the prevalence, nature, and context of beliefs about naloxone and overdose among U.S. laypersons.
We conducted a cross-sectional study (n = 702) using Prolific.co (representative of the U.S. population by age, gender, and race). Primary outcomes were the believability of six statements about overdose/naloxone on a seven-point Likert-type scale. Five statements were unsupported, and one was supported, by current scientific evidence. We used latent profile analysis to classify participants into belief groups, then used regression to study correlates of profile classification.
Believability of the statements (7: extremely believable) ranged from m = 5.57 (SD = 1.38) for a scientifically supported idea (trained bystanders can reverse overdose with naloxone), to m = 3.33 (SD = 1.83) for a statement claiming opioid users can get high on naloxone. Participants were classified into three latent belief profiles: Profile 1 (most aligned with current evidence; n = 246), Profile 2 (moderately aligned; n = 351), and Profile 3 (least aligned, n = 105). Compared to Profile 1, several covariates were associated with categorization into Profiles 2 and 3, including lower trust in science (RRR = 0.36, 95%CI = 0.24-0.54; RRR = 0.21, 95%CI = 0.12-0.36, respectively), conservative political orientation (RRR = 1.41, 95%CI = 1.23-1.63; 3:RRR = 1.62, 95%CI = 1.35-1.95, respectively), and never being trained about naloxone (Profile 3: RRR = 3.37, 95%CI = 1.16-9.77).
Preliminary evidence suggests some U.S. laypersons simultaneously believe that bystander overdose prevention with naloxone can prevent overdose and one or more scientifically unsupported claims about naloxone/overdose. Categorization into clusters displaying such belief patterns was associated with low trust in science, conservative political orientation, and not having been trained about naloxone.
This cross-sectional study was preregistered prior to any data collection using the Open Science Framework: https://osf.io/c6ufv.
向非专业人员提供过量用药教育和纳洛酮分发（OEND）是减少阿片类药物过量的关键方法。虽然一些研究已经考察了人们对 OEND 的态度，尤其是药剂师和急救人员的态度，但我们对非专业人员对过量用药和纳洛酮的看法的了解却出人意料地有限。此外，一些学者对过量用药和纳洛酮的非循证信念的流行表示担忧。我们设计了这项研究，以分析美国非专业人员对纳洛酮和过量用药的看法的流行程度、性质和背景。
我们使用 Prolific.co（按年龄、性别和种族代表美国人口）进行了一项横断面研究（n=702）。主要结局是对 7 点李克特量表上的六个关于过量用药/纳洛酮的陈述的可信度进行评分。其中五个陈述没有得到当前科学证据的支持，一个陈述得到了支持。我们使用潜在剖面分析将参与者分为信念组，然后使用回归分析研究与分组相关的因素。
陈述的可信度（7：非常可信）从接受过培训的旁观者可以使用纳洛酮逆转过量用药（m=5.57，SD=1.38）到阿片类药物使用者可以从纳洛酮中获得快感（m=3.33，SD=1.83）不等。参与者被分为三个潜在的信念组：组 1（最符合当前证据；n=246）、组 2（中度符合；n=351）和组 3（最不符合，n=105）。与组 1相比，几个协变量与组 2 和组 3的分类有关，包括对科学的信任度较低（RRR=0.36，95%CI=0.24-0.54；RRR=0.21，95%CI=0.12-0.36）、保守的政治取向（RRR=1.41，95%CI=1.23-1.63；3：RRR=1.62，95%CI=1.35-1.95）和从未接受过纳洛酮培训（组 3：RRR=3.37，95%CI=1.16-9.77）。
初步证据表明，一些美国非专业人员同时认为，使用纳洛酮进行旁观者过量预防可以预防过量用药，并且有一个或多个关于纳洛酮/过量用药的科学上不支持的说法。将具有这种信念模式的集群进行分类与对科学的信任度低、保守的政治取向以及未接受过纳洛酮培训有关。
这项横断面研究在任何数据收集之前都使用开放科学框架进行了预先注册：https://osf.io/c6ufv。
