Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Needle and Syringe program, Stockholm Centre for Dependency Disorders, Stockholm, Sweden.
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Centre for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
Int J Drug Policy. 2023 May;115:104021. doi: 10.1016/j.drugpo.2023.104021. Epub 2023 Apr 1.
Take-Home Naloxone (THN) programs were introduced in Sweden in 2018 - a country with one of the highest rates of overdose mortality in the EU and a severe stigmatisation of people who inject drugs. This qualitative study builds on the international research that has expanded a previously narrow and medical focus on overdose deaths. It uses Zinberg's framework to look beyond the role of the "drug" to include the attitudes and personality of the person ("set") and contextual factors ("setting"). This study explores the impacts of THN from the perspective of overdose survivors.
Between November 2021 and May 2022 semi-structured interviews were conducted with 22 opioid overdose survivors, recruited among clients of the Stockholm needle and syringe program. All the participants had been treated with naloxone in an overdose situation. The interviews were processed through thematic analysis using deductive and inductive coding in accordance with the theoretical framework.
Interviewees included men and women who used different types of drugs. THN has impacted on "drug" in terms of naloxone-induced withdrawal symptoms and peers having to deal with survivors' emotions. Exploring "set" revealed feelings of shame following naloxone revival for the person who overdosed. Despite such reactions, participants retained an overwhelmingly positive attitude towards THN. Participants integrated THN into their risk management practices ("setting") and some acknowledged that THN provided a new way to treat overdoses without necessarily needing to interact with authorities, especially the police.
The THN program has influenced "drug, set and setting" for participants, providing increased safety at drug-intake and transferring overdose management and the burden of care to the community. The lived experience of participants also exposes the limitations of THN indicating that there are additional unmet needs beyond THN programs, particularly in terms of "setting".
瑞典于 2018 年推出了“随取纳洛酮（THN）”计划，该国是欧盟内阿片类药物过量死亡率最高的国家之一，对注射毒品的人存在严重污名化。这项定性研究是在国际研究的基础上进行的，该研究扩大了之前对药物过量死亡的狭隘和医学关注范围。它使用津伯格的框架，超越了“药物”的作用，包括人的态度和个性（“设定”）以及背景因素（“环境”）。本研究从药物过量幸存者的角度探讨 THN 的影响。
2021 年 11 月至 2022 年 5 月，对斯德哥尔摩针具交换计划的客户中招募的 22 名阿片类药物过量幸存者进行了半结构式访谈。所有参与者都曾在药物过量情况下接受过纳洛酮治疗。访谈通过主题分析进行处理，使用理论框架的演绎和归纳编码。
受访者包括使用不同类型药物的男性和女性。THN 对“药物”产生了影响，表现为纳洛酮引起的戒断症状和同伴不得不应对幸存者的情绪。探索“设定”揭示了药物过量者在纳洛酮复苏后的羞耻感。尽管有这样的反应，参与者对 THN 仍持压倒性的积极态度。参与者将 THN 融入他们的风险管理实践中（“环境”），一些人承认 THN 提供了一种新的治疗药物过量的方法，而无需与当局，特别是警察互动。
THN 计划对参与者的“药物、设定和环境”产生了影响，增加了药物摄入时的安全性，并将药物过量管理和护理负担转移到社区。参与者的亲身体验也暴露了 THN 的局限性，表明除了 THN 计划之外，还存在其他未满足的需求，特别是在“环境”方面。
