Department of Pediatrics, University of Calgary, Canada.
Department of Medicine, University of Alberta, Canada.
Int J Drug Policy. 2024 Oct;132:104559. doi: 10.1016/j.drugpo.2024.104559. Epub 2024 Aug 28.
North America is grappling with an ongoing drug overdose crisis. While harm reduction measures like take-home naloxone kits, and supervised consumption sites, have helped reduce mortality, other strategies to address this public health emergency are required. Good Samaritan Laws (GSLs) offer legal protection for individuals who report overdoses, yet people who use substances (PWUS) may still hesitate to seek help due to concerns about existing legislation. This scoping review explores barriers preventing PWUS from calling emergency services for overdoses, along with potential solutions and facilitators to address this challenge.
PRISMA-ScR was used as a guide to conduct this study. Health sciences librarians searched Medline, Embase, PsychINFO, CINAHL, and SCOPUS to identify relevant articles. Six reviewers contributed to screening and extracting the articles through Covidence. Two reviewers performed thematic analysis using NVivo software to identify key barriers and facilitators.
An initial search found 6275 articles for title and abstract screening, resulting in 48 studies meeting the inclusion criteria. The primary barrier to calling 911 pertained to concerns about police arrivng with other first responders, especially regarding their presence and involvement at the scene of overdose. This was followed by legal repercussions, including fear of arrest, incarceration, and fear of eviction, amongst others. Some studies noted the lack of knowledge or trust in GSLs as a deterrent to seeking medical assistance. Additional barriers included concerns about privacy and confidentiality, preference to manage an overdose alone/receive help from another peer, confidence in naloxone effectiveness, limited access to cell phones, peer pressure to not call for help, and identifying as Black, Indigenous, or a Person of Colour (BIPOC). Facilitators include increased GSL awareness among PWUS and law enforcement, expanded legal safeguards for 911 callers, reduced police intervention in overdose cases, and enhanced naloxone availability at key access points.
Despite the good intentions of GSLs, PWUS continue to experience significant barriers to calling emergency services in the event of an overdose. Understanding these barriers and key facilitators is necessary to inform future drug policy and advocacy efforts.
北美洲正在应对一场持续的药物过量危机。尽管减少伤害措施，如携带回家的纳洛酮试剂盒和监督消费场所，已经帮助降低了死亡率，但仍需要采取其他策略来应对这一公共卫生紧急情况。好撒玛利亚人法（Good Samaritan Laws，GSLs）为报告过量用药的个人提供法律保护，但药物使用者（PWUS）可能仍然因为担心现有立法而不愿寻求帮助。本范围审查探讨了阻止 PWUS 因过量用药而拨打紧急服务电话的障碍，以及解决这一挑战的潜在解决方案和促进因素。
PRISMA-ScR 被用作指导进行这项研究。健康科学图书馆员在 Medline、Embase、PsychINFO、CINAHL 和 SCOPUS 中搜索了相关文章。六名评论员通过 Covidence 参与了筛选和提取文章。两名评论员使用 NVivo 软件进行主题分析，以确定关键障碍和促进因素。
初步搜索发现有 6275 篇文章进行了标题和摘要筛选，最终有 48 篇研究符合纳入标准。拨打 911 的主要障碍与担心警察与其他急救人员一起到达有关，特别是担心他们在过量用药现场的出现和参与。其次是法律后果，包括担心被捕、监禁和被驱逐等。一些研究指出，缺乏对 GSL 的了解或信任是寻求医疗帮助的一个障碍。其他障碍包括对隐私和保密性的担忧、更喜欢独自处理过量用药/从另一个同伴那里获得帮助、对纳洛酮有效性的信心、手机使用受限、同伴压力不要寻求帮助，以及认同自己是黑人、原住民或有色人种（BIPOC）。促进因素包括增加 PWUS 和执法人员对 GSL 的认识、扩大 911 来电者的法律保护、减少警察对过量用药案件的干预，以及在关键接入点增加纳洛酮的供应。
尽管好撒玛利亚人法的初衷是好的，但 PWUS 在发生药物过量时继续面临拨打紧急服务电话的重大障碍。了解这些障碍和关键促进因素对于制定未来的毒品政策和宣传工作是必要的。
