National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.
National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia; Burnet Institute, Melbourne, Australia.
Int J Drug Policy. 2024 Nov;133:104572. doi: 10.1016/j.drugpo.2024.104572. Epub 2024 Sep 7.
Examining take-home naloxone (THN) uptake using a 'cascade of care' framework could help identify targets for increasing THN training and carriage among people who may witness or experience opioid overdose. We describe the THN cascade and factors associated with engagement among people who inject drugs.
People aged ≥18 years in Australia who inject drugs were interviewed from 2020 to 2022, reporting lifetime THN awareness and acquisition and past-month carriage. We examined factors associated with engagement using multivariable logistic regression.
Of 2,149 participants (64 % men, mean age 44.5), 85 % had heard of naloxone, of whom 76 % were aware of THN programs. Of these, 72 % had ever participated in THN training/brief education, 92 % of whom had acquired THN. Of those who had ever acquired THN and reported past-month opioid use, 63 % always/often carried THN when using opioids. Past six-month opioid agonist treatment (OAT) (adjusted odds ratio [AOR] 2.55; 95 %CI 1.91-3.42) and ≥daily injecting (1.32; 1.01-1.73) were associated with awareness. OAT (1.79; 1.38-2.33), past-year opioid overdose (1.68; 1.18-2.42) and older age (1.02; 1.00-1.03) were associated with acquisition. Primarily injecting methamphetamine (versus heroin) in the past month was associated with lower awareness (0.43; 0.31-0.58) and acquisition (0.59; 0.44-0.78). Reporting no accommodation (squatting/sleeping rough) was associated with reduced odds of carriage (0.46; 0.24-0.88).
Participants reported high THN awareness and acquisition, with lower carriage. Future efforts should focus on improving THN access and reducing barriers to carriage, particularly for people experiencing homelessness or who primarily inject non-opioids.
使用“关怀链”框架来研究纳洛酮的家庭使用情况，有助于确定目标人群，以增加可能目睹或经历阿片类药物过量的人群对纳洛酮培训和携带的接受程度。我们描述了与注射毒品者的纳洛酮使用相关的关怀链和参与因素。
2020 年至 2022 年期间，对澳大利亚年龄≥18 岁的注射毒品者进行访谈，报告其一生中对纳洛酮的认识和获取情况以及过去一个月的携带情况。我们使用多变量逻辑回归来检验与参与相关的因素。
在 2149 名参与者中（64%为男性，平均年龄 44.5 岁），85%听说过纳洛酮，其中 76%听说过纳洛酮方案。在这些人中，72%曾参加过纳洛酮培训/简短教育，其中 92%曾获得过纳洛酮。在过去一个月曾使用过阿片类药物且报告过去一个月曾携带过纳洛酮的人中，63%的人在使用阿片类药物时经常携带纳洛酮。过去六个月的阿片类药物激动剂治疗（OAT）（调整后的优势比[OR] 2.55；95%CI 1.91-3.42）和≥每天注射（1.32；1.01-1.73）与意识有关。OAT（1.79；1.38-2.33）、过去一年阿片类药物过量（1.68；1.18-2.42）和年龄较大（1.02；1.00-1.03）与获得纳洛酮有关。过去一个月主要注射甲基苯丙胺（而不是海洛因）与意识降低（0.43；0.31-0.58）和获取率降低（0.59；0.44-0.78）有关。报告没有住所（居住在简陋居所或无家可归）与携带纳洛酮的可能性降低（0.46；0.24-0.88）有关。
参与者报告说对纳洛酮的认识和获取程度很高，但携带率较低。未来的努力应侧重于改善纳洛酮的获取途径，并减少携带纳洛酮的障碍，特别是针对无家可归者或主要注射非阿片类药物者。
