Sisson Laura N, Winiker Abigail K, Triece Tricia, Rousch Richard S, Rouhani Saba, Owczarzak Jill, Sherman Susan G, Schneider Kristin E
Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Subst Use Misuse. 2025;60(8):1164-1172. doi: 10.1080/10826084.2025.2491768. Epub 2025 Apr 12.
Community-based distribution of naloxone has continued to serve as an important strategy in combatting the U.S. opioid overdose crisis. People who use drugs are first responders in this crisis, administering and disseminating knowledge about naloxone among their social networks. However, it is unclear how knowledge of naloxone evolves over time and across individuals, especially amid a volatile, unregulated drug market.
We conducted 22 qualitative interviews with people who use drugs in rural, suburban, and urban regions of Maryland. Interviews focused on respondents' experiences witnessing and experiencing overdose, reversing overdoses with naloxone, and sources of uncertainty in overdose response.
Participants demonstrated high willingness and capacity to respond to overdose using naloxone. However, limited technical knowledge about naloxone contributed to riskier overdose reversal strategies, especially among individuals who had not received formal training. Non-naloxone reversal strategies, such as rescue breathing, were not widely used by participants. Finally, perceived volatility within local drug markets, specifically fentanyl analogues and xylazine, undermined participants' confidence in the effectiveness of naloxone.
People who use drugs serve an important role in community-based overdose reversal. Leveraging their experiential knowledge of overdose with technical knowledge of naloxone is foundational to effective community-based naloxone dissemination. Harm reduction programs should ensure that educational materials describe technical aspects of overdose response in ways that are intuitive to the experiences of people who use drugs, as well as ensure materials are responsive to an evolving drug supply.
基于社区的纳洛酮分发一直是美国应对阿片类药物过量危机的一项重要策略。吸毒者是这场危机的第一响应者，他们在自己的社交网络中管理和传播有关纳洛酮的知识。然而，尚不清楚人们对纳洛酮的了解是如何随时间推移以及在不同个体之间演变的，尤其是在一个不稳定、不受监管的毒品市场中。
我们对马里兰州农村、郊区和城市地区的吸毒者进行了22次定性访谈。访谈重点关注受访者目睹和经历过量用药的经历、用纳洛酮逆转过量用药的情况以及过量用药应对中的不确定性来源。
参与者表现出很高的意愿和能力使用纳洛酮应对过量用药。然而，对纳洛酮的技术知识有限导致了风险更高的过量用药逆转策略，尤其是在那些没有接受过正规培训的个体中。参与者并未广泛使用非纳洛酮逆转策略，如人工呼吸。最后，当地毒品市场的感知波动性，特别是芬太尼类似物和赛拉嗪，削弱了参与者对纳洛酮有效性的信心。
吸毒者在基于社区的过量用药逆转中发挥着重要作用。将他们对过量用药的经验知识与纳洛酮的技术知识相结合，是有效进行基于社区的纳洛酮传播的基础。减少伤害项目应确保教育材料以吸毒者的经验易于理解的方式描述过量用药应对的技术方面，并确保材料能应对不断变化的毒品供应。
