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Article
Publication date: 15 December 2023

Rose Rosemary Ricciardelli, Matthew S. Johnston and Katharina Maier

Prisonersare at disproportionate risk of suffering substance-related harms. The administration of naloxone is essential to reversing opioid overdose and minimizing…

Abstract

Purpose

Prisonersare at disproportionate risk of suffering substance-related harms. The administration of naloxone is essential to reversing opioid overdose and minimizing substance-related harms in prison and the community. The purpose of this study is to examine how naloxone administration is practiced and perceived in prison settings.

Design/methodology/approach

The authors conducted surveys with correctional workers in Manitoba, Canada (n = 257) to examine how they understand and feel about the need for and practice of administering naloxone in their everyday work with criminalized populations.

Findings

Respondents reported feeling a great need to administer naloxone, but most did not feel adequately trained to administer naloxone, creating the perception that criminalized populations remain at enhanced risk.

Originality/value

Findings provide emerging evidence of the need for training and accompanying policies and procedures for correctional workers on how to access and administer naloxone.

Details

International Journal of Prison Health, vol. 20 no. 1
Type: Research Article
ISSN: 2977-0254

Keywords

Article
Publication date: 1 June 2015

Josefien J. F. Breedvelt, Derek K. Tracy, Emily C. Dickenson and Lucy V. Dean

Opiod users are at high risk of suffering from drug overdoses. Naloxone has been used for decades in emergency treatment settings to reverse the symptoms of opioid overdose. Pilot…

Abstract

Purpose

Opiod users are at high risk of suffering from drug overdoses. Naloxone has been used for decades in emergency treatment settings to reverse the symptoms of opioid overdose. Pilot studies and regional programmes have been rolled out to make naloxone more widely available. This review of user/carer administration of naloxone – so-called “take home naloxone” – aims to provide health professionals and interested readers with an up-to-date evidence base, clinical implications and practical concern considerations for such community management. The paper aims to discuss these issues.

Design/methodology/approach

A review and analysis of the recent literature on naloxone.

Findings

The evidence base suggests training and education is effective in preparing users for wider naloxone distribution. Furthermore, studies of varying quality indicate that naloxone may prove useful in reducing overdose-related deaths. However, even after implementation ineffective response techniques continued to be used at times and there remained a heistance to call medical services post overdose. Intranasal naloxone may reduce some of the risks associated with intramuscular naloxone. Ethical considerations, including provision of a needle and syringe kit to the community, should be considered. Studies suffered from a lack of follow-up data and methodological difficulties are associated with establishing opioid-related deaths post implementation. Two running trials in the UK might mitigate these concerns.

Research limitations/implications

Future research is needed to address wider context of an overdose and targeting associated risk factors.

Originality/value

Clinicians and other professionals will be informed on the most up-to-date evidence base and which areas are improtant to consider when take-home naloxone is introduced in their services.

Details

Drugs and Alcohol Today, vol. 15 no. 2
Type: Research Article
ISSN: 1745-9265

Keywords

Article
Publication date: 7 October 2021

Sara Rolando, Franca Beccaria and Susanna Ronconi

Spanning almost 30 years, Italy’s experience with take-home-naloxone (THN) provides an interesting case study on the international scene because of its specific history…

Abstract

Purpose

Spanning almost 30 years, Italy’s experience with take-home-naloxone (THN) provides an interesting case study on the international scene because of its specific history, regulation and trends in overdose (OD) rates. Accordingly, this study aims to contribute to the evidence base for THN and its delivery in a different setting.

Design/methodology/approach

The study focuses on service providers’ perceptions of the benefits, risks and barriers associated with THN provision. Data was collected using a mixed-methods approach as follows: an online structured questionnaire (no. of respondents = 63) and two focus groups (no. of total participants = 18).

Findings

Findings show that service providers believe the benefits of THN far outweigh the risks and accrue to services, as well as users. The study also suggests that the barriers in Italy are mostly ideological and political, and illustrates how resistance to administering THN can re-emerge when ODs are no longer a social emergency. Furthermore, the study found that health and social workers have different attitudes which are also reflected at the level of public and private services, thereby shaping slightly different models of THN supply.

Originality/value

The study suggests that barriers associated to THN are more ideological and political rather than concrete, which explains why, even where it seems long established, can easily re-emerge once ODs are no longer a social emergency.

Details

Drugs and Alcohol Today, vol. 22 no. 1
Type: Research Article
ISSN: 1745-9265

Keywords

Article
Publication date: 25 August 2021

Katherine E. McLeod, Jessica Xavier, Ali Okhowat, Sierra Williams, Mo Korchinski, Pamela Young, Kristi Papamihali, Ruth Elwood Martin, Angus Monaghan, Nader Sharifi and Jane A. Buxton

This study aims to describe knowledge of Canada’s Good Samaritan Drug Overdose Act (GSDOA) and take home naloxone (THN) training and kit possession among people being released…

Abstract

Purpose

This study aims to describe knowledge of Canada’s Good Samaritan Drug Overdose Act (GSDOA) and take home naloxone (THN) training and kit possession among people being released from provincial correctional facilities in British Columbia.

Design/methodology/approach

The authors conducted surveys with clients of the Unlocking the Gates Peer Health Mentoring program on their release. The authors compared the characteristics of people who had and had not heard of the GSDOA and who were in possession of a THN kit.

Findings

In this study, 71% people had heard of the GSDOA, and 55.6% were in possession of a THN kit. This study found that 99% of people who had heard of the GSDOA indicated that they would call 911 if they saw an overdose. Among people who perceived themselves to be at risk of overdose, 28.3% did not have a THN kit. Only half (52%) of participants had a mobile phone, but 100% of those with a phone said they would call 911 if they witnessed an overdose.

Originality/value

The authors found that people with knowledge of the GSDOA were likely to report that they would call 911 for help with an overdose. Education about the GSDOA should be a standard component of naloxone training in correctional facilities. More than one in four people at risk of overdose were released without a naloxone kit, highlighting opportunities for training and distribution. Access to a cellphone is important in enabling calls to 911 and should be included in discharge planning.

Details

International Journal of Prisoner Health, vol. 18 no. 1
Type: Research Article
ISSN: 1744-9200

Keywords

Article
Publication date: 20 February 2019

Lindsay A. Pearce, Lauren Mathany, Diane Rothon, Margot Kuo and Jane A. Buxton

To understand how the Take Home Naloxone (THN) program is implemented in two pilot correctional facilities in British Columbia (BC), Canada, in order to identify areas for program…

Abstract

Purpose

To understand how the Take Home Naloxone (THN) program is implemented in two pilot correctional facilities in British Columbia (BC), Canada, in order to identify areas for program improvement and inform the expansion of the program to other Canadian correctional facilities The paper aims to discuss these issues.

Design/methodology/approach

Two focus groups and one interview were conducted with healthcare staff at two pilot correctional facilities. Sessions were audio recorded, transcribed verbatim and divergent and convergent experiences within and between the facilities were explored in an iterative process. Key themes and lessons learned were identified and later validated by focus group participants.

Findings

Key themes that emerged included: challenges and importance of the train-the-trainer program for healthcare staff conducting participant training sessions; potential for improved prison population engagement and awareness of the program; tailoring program resources to the unique needs of an incarcerated population; challenges connecting participants to community harm reduction resources following release; and clarifying and enhancing the role of correctional officers to support the program.

Research limitations/implications

The correctional setting presents unique challenges and opportunities for the THN program that must be considered for program effectiveness.

Originality/value

This evaluation was conducted to inform program expansion amidst a historic opioid overdose epidemic in BC, and adds to the limited yet growing body of literature on the implementation and evaluation of this program in correctional settings globally.

Details

International Journal of Prisoner Health, vol. 15 no. 1
Type: Research Article
ISSN: 1744-9200

Keywords

Article
Publication date: 6 June 2016

Arun Charles Sondhi

The purpose of this paper is to understand prisoner perceptions on being trained and having received take-home naloxone (THN) kits once released from prison back into the…

Abstract

Purpose

The purpose of this paper is to understand prisoner perceptions on being trained and having received take-home naloxone (THN) kits once released from prison back into the community, in order to prevent an opiate-related overdose.

Design/methodology/approach

A survey was run of all prisoners receiving THN training across ten prisons in one English region. In total, 142 prisoners were surveyed out of 206 (69 per cent) being trained in THN across the ten prisons. Five focus groups (n=26) with prisoners were conducted across four remand and one open prison that included discussions on THN within a range of topics. Discussions were recorded using short-hand and the data were subsequently thematically interpreted using visual mapping techniques.

Findings

The survey highlighted a high degree of exposure amongst prisoners to overdose either directly (54 per cent) or having witnessed another person’s overdose (73 per cent). For prisoners who had overdosed, only a minority (38 per cent) were taken to hospital by an ambulance. In total, 81 per cent of prisoners surveyed also expressed little or no knowledge about THN prior to training. Prisoners were resistant to THN as an intervention resulting from this lack of prior knowledge. Focus group interviews suggested that there was a confused and mixed message in providing a harm reduction initiative within the context of recovery-orientated treatment. Prisoners also exhibited name confusion with other drugs (naltrexone) and there was some degree of resistance to being trained based on perceived side-effects brought on by its administration. Prisoners were also acutely aware of official agency perceptions (e.g. police) if seen to be in possession of THN kits.

Practical implications

The distribution of THN within a custodial setting requires consideration of wider marketing approaches to address levels of confusion and misapprehension amongst prisoners.

Originality/value

The study is one of the few focused on THN based on a UK prison environment.

Details

Drugs and Alcohol Today, vol. 16 no. 2
Type: Research Article
ISSN: 1745-9265

Keywords

Article
Publication date: 30 December 2021

Linsey Ann Belisle and Elia Del Carmen Solano-Patricio

As prison drug use continues to be a concern worldwide, harm reduction practices serve as an alternative approach to traditional abstinence-only or punishment-oriented methods to…

Abstract

Purpose

As prison drug use continues to be a concern worldwide, harm reduction practices serve as an alternative approach to traditional abstinence-only or punishment-oriented methods to address substance use behind bars. The purpose of this study is to present a summary of research surrounding prison-based harm reduction programs.

Design/methodology/approach

This narrative review of the international literature summarizes the harms associated with prison drug use followed by an overview of the literature surrounding three prison-based harm reduction practices: opioid agonist therapy, syringe exchange programs and naloxone distribution.

Findings

A collection of international research has found that these three harm reduction programs are safe and feasible to implement in carceral settings. Additionally, these services can effectively reduce some of the harms associated with prison drug use (e.g. risky injection practices, needle sharing, fatal overdoses, etc.). However, these practices are underused in correctional settings in comparison to their use in the community.

Originality/value

Various policy recommendations are made based on the available literature, including addressing ethical concerns surrounding prison populations’ rights to the same standard of health care and services available in the community. By taking a public health approach to prison drug use, harm reduction practices can provide a marginalized, high-risk population of incarcerated individuals with life-saving services rather than punitive, punishment-oriented measures.

Details

International Journal of Prisoner Health, vol. 18 no. 4
Type: Research Article
ISSN: 1744-9200

Keywords

Article
Publication date: 15 June 2021

Megan Reed, Anne Siegler, Loni P. Tabb, Florence Momplaisir, Dorsche Krevitz and Stephen Lankenau

The purpose of this paper is to present evaluation results. People exiting incarceration who use opioids are at an elevated risk for overdose following release. People living with…

Abstract

Purpose

The purpose of this paper is to present evaluation results. People exiting incarceration who use opioids are at an elevated risk for overdose following release. People living with HIV (PLWH) who use drugs are also at increased overdose risk. Overdose education and naloxone distribution (OEND) is an effective community-based intervention, but few OEND programs have been evaluated in a correctional setting and none have specifically targeted PLWH.

Design/methodology/approach

An OEND pilot program was implemented in the Philadelphia jail from December 2017 to June 2019. OEND was provided through an HIV case management program and naloxone given at release. Participants (n = 68) were assessed for changes in overdose knowledge and beliefs in their ability to respond to an overdose from baseline to one month later while still incarcerated. Other demographic variables were assessed via publicly available records and case manager chart abstraction.

Findings

A total of 120 incarcerated PLWH were OEND trained; 68 (56.7%) were still incarcerated one month later and received post-tests. The 68-person sample was predominantly male (79.4%) and Black (64.7%). One-fifth reported heroin use, a third reported cocaine use and nearly 2/3 reported use of any illegal drug on date of arrest. Among these 68, overdose knowledge and overdose attitudes improved significantly (p = 0.002 and p < 0.001, respectively).

Originality/value

OEND in correctional settings is feasible and knowledge and overdose attitudes improved significantly from baseline. OEND programs should be implemented within the general population of incarcerated people but, as with PLWH, can be extended to other vulnerable populations within correctional settings, such as persons with mental health conditions and a history of homelessness.

Details

International Journal of Prisoner Health, vol. 17 no. 4
Type: Research Article
ISSN: 1744-9200

Keywords

Article
Publication date: 24 August 2022

Corinne A. Beaugard, Valerie Hruschak, Christina S. Lee, Jenifer Swab, Sheila Roth and Daniel Rosen

Emergency medical service (EMS) workers are at risk for burnout related to the opioid overdose crisis because they are frequently present during overdose events. The study’s aims…

Abstract

Purpose

Emergency medical service (EMS) workers are at risk for burnout related to the opioid overdose crisis because they are frequently present during overdose events. The study’s aims were twofold: 1) to determine whether variables related to the opioid crisis were associated with burnout and 2) to explore the relationship between mental health, sleep, substance use, social support, and attitudes about working during the opioid overdose crisis with burnout.

Design/methodology/approach

In a cross-sectional web-based study, surveys were distributed by supervisors to EMS workers in Pennsylvania (winter 2018). Participants (n = 214) completed measures on burnout, social support, mental health, substance use, and sleep quality and reported their frequency of naloxone administration and their attitudes about working during the opioid overdose crisis. Bivariate and multivariable analyses were run to determine correlates of burnout.

Findings

The sample was 65.4% male, 91.5% white, and 43% were between 36–55 years old. In the regression model (n = 177), depression, anxiety, post-traumatic stress disorder (PTSD), sleep, attitudes about working during the opioid crisis, cannabis use, social support, age, hours worked each week, and frequency of naloxone administration were significantly correlated with burnout.

Originality/value

This study contributes to the emergent literature on burnout and EMS professionals during the opioid overdose crisis by finding that attitudes about working during the opioid overdose crisis are correlated with burnout. While the relationship should be explored in future research, the authors believe that interventions to prevent EMS burnout could incorporate training to improve attitudes about supporting individuals during overdose events.

Details

International Journal of Emergency Services, vol. 12 no. 1
Type: Research Article
ISSN: 2047-0894

Keywords

Article
Publication date: 26 August 2014

Farrukh Alam and Peter Barker

The purpose of this paper is to identify risk factors for interruptions in opioid dependence treatment and barriers to (re) entering effective treatment through real-world insight…

Abstract

Purpose

The purpose of this paper is to identify risk factors for interruptions in opioid dependence treatment and barriers to (re) entering effective treatment through real-world insight on current opioid dependence treatment in the UK.

Design/methodology/approach

Project Access UK, a national survey deployed across multiple regions in England, Wales and Scotland, collected data on the perspectives of patients receiving medication-assisted treatment (MAT) for opioid dependence (n=248), out-of-treatment opioid users (n=196), and physicians (n=100).

Findings

Both patients and users reported multiple prior episodes of MAT and detoxification. Among patients, 57 per cent reported continuing illicit drugs use in addition to their treatment, 25 per cent had misused (injected or snorted) and 30 per cent had diverted (sold or given away) prescribed opioid medications. Diverted medications were currently being used by 26 per cent of out-of-treatment users; of these, 21 per cent used methadone. Supervised dosing was rated as the condition of treatment with the biggest impact on daily life. Daily supervision was a requirement for 44, 34 and 23 per cent of patients receiving methadone, mono-buprenorphine and buprenorphine-naloxone, respectively.

Practical implications

Interruptions to opioid dependence treatment in various forms can hamper the recovery of opioid-dependent patients. The benefits of MAT may not be fully realised if treatment is interrupted due to compliance failure, or inflexible treatment programmes leading to premature treatment exit. These findings serve to highlight areas in which treatment disruption can potentially be addressed.

Originality/value

Consideration of these findings may aid in the optimisation of treatment delivery practices to better meet the UK policy of recovery, and ultimately improve patient outcomes.

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