Data_Sheet_1_Characteristics of and Experience Among People Who Use Take-Home Naloxone in Skåne County, Sweden.PDF

BackgroundOpioid overdose related injury or death can be prevented by bystander naloxone administration. For naloxone to be present when and where overdoses occur, opioid prevention education and naloxone distribution (OPEND) must be established on a broad level. This is the 30-month follow-up of the first multi-site naloxone project in Sweden, implemented at 31 sites in the County of Skåne 2018.
AimTo address participant characteristics and factors associated with returning for naloxone refill and with having used naloxone for overdose reversal. An additional aim was to describe self-reported reasons for naloxone refill and overdose experiences.
MethodsData were collected during June 2018—December 2020 through questionnaires at baseline and upon naloxone refill of the initial and subsequent naloxone kit. Descriptive statistics was used to address participant characteristics, those returning for naloxone refill and reporting overdose reversal. Chi-2 test was used for variable comparison between groups. Factors associated with overdose reversals were examined by logistic regression analysis. Reasons for naloxone refill, overdose situation and management were presented descriptively.
ResultsAmong 1,079 study participants, 22% (n = 235) returned for naloxone refill, of which 60% (n = 140) reported a total of 229 overdose reversals. Reversals were more likely to be reported by participants trained at needle exchange programs (NEPs) [adjusted odds ratio (AOR) = 5.18, 95% Confidence interval (CI) = 3.38–7.95)], with previous experience of own (AOR = 1.63, 95% CI = 1.03–2.58) or witnessed (AOR = 2.12, 95% CI = 1.05–4.29) overdose, or who had used sedatives during the last 30 days before initial training (AOR = 1.56, 95% CI = 1.04–2.33). A majority of overdoses reportedly occurred in private settings (62%), where the victim was a friend (35%) or acquaintance (31%) of the rescuer.
ConclusionParticipants with own risk factors associated with overdose (e.g., injection use, concomitant use of benzodiazepines and previous experience of own overdose) were more likely to report administering naloxone for overdose reversal. Overdose management knowledge was high. The findings indicate that implementation of multi-site OPEND reaches individuals at particularly high risk of own overdose in settings with limited previous harm reduction strategies and favors a further scaling up of naloxone programs in similar settings.

背景：阿片类药物过量相关损伤或死亡可通过旁观者给予纳洛酮（naloxone）得以预防。若要在过量事件发生的时间与地点配备纳洛酮，需在广泛层面建立阿片类药物预防教育与纳洛酮分发（opioid prevention education and naloxone distribution，简称OPEND）项目。本研究为瑞典首个多站点纳洛酮项目的30个月随访研究，该项目于2018年在斯科讷县（County of Skåne）的31个站点开展。

研究目的：本研究旨在探讨参与者的特征，以及与复取纳洛酮补充装、曾使用纳洛酮逆转过量事件相关的影响因素。附加研究目的为描述参与者自述的纳洛酮补充需求原因与过量事件经历。

研究方法：研究数据于2018年6月至2020年12月期间收集，方式为在基线时以及首次及后续纳洛酮试剂盒补充时发放问卷。采用描述性统计分析参与者特征、复取纳洛酮补充装的人群以及报告曾逆转过量事件的人群特征。组间变量比较采用卡方（Chi-2）检验。采用逻辑回归分析探讨与过量事件逆转相关的影响因素。对纳洛酮补充原因、过量事件场景与处置方式进行描述性呈现。

研究结果：在1079名研究参与者中，22%（n=235）复取了纳洛酮补充装，其中60%（n=140）报告共发生229次过量事件逆转。在针具交换项目（needle exchange programs，NEPs）接受培训的参与者更有可能报告曾实施过量逆转[调整后比值比（adjusted odds ratio，AOR）=5.18，95%置信区间（confidence interval，CI）=3.38~7.95]；有自身过量经历（AOR=1.63，95%CI=1.03~2.58）或目击他人过量经历（AOR=2.12，95%CI=1.05~4.29）的参与者，以及在首次培训前30天内曾使用镇静剂的参与者（AOR=1.56，95%CI=1.04~2.33），同样更有可能报告实施过量逆转。据报告，大部分过量事件发生在私人场景（62%），受害者为施救者的朋友（35%）或熟人（31%）。

结论：存在与过量风险相关的自身危险因素（如注射吸毒、与苯二氮䓬类药物联合使用、曾有自身过量经历）的参与者，更有可能报告曾使用纳洛酮逆转过量事件。参与者对过量处置的知晓度较高。研究结果表明，多站点OPEND项目可覆盖那些此前减少伤害策略有限、自身过量风险尤其高的人群，支持在类似场景中进一步扩大纳洛酮项目的规模。