(115) Substance Use Disorder Patient Experience with “Leave Behind Naloxone” in the Community

Background & Introduction: Opioid overdoses remain a major public health crisis, claiming 82,000 lives in 2022 alone (CDC Overdose 2024). Naloxone, also known as Narcan, is an opioid antagonist that has been shown to significantly reduce overdose mortality and effectively reverse the effects of opioid intoxication (Pitt et al., 2018). Recognizing the life-saving potential of this medication, extensive efforts have been made to distribute naloxone widely. In 2021, New Jersey introduced the Naloxone Distribution Program, providing free naloxone to emergency medical responders to give to the public and encouraging the dissemination of opioid prevention information (State of New Jersey Department of Health, 2021).

Despite these efforts, questions remain about how naloxone is used in real-world scenarios, particularly in community settings. The Leave Behind Naloxone intervention, which equips individuals with naloxone post-overdose, is a key initiative aimed at empowering communities to respond to overdoses (Scharf et al., 2021). Our pilot study aimed to evaluate the effectiveness of this intervention by surveying patients about their experiences with naloxone, focusing on community-level responses to overdoses.

Methods: Participants were recruited from a low-barrier office-based opioid treatment center. Patients in the clinic waiting area were approached by study staff and invited to complete a brief survey about their experiences with Narcan.

The survey was developed to address a noticeable gap in the literature concerning patient experiences with leave-behind naloxone programs and its use in community settings. Existing studies have primarily focused on naloxone distribution and overall effectiveness but have rarely explored how individuals interact with and perceive naloxone after it is provided through these programs. To fill this gap, the survey was designed by EMS and toxicology physicians as a structured tool that captures critical insights into patient experiences with leave-behind naloxone.

The survey, which took approximately 10 minutes to complete, collected data on participant demographics, education about Narcan, prior administration, perceived effectiveness, and barriers to use. Participants had the option to complete the survey independently or with assistance from study staff if needed.

Descriptive statistics were conducted to summarize demographic information and participant responses. Additionally, Pearson Chi-Square tests were used to examine relationships between key variables, such as participant knowledge of opioid overdose signs, likelihood of recommending naloxone, and experiences with observing naloxone administration by non-healthcare providers.

Results: A total of 52 participants completed the survey. The average age of respondents was 41.2 years (SD=11.36). The sample included 30 male participants (57.7%) and 22 female participants (42.3%). Majority of participants identified as White/Caucasian (59.6%), followed by Black/African American (23.1%). Other racial and ethnic groups included Hispanic (7.7%), American Indian/Alaskan Native (3.8%), and individuals identifying with multiple ethnicities (3.8%).

Among the respondents, 59.6% reported that they or a family member had received naloxone from a first responder, with 28.8% personally receiving it once and 9.6% receiving it more than three times. Over half (55.8%) reported having used naloxone nasal spray on others, and 53.2% of those described it as very effective in reversing an overdose.

Confidence in using naloxone was high, with 63.5% feeling "very confident," and ease of use was similarly positive, as 58.3% rated it "very easy" to use. Additionally, 75.1% reported that instructions on how to use Naloxone provided by first responders were explained "very well”.

A majority (71.4%) felt that having naloxone available provided "definite" peace of mind, and 84.6% were "very likely" to recommend its availability. However, 9.6% experienced barriers to accessing additional naloxone, primarily citing a lack of knowledge on where to obtain it (15.4%).

Community involvement was reflected in the findings, with 48% of participants reporting that they had observed non-healthcare providers administer naloxone, and 51% indicating that they had received naloxone from a family member or member of the public. Finally, 88.5% of participants supported the wider public availability of naloxone, reflecting overall satisfaction with the Leave Behind Naloxone program (68.8% "very satisfied").

Participants who observed a non-healthcare provider administer naloxone were more likely to feel knowledgeable about opioid overdose signs, χ² (6, N=48) = 13.51, p = .036. A significant relationship was also found between participants’ knowledge of opioid overdose signs and their likelihood of recommending naloxone, χ² (9, N=50) = 26.98, p = .001. Specifically, those who felt "very knowledgeable" about overdose signs were more likely to recommend naloxone. Similarly, confidence in using naloxone nasal spray was a key factor, χ² (9, N=52) = 48.96, p < .001. Of those who were "very confident," 97% were "very likely" to recommend naloxone, compared to 75% of those who were "not at all confident."

Conclusion & Discussion: This study highlights the role of non-healthcare providers in managing opioid overdoses, as evidenced by the significant association between observing naloxone administration by non-healthcare providers and increased knowledge of overdose signs. This suggests that community-level responses are a critical component of overdose intervention. Participants who felt knowledgeable and confident in using naloxone were also more likely to recommend its use, emphasizing the importance of public health initiatives in building capacity for overdose responses.

However, these findings raise concerns about whether emergency medical services (EMS) are being engaged during overdose situations. As individuals gain confidence and knowledge, they may feel capable of managing overdoses without calling 911, potentially leading to gaps in care. Patients revived with naloxone may also refuse transport to the emergency department, limiting access to follow-up care. Given naloxone’s temporary effects, refusing EMS intervention increases the risk of re-overdose and preventable harm.

These findings underscore the need for future research to investigate factors influencing 911-calling behavior, including stigma, legal concerns, and perceived self-sufficiency. A limitation of this study is its small sample size, which may restrict generalizability. Future studies should include larger populations to validate these findings and improve overdose response strategies by integrating community and EMS involvement.

References: CDC. (2024, November 1). Understanding the Opioid Overdose Epidemic. Overdose Prevention. https://www.cdc.gov/overdose-prevention/about/understanding-the-opioid-overdose-epidemic.html

Pitt, A. L., Humphreys, K., & Brandeau, M. L. (2018). Modeling Health Benefits and Harms of Public Policy Responses to the US Opioid Epidemic. American journal of public health, 108(10), 1394-1400. https://doi.org/10.2105/AJPH.2018.304590

Scharf, B. M., Sabat, D. J., Brothers, J. M., Margolis, A. M., & Levy, M. J. (2021). Best Practices for a Novel EMS-Based Naloxone Leave behind Program. Prehospital Emergency Care, 25(3), 418–426. https://doi.org/10.1080/10903127.2020.1771490

State of New Jersey Department of Health. (2021, August 31). Standing Order to Distribute Opioid Antidote for Overdose Prevention Control No. 2021-02. https://www.nj.gov/governor/news/news/562021/docs/DOHS0202102.pdf