Naloxone possession and carriage among people who use opioids in NYC: The impact of person-level and time-varying contextual factors

Author: Kathleen Ward, Devon Hensel, Luther Elliott, Alexander Bennett, Alexis Roth

Theme: Epidemiology & Public Health Research Year: 2023

Naloxone distribution is critical for preventing opioid overdose deaths. However, there is limited research examining the impact of time-varying factors on possessing and carrying naloxone; two behaviors essential for opioid overdose reversal. Data collection using ecological momentary assessment (EMA) can address this gap by frequently assessing behaviors and attitudes, thus improving ecological validity.

We analyzed 3,180 weekly electronic EMAs collected from 40 people who use illicit opioids (PWUO) in New York City between May 2019-May 2022. The EMA assessed mood, drug use, and overdose prevention-related behaviors once a week for 24 months. Descriptive statistics were used to assess the frequency of consistent (“all the time” in the past 7 days) naloxone possession or carriage. Mixed effects binary and multivariable logistic regression was used to test for the impact of time-varying EMA- and baseline-level predictors on each outcome.

Naloxone possession or carriage was reported in 70% of EMAs, with an average of 76 (SD=35.6) EMAs submitted per person. In multivariable models, being in COVID-19 (after 3/12/2020; Odds Ratio (OR)=10.25, 95% Confidence Interval (CI)=3.39-30.98), being female (OR=13.42, CI=2.93-61.39), being White (OR=11.04, CI=2.25-54.14) and lifetime overdose (OR=5.96, CI=1.32-26.82) were associated with higher odds of consistent possession. Being in COVID-19 (OR=4.39, CI=2.04-9.45), recent opioid injection (OR= 3.74, CI=1.40-10.21) being female (OR=17.71, CI=3.98-78.77) and being White (OR=5.85, CI=1.35-25.29) were associated with higher odds of consistent carriage. The most common reasons for inconsistent possession and carriage were forgetting to refill after use (29%) and forgetting to bring it along (40%), respectively.

Our findings suggest consistent naloxone possession and carriage during COVID-19, particularly among women. To improve naloxone possession and carriage in the US, more outreach to Black and Hispanic/Latinx men is crucial. Findings also highlight the importance of using EMA to identify situations when PWUO may need prompt naloxone refills (e.g., after a recent injection event).

Download abstract Download poster