Take-Home Naloxone and risk management from the perspective of people who survived an opioid overdose in Stockholm - An analysis informed by drug, set and setting

E Holmén; A Hammarberg; M Kåberg; J Storbjörk

doi:10.1016/j.drugpo.2023.104021

Take-Home Naloxone and risk management from the perspective of people who survived an opioid overdose in Stockholm - An analysis informed by drug, set and setting

Int J Drug Policy. 2023 May:115:104021. doi: 10.1016/j.drugpo.2023.104021. Epub 2023 Apr 1.

Authors

E Holmén¹, A Hammarberg², M Kåberg³, J Storbjörk⁴

Affiliations

¹ Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Needle and Syringe program, Stockholm Centre for Dependency Disorders, Stockholm, Sweden. Electronic address: elin.holmen.2@ki.se.
² Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Centre for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
³ Stockholm Needle and Syringe program, Stockholm Centre for Dependency Disorders, Stockholm, Sweden; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
⁴ Department of Public Health Sciences, Stockholm University, Stockholm, Sweden.

PMID: 37011507
DOI: 10.1016/j.drugpo.2023.104021

Abstract

Background: Take-Home Naloxone (THN) programs were introduced in Sweden in 2018 - a country with one of the highest rates of overdose mortality in the EU and a severe stigmatisation of people who inject drugs. This qualitative study builds on the international research that has expanded a previously narrow and medical focus on overdose deaths. It uses Zinberg's framework to look beyond the role of the "drug" to include the attitudes and personality of the person ("set") and contextual factors ("setting"). This study explores the impacts of THN from the perspective of overdose survivors.

Methods: Between November 2021 and May 2022 semi-structured interviews were conducted with 22 opioid overdose survivors, recruited among clients of the Stockholm needle and syringe program. All the participants had been treated with naloxone in an overdose situation. The interviews were processed through thematic analysis using deductive and inductive coding in accordance with the theoretical framework.

Results: Interviewees included men and women who used different types of drugs. THN has impacted on "drug" in terms of naloxone-induced withdrawal symptoms and peers having to deal with survivors' emotions. Exploring "set" revealed feelings of shame following naloxone revival for the person who overdosed. Despite such reactions, participants retained an overwhelmingly positive attitude towards THN. Participants integrated THN into their risk management practices ("setting") and some acknowledged that THN provided a new way to treat overdoses without necessarily needing to interact with authorities, especially the police.

Conclusion: The THN program has influenced "drug, set and setting" for participants, providing increased safety at drug-intake and transferring overdose management and the burden of care to the community. The lived experience of participants also exposes the limitations of THN indicating that there are additional unmet needs beyond THN programs, particularly in terms of "setting".

Keywords: People who inject drugs; Qualitative; Sweden; Take-Home Naloxone.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Drug Overdose* / drug therapy
Female
Humans
Male
Naloxone / therapeutic use
Narcotic Antagonists / therapeutic use
Opiate Overdose* / drug therapy
Opioid-Related Disorders* / drug therapy
Peer Group

Substances

Naloxone
Narcotic Antagonists