Take-home naloxone crucial but broader changes needed too: findings from ARC project

2019 workshop at the Australasian Professional Society on Alcohol and other Drugs (APSAD) conference: Tuesday 12 November, Grand Chancellor, Hobart, Tasmania.

In early 2017 members of the SSAC team began work on an ARC Discovery project on take-home naloxone uptake in Australia. Entitled Understanding the impediments to uptake and diffusion of take-home naloxone in Australia, this project investigates the social and material arrangements that shape take-home naloxone uptake and experiences of responding to opioid overdose. As the year draws to a close, we are excited to be presenting the findings of this project in a workshop at the upcoming 2019 APSAD conference.

Workshop – Understanding the impediments to uptake and diffusion of take-home naloxone in Australia: Findings from a large national qualitative study

The workshop will include presentations from members of our research team: Dr Adrian Farrugia, Professor Suzanne Fraser, Professor Paul Dietze, Dr Robyn Dwyer, Professor Joanne Neale and Ms Nyssa Ferguson. It will also be followed by the launch of our forthcoming website on overdose and take-home naloxone: http://www.overdoselifesavers.org

The team will present findings from two studies aiming to identify impediments to uptake. The workshop will also contextualise these findings in relation to a third study exploring the implementation of an overdose education initiative in New York City, US.

Project 1, our ARC Discovery project, conducted 83 interviews with people who consume opioids and health professionals in Australia. Project 2, conducted by SSAC PhD Student Nyssa Ferguson, entailed ethnographic observations of 24 overdose response training events and 12 interviews with training participants in Victoria, Australia. Project 3 conducted by our international collaborator Professor Joanne Neale (King’s College, London) entailed 39 interviews with participants of overdose response training in New York City, US.

Together these projects identified eight impediments to uptake (i) unsupportive familial and peer relationships; (ii) past negative experiences of naloxone revival; (iii) little or no knowledge of take-home naloxone in some groups; (iv) distressing memories of overdose prompted by overdose response training; (v) organisational hurdles that impede implementation of take-home naloxone initiatives; (vi) limited awareness among professionals outside specialist alcohol and other drug (AOD) services; (vii) complex forms of drug use stigma, including the effects of legal prohibition; and (viii) many social and interpersonal obstacles beyond the control of consumers.

Importantly, our research suggests that while people who consume opioids and relevant health professionals view take-home naloxone as necessary and effective, they also say it needs to be supported by broader social, institutional and legal shifts aimed at reducing overdose deaths. Indeed, without broader reforms, the capacity of this initiative to save lives can be stifled.

We look forward to presenting implications for take-home naloxone practice and policy in Australia. This part of the workshop will include discussion of the need for (i) a broader range of naloxone devices to be made available; (ii) increased support for healthcare services to implement take-home naloxone initiatives and; (iii) increased professional development on it. In addition, our data indicate that initiatives are urgently needed to de-stigmatise opioid overdose. This workshop will present the draft recommendations from our ARC Discovery project and facilitate a discussion on ways of, and issues in, implementing the findings in practice.

Project coordinator Dr Adrian Farrugia explains why the 2019 APSAD workshop is important to the SSAC team:

Workshops are a great way to explore the implications of research with a diverse group of people with a stake in the outcomes, and really nut out how they could shape policy and practice. It’s also a great opportunity to discuss some of the broader initiatives needed to facilitate take-home naloxone uptake, and perhaps, reduce the need for it overall.

SSAC team: Dr Adrian Farrugia, Ms Renae Fomiatti, Professor Suzanne Fraser

The project has already produced a range of scholarly and public presentations. Key publications so far are:

Fomiatti, R., Farrugia, A., Dwyer, R., Fraser, S., Neale, J. & Strang, J. Addiction stigma and the production of impediments to uptake of take-home naloxone. Under review at Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine.

Farrugia, A. Commentary on Elliot et al. (2019): How stigma shapes overdose revival and possible avenues to disrupt it (invited commentary). Addiction, 114 (8), 1387-1388.

Farrugia, A., Neale, J., Dwyer, R., Fomiatti, R., Fraser, S., Strang, J. & Dietze, P. (2019). Conflict and communication: Managing the multiple affordances of take-home naloxone administration events in Australia. Addiction Research & Theory (early online).

Farrugia, A., Fraser, S., Dwyer, R., Fomiatti, R., Neale, J., Dietze, P. & Strang, J. (2019). Take-home naloxone and the politics of care. Sociology of Health and Illness, 41 (2), 427-443.

Fraser, S., Farrugia, A. & Dwyer, R. (2018). Grievable lives? Death by opioid overdose in Australian newspaper coverage. International Journal of Drug Policy, 59, 28-35.

Farrugia, A., Fraser, S. & Dwyer, R. (2017). Assembling the social and political dimensions of take-home naloxone. Contemporary Drug Problems, 44 (3), 163-175.