Does take-home naloxone training lead to riskier drug use?
Does providing take-home naloxone training lead to riskier drug use?
Naloxone is a lifesaving antidote to opioid overdose. Take-home naloxone (THN) programs involve providing naloxone and educating people on how to respond to an opioid overdose. They aim to increase availability of naloxone in the community, especially among people who may witness an overdose, such as peers, family and friends of people who use opioids.
Distributing THN in the community has been associated with reducing overdose deaths but some healthcare providers, and other stakeholders, have expressed concern that THN training could lead to riskier drug use. ‘Risk compensation’ occurs when someone engages in more risky behaviour (e.g., uses more opioids than usual) because they’ve taken a protective measure (e.g., having naloxone on hand). Such concerns have acted as a substantial barrier to THN implementation in some settings.
This study used self-report behavioural data before and after THN training of participants in the SuperMIX cohort, a sample of people who inject drugs in Melbourne, to assess whether they were engaging in risk compensation.
This study of people who inject drugs found that after THN training and supply there was no evidence of an increase in frequency of opioid or other injecting, or other markers of overdose risk such as benzodiazepine use or proportion of time using drugs alone.
While not all overdose risk behaviours were examined and association between knowledge of and engagement in overdose risk behaviours is complex, these findings are consistent with an emerging evidence base suggesting concerns about risk compensation with naloxone availability are unfounded.
Concerns about risk compensation should not lead to take-home naloxone (or accompanying training sessions) being withheld. Education is needed among health care practitioners and other stakeholders to address this misperception of risk compensation and thus remove this barrier to increasing access to this life-saving medication.
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Posted on: 7 Aug 2023