Adapting Naloxone Distribution to Reach Young Adults

NICOLE WAGNER, PhD
University of Colorado School of Medicine

Take home naloxone (THN) programs have been shown to effectively reverse opioid overdose events with limited adverse events, yet often miss young adults who misuse opioids. Strategies to adapt naloxone distribution programs to reach young adults are needed. Public health vending machines (PHVM), shown to increase access to syringes in young adults in Europe, is an emerging, community-initiated naloxone distribution adaptation in the United States (U.S.). However, little is currently known about U.S. young adults’ perspectives of PHVMs and how they may contribute to naloxone uptake. We conducted interviews with young adults who had misused opioids exploring perceived factors contributing to naloxone uptake under current THN, ideal and PHVMs.

We interviewed 16 young adults receiving substance treatment services within an integrated safety net healthcare system in Colorado. Participants were 18-30 years of age and had witnessed or experienced an opioid overdose, or used nonmedical opioids in the last 4 months.

We used directed content analysis guiding all aspects of the study. We developed interview guides based on Practical, Robust Implementation and Sustainability Model (PRISM). We transcribed interviews and coded by team-based methods. Themes were developed using an inductive-deductive iterative approach and defined through consensus.

Participants reported limited experience with current THN programs. Treatment was often the first exposure to naloxone. Participants ideal naloxone distribution strategies focused on convenience such as mail distribution and routine distribution in primary care. There was overall positive feedback on PHVMs. Three key themes were identified to improve naloxone uptake: knowledge, convenience, and privacy. Participants identified safety, lack of police presence, and low costs as important vending machine features.

Our results suggest providing anonymous and convenient access points to naloxone in the community will increase naloxone uptake. PHVMs may present an opportunity to increase uptake if features of the physical location and access strategies are considered.