Understanding preferences for type of take-home naloxone device: international qualitative analysis of the views of people who use opioids

Abstract

Background

Take-home naloxone (THN) is provided to non-medically trained people to reverse potential opioid overdoses. There is an increasing range of effective intramuscular (IM) and intranasal (IN) naloxone devices and this paper explores the types preferred by people who use opioids, using consumer behaviour literature to interpret the findings.

Methods

Data derive from two unconnected qualitative studies involving audio-recorded semi-structured interviews. Study 1 was conducted in the United States (n = 21 users of non-medical/illicit opioids). Study 2 was conducted in Australia (n = 42 users of non-medical/illicit or prescribed opioids).

Findings

Most participants preferred IN naloxone. Preferences were based on the ease, speed, safety and comfort of each device and underpinned by accounts of overdose revivals as being very rushed and frightening situations. Preferences related to complex interactions between the naloxone device (‘product’); the knowledge, skills, experience and attitudes of the lay responder (‘consumer’), and when, where and how naloxone was to be used (‘usage situation’).

Conclusions

THN programs should offer choice of device when possible and nasal naloxone if resources permit. Asking people which devices they prefer and why and treating them as valued consumers of naloxone products can generate insights that improve future naloxone technology and increase THN uptake and usage.

Keywords:

• Consumer behaviour
• iterative categorization
• naloxone
• overdose
• qualitative
• usage situation

Acknowledgements

The authors would like to express their thanks to the participants who gave so generously of their time, insights and experiences. The US interviews were conducted by Aimee Campbell, Jermaine Jones and Verena Metz, and data coding was undertaken by Caral Brown with input from other team members. The Australian team also thank the expert advisory panel guiding aspects of the research. The Australian interviews were conducted by Adrian Farrugia, Renae Fomiatti, and Jeanne Ellard.

Disclosure statement

In the last three years, J.N. has received, through her university, research funding from Mundipharma Research Ltd (for an on-going study of naloxone) and Camurus AB (for unrelated research). In the last three years, P.D. has received investigator-driven funding from Gilead Sciences and an untied educational grant from Indivior unrelated to this study. PD has also served as an unpaid member of an Advisory Board for an intranasal naloxone product. In the last three years, J.D.J. has received compensation - in the form of partial salary support - from a study partially supported by Cerecor Inc., is the recipient of an investigator-initiated grant from Merck Pharmaceuticals, and has served as a consultant for Alkermes. In the last three years, S.D.C. has received research funding from Alkermes, Braeburn Pharmaceuticals, Cerecor Inc., Corbus, Go Medical, Intra-cellular Therapies, and Lyndra. Dr. Comer has also consulted for: Alkermes, Charleston Labs, Clinilabs, Collegium, Depomed, Epiodyne, Mallinckrodt, Nektar, Newron, Opiant, Otsuka, and Sun Pharma. She has additionally received honoraria from the World Health Organization. J.S. has received, through his university, research grant support and his university has received consultancy payments from government and grant-awarding bodies as well as from pharmaceutical companies (including, last 3 years, Indivior, MundiPharma, Camurus, Molteni Farma) and trial medication supply from iGen and Braeburn. JS has also discussed, with various companies, potential medications and technologies which might be applicable in the treatment of addictions and related problems including potential novel non-injectable naloxone. For updated information see John Strang’s info on his Departmental website at: http://www.kcl.ac.uk/ioppn/depts/addictions/people/hod.aspx. A.F., A.N.C., R.D., R.F. and S.F. have no declarations of interest to report.

Data availability statement

Neither data set is publicly available. Contact the first author for further information on the US data and the corresponding author for further information on the Australian data.

Notes

1 After August 2017, trial participants were no longer offered the improvised IN device. Instead they were invited to choose between the IM device and one of the newly available purpose-designed, one-step, concentrated nasal sprays (4mg/0.1ml provided in a twin-pack, marketed as ‘Narcan® Nasal Spray’). Participants receiving the purpose-designed spray are not included in the analyses presented as only a small number participated in a qualitative interview and their accounts of choosing between the IM and the new IN device could not be compared meaningfully with the majority of participants who chose between the IM and the improvised IN device.

2 Although it is important to note that IM naloxone can, in fact, be administered through clothing.

3 In terms of safety, we note that a nasal device that can be administered quickly and with minimal physical contact is likely to have added advantages over other devices in the context of the recent global COVID-19 pandemic.

Additional information

Funding

The randomized controlled trial (“Risks and benefits of overdose education and naloxone prescribing to heroin users”) was funded by the National Institute on Drug Abuse (NIDA) [R01DA035207; Comer – Principal Investigator]. The Australian research was supported by an Australian Research Council (ARC) Discovery Project grant [DP170101669; Fraser – Principal Investigator]. The ARC project has been based in two institutions over time: The National Drug Research Institute, Curtin University, and The Australian Research Centre in Sex, Health and Society, La Trobe University. The National Drug Research Institute is supported by core funding from the Australian Government under the Drug and Alcohol Program and also receives significant funding from Curtin University. J.N. is part-funded by, and J.S. is supported by, the NIHR (National Institute for Health Research) Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, UK. P.D. is funded by a National Health and Medical Research Council (NHMRC) Senior Research Fellowship [#1136908]. The views expressed are those of the authors and not necessarily those of NIDA, the ARC, the NIHR, the NHS, the Department of Health, or the NHMRC.