Factors Associated with Non-Evidence-Based Overdose Responses among People Who Use Prescription Opioids Non-Medically in Rural Appalachia

Abstract

Background: Opioid-related overdose deaths recently accelerated. In response, overdose education and naloxone distribution (OEND) has been implemented widely, though access remains sparse in rural Appalachia. Despite increasing OEND, risk factors for non-evidence-based overdose responses among the training-naïve remain unknown. Methods: We enrolled 169 adults who use prescription opioids non-medically and reside in rural West Virginia (August 2014-March 2015). Participants were interviewed about witnessing overdose (lifetime and prior-year), characteristics of the most recent overdose, responses to the overdose, and OEND acceptability. Logistic regression was used to assess factors associated with non-evidence-based responses to overdose. Results: Among the 73 participants who witnessed an opioid-related overdose, the majority (n = 53, 73%) reported any non-evidence-based responses. Participants were significantly more likely to report a non-evidence-based response when victims were unresponsive (OR = 3.36; 95% CI = 1.07, 10.58). Common evidence-based responses included staying with the victim until help arrived (n = 66, 90%) and calling 911 (n = 63, 86%), while the most common non-evidence-based responses were hitting or slapping the victim (n = 37, 51%) and rubbing the victim with ice or placing them in a cold shower or bath (n = 14, 19%). While most (n = 60, 82%) had never heard of OEND, the majority (n = 69, 95%) were willing to train, particularly those reporting non-evidence-based responses (n = 52, 98%). Conclusions: These findings underscore the need to expand access to OEND in rural communities and indicate OEND is acceptable to training-naïve individuals who use opioids in rural Appalachia. Given the “harm reduction deserts” in the region, approaches to expand OEND should be pursued.

Keywords:

• Opioids
• overdose prevention
• rural
• Appalachia

Acknowledgments

The authors would like to thank the participants in this study for sharing their time and experiences with us, as well as our project interviewers, researchers, and staff. We would also like to give special thanks to Brandon Rhodes for his tireless assistance in participant recruitment.

Author contributions

KKG, HIL, and AM made significant contributions to the study design and conduct, and KKG secured funding. KKG and AM developed the research question and drafted the analysis plan. AM conducted the analyses and was the lead writer. All authors contributed to the interpretation of the data, and KKG, HIL, GSS, and JF critically revised the manuscript. All authors approved the final manuscript for publication.

Disclosure statement

The authors declare that they have no conflicts of interest. The views and opinions outlined herein are those of the authors and do not necessarily reflect those of any affiliate institutions or funding agencies.

Ethics approval

The Institutional Review Board at West Virginia University reviewed and approved this study.

Data availability statement

The data collection instruments and datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

This pilot study was supported by a grant from the National Institute of General Medical Sciences of the National Institutes of Health (5U54GM104942-05), and AM was supported by a grant from the National Institute on Drug Abuse (F31-DA052971-01). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The sponsors had no role in the study design; the collection, analysis and interpretation of data; the writing of the report; or in the decision to submit the article for publication.