Conflict and communication: managing the multiple affordances of take-home naloxone administration events in Australia

Abstract

Opioid overdose is a growing issue in Australia. Programs to provide opioid consumers with ‘take-home’ naloxone to reverse overdose exist internationally and in some Australian cities, but uptake remains inconsistent. As an opioid antagonist, naloxone has the capacity to stimulate distressing withdrawal symptoms. These sensations are shaped by complex factors – including the quantity and intervals of naloxone administration – and can contribute to conflict during, and immediately following, revival. This possibility of conflict is thought to negatively affect willingness to use naloxone. Researchers have not yet analysed this conflict in detail nor considered the potential positive social interactions that can occur in the context of take-home naloxone administration. We draw on interviews conducted as part of a broader Australian study of the use of take-home naloxone by people who consume opioids (or ‘peer administration’) to identify accounts of both conflict and appreciation. Additionally, we analyse the strategies people administering naloxone use to manage and avert potential conflict. Drawing on Science and Technologies Studies, we conceptualise take-home naloxone as a technology that takes shape in practice with effects that are produced through specific practices during particular administration events. Focussing primarily on titration and communication, we argue that those administering naloxone actively manage the potential for conflict during administration. We conclude that if efforts to increase the uptake of take-home naloxone highlight these strategies they have the potential to improve administration experiences and the reputation of take-home naloxone and, in the process, help challenge the stigma faced by people who consume opioids.

Keywords:

• Take-home naloxone
• opioid overdose
• Science and Technology Studies
• conflict
• communication

Acknowledgements

We express our thanks to the participants who gave so generously of their time, insights and experiences. We also thank the expert advisory panel guiding aspects of the research. This work was supported by an Australian Research Council Discovery Project grant (DP170101669). The National Drug Research Institute is supported by funding from the Australian Government under the Substance Misuse Prevention and Service Improvement Grants Fund. The interviews were conducted by Adrian Farrugia, Renae Fomiatti, and Jeanne Ellard. Thanks go also to the two anonymous reviewers and journal editorial team whose comments helped improve the article.

Disclosure statement

Joanne Neale is part-funded, and John Strang is supported, by the National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King’s College London. Neale and Strang are also supported by the Pilgrim Trust, and Strang is an NIHR Senior Investigator. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health or the Pilgrim Trust. Joanne Neale has received honoraria and research grants from pharmaceutical companies: Camurus AB and Mundipharma International Ltd. John Strang is a researcher and clinician who has worked with a range of types of treatment and rehabilitation service-providers. He has also worked with a range of governmental and non-governmental organizations, and with pharmaceutical companies to seek to identify new or improved treatments from whom he and his employer (King’s College London) have received honoraria, travel costs and/or consultancy payments. Paul Dietze has been appointed as an unpaid member of the Australian Mundipharma Advisory Board for an intranasal naloxone formulation. Paul Dietze has received investigator-driven funding from Gilead Sciences Inc. for work related to hepatitis C treatment and an untied educational grant from Indivior for work related to the introduction of buprenorphine/naloxone into Australia.

Notes

1 This background section is adapted from: Farrugia et al. (2018).

2 Take-home naloxone initiatives of various scales have been established in New South Wales, Western Australia, Victoria, Queensland and the Australian Capital Territory. Take-home naloxone initiatives are beginning to emerge in South Australia, Tasmania and the Northern Territory.

3 ‘Understanding the impediments to uptake and diffusion of take-home naloxone in Australia’ (Fraser, Dwyer, Dietze, Neale, & Strang, 2017). Australian Research Council Discovery Project DP170101669

4 To preserve anonymity, all participants’ names in this article are pseudonyms.

5 Naloxone is often referred to as Narcan®, a brand name it is sold under.