Nobody Wants to Be Narcan'd: A Pilot Qualitative Analysis of Drug Users' Perspectives on Naloxone

Jeffrey T. Lai, MD; Charlotte E. Goldfine, MD; Brittany P. Chapman, BSc; Melissa M. Taylor, BA; Rochelle K. Rosen, PhD; Stephanie P. Carreiro, MD; Kavita M. Babu, MD

Disclosures

Western J Emerg Med. 2021;22(2):339-345. 

In This Article

Methods

Study Design and Setting

This pilot study was part of a larger multisite effort by the NDEWS workgroup to validate a qualitative interview agenda regarding knowledge and perceptions of bystander naloxone among PWUD. During the trial period (March–April 2019), we enrolled a convenience sample of 10 adult patients who presented to the University of Massachusetts Memorial Medical Center emergency department (ED) with an opioid-related chief complaint (eg, drug overdose, cutaneous abscess, etc) and history of non-medical opioid use. Among the three sites in the study, ours was distinct in that we focused on individuals who presented for evaluation in the emergency care setting rather than in an outpatient clinic. This protocol was approved by the University of Massachusetts Medical School Institutional Review Board. A Certificate of Confidentiality was obtained to provide an additional layer of participant protection.

Selection of Participants

Study investigators screened the electronic health record ED tracking board for individuals meeting inclusion criteria and approached them once they were deemed medically stable by the provider overseeing their clinical care. Eligible participants were 18–65 years of age, had presented to the ED with an opioid-related chief complaint, had a history of non-medical opioid use, were English-speaking, and were able to provide informed consent. Individuals were excluded if they had previously participated in this study or were in police custody. A study investigator obtained verbal informed consent from participants, who were brought to a private room in the ED for the duration of the interview. Participants were compensated for their time with a $10 gift card to a local retail store.

Interventions

Two investigators were present during study interviews, with one taking the lead role as facilitator and the other functioning as a notetaker. Investigators administered a brief questionnaire regarding demographic characteristics, as well as a semi-structured interview developed by the NDEWS workgroup, which contained open-ended questions regarding naloxone. A written agenda was used to guide each interview, ensuring that the same key questions were asked of all participants. This allowed each individual to answer in his/her own words, and to describe relevant experiences. The agenda included questions about access to, knowledge of, attitudes about, and experiences with naloxone, as well as each participant's prior history of drug overdose. Participants were asked to respond based on their own thoughts and experiences, as well as provide insight on their perceptions of what other people who use opioids think about naloxone, and whether the availability of naloxone has changed how other users conceptualize drug use.

Analysis

We tabulated and entered demographic data into Research Electronic Data Capture (REDCap), a secure web-based application for building and managing online surveys and databases.[9,10] Semi-structured interviews were audio-recorded on a digital voice recorder and transcribed by trained study staff or by a transcription service compliant with the Health Insurance Portability and Accountability Act. Study staff reviewed each transcription to ensure accuracy and to deidentify qualitative data.

Two researchers (BC and MT) independently coded the first two transcripts, creating deductive codes based on questions in the semi-structured qualitative agenda and inductive codes for emergent topics raised by participants. The initial codes were reviewed by the research team, resulting in a preliminary thematic coding scheme. This framework was applied to all transcripts, which were independently coded by both researchers (BC and MT). New codes were created as needed when adjustments were made to accommodate topics in subsequently coded transcripts, which were then retroactively applied to initially coded transcripts as well. Upon completion of independent coding, both researchers met to review differences in coding, which were discussed and refined until agreement between the researchers was reached. After five interviews no further changes were made to the codes. We entered the agreed-upon codes into NVivo 12 Plus (QSR International, Burlington, MA) to complete the thematic analysis, and then reviewed them in aggregate to create summaries of key topic areas.

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