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


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

In This Article


The limitations of this pilot study include a small sample size (n = 10) and the fact that it was conducted in a single community where several groups were over-represented (eg, male, White, prior naloxone resuscitation, prior treatment for OUD). Although our study population was fairly homogenous and not representative of PWUD on a national scale, it is a typical sample for PWUD in our region in terms of demographics and experience with drug use. We did not appreciate a difference in characteristics between approached vs enrolled patients. Nevertheless, this may detract from generalizability to other settings where the demographics may differ and individuals may have cultural differences or less familiarity with opioid use, opioid antagonists, and treatment modalities for OUD.

That our study was conducted in an urban ED at the epicenter of the North American opioid epidemic likely does skew our study population to favor individuals with more experience and health literacy surrounding their substance use disorder, as evidenced by a majority having previously received naloxone for overdose reversal and treatment for OUD. Furthermore, our state government's progressive response to the opioid epidemic likely enhances our PWUD population's familiarity with naloxone. Additionally, although all study staff are trained in qualitative interview techniques, inadvertent use of leading questions could have led to interviewer bias.

Since the data were analyzed by the qualitative interviewers, there was no ability to blind the coders. This could have resulted in bias when assigning the thematic codes, which is why two independent reviewers coded the data and analysis was reviewed by all researchers. Moreover, we were unable to administer the interview in languages other than English, resulting in the exclusion of several individuals who were otherwise eligible for participation. Finally, our study used self-report of an illegal and stigmatized behavior, rather than direct observations of how naloxone availability affected drug use behaviors; the results may therefore be influenced by recall bias and social desirability bias. These factors limit the generalizability of our findings to other demographic groups and locales.