Barriers to and recommendations for take-home naloxone distribution: perspectives from opioid treatment programs in New Mexico

Julie G Salvador; Andrew L Sussman; Mikiko Y Takeda; William G Katzman; Monica Moya Balasch; Joanna G Katzman

doi:10.1186/s12954-020-00375-2

Barriers to and recommendations for take-home naloxone distribution: perspectives from opioid treatment programs in New Mexico

Harm Reduct J. 2020 May 13;17(1):31. doi: 10.1186/s12954-020-00375-2.

Authors

Julie G Salvador¹, Andrew L Sussman², Mikiko Y Takeda³, William G Katzman⁴, Monica Moya Balasch⁵, Joanna G Katzman⁵

Affiliations

¹ Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, MSC09 5030 1UNM, Albuquerque, NM, 87131-0001, USA. jgsalvador@salud.unm.edu.
² Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, USA.
³ Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, University of New Mexico, Albuquerque, USA.
⁴ University of Michigan, Ann Arbor, USA.
⁵ Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, USA.

Abstract

Background: Naloxone is a safe and effective medication to help reverse opioid overdose. Providing take-home naloxone to patients in opioid treatment settings is a critical step to reducing opioid overdose deaths. In New Mexico, a US state with one of the highest rates of opioid overdose deaths, legislation was passed in 2017 (House Bill 370) to support take-home naloxone, and followed by naloxone training of Opioid Treatment Program staff to increase distribution.

Methods: Naloxone training was offered to all New Mexico Opioid Treatment Programs along with a baseline survey to assess current practices and barriers to take-home naloxone distribution. Focus groups were conducted approximately 1 year post-training with staff at a subset of the trained Opioid Treatment Programs to assess the impact of the legislation and training provided.

Results: Baseline survey results show most Opioid Treatment Program staff were unfamiliar with House Bill 370, reported conflicting understandings of their agency's current take-home naloxone practices, and reported a number of barriers at the patient, agency, and policy level. Follow-up focus groups revealed support for House Bill 370 but persistent barriers to its implementation at the patient, agency, and policy level including patient receptivity, cost of naloxone, staff time, and prohibitive pharmacy board regulations.

Conclusions: In spite of targeted legislation and training, provision of take-home naloxone at remained low. This is alarming given the need for this lifesaving medication among the Opioid Treatment Program patient population, and high opioid death rate in New Mexico. Locally, important next steps include clarifying regulatory guidelines and supporting policy/billing changes to offset costs to Opioid Treatment Programs. Globally, additional research is needed to identify the prevalence of take-home naloxone distribution in similar settings, common barriers, and best practices that can be shared to increase access to this vital lifesaving medication in this critical context.

Keywords: Drug policy; Opioid overdose; Opioid treatment programs; Take-home naloxone.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Drug Overdose / prevention & control*
Female
Health Services Accessibility / statistics & numerical data*
Humans
Male
Naloxone / therapeutic use*
Narcotic Antagonists / therapeutic use*
New Mexico
Opioid-Related Disorders / complications*
Program Evaluation / methods*

Substances

Narcotic Antagonists
Naloxone