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1. Experiences of people who use drugs with naloxone administration: a qualitative study

   https://doi.org/10.1080/09687637.2020.1855116  

   Rochester, Eleanor; Graboyes, Melissa (January 2022, Drugs: Education, Prevention and Policy)

   The United States is in the midst of an epidemic of opioid-related overdose deaths. In response, harm reduction programs commonly distribute the opioid antagonist naloxone directly to PWUD so that they can act as first responders when an overdose occurs. Naloxone reverses respiratory depression and can save the life of a person overdosing on opioids. Little research has been conducted about the lived experiences of PWUD who use naloxone, particularly their motivations for carrying it, their experiences serving as first responders to overdoses, and how new communities of care have sprung up around the widespread use of naloxone. To better understand the lived experiences of PWUD, semi-structured interviews were conducted with seventeen syringe exchange participants who currently carry and/or have administered naloxone. In interviews, participants describe taking on the role of peer naloxone administrator as empowering, partially because it contrasts with the powerlessness they recounted in other areas of their lives. Peer administrators also use naloxone in a way that reinforces overdose care among people who use drugs. Future programs distributing naloxone to PWUD should be aware of its potential not only to save lives, but to increase participants’ self-confidence and strengthen the network of overdose care in their communities. 

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2. Closed-loop wearable naloxone injector system

   https://doi.org/10.1038/s41598-021-01990-0  

   Chan, Justin; Iyer, Vikram; Wang, Anran; Lyness, Alexander; Kooner, Preetma; Sunshine, Jacob; Gollakota, Shyamnath (November 2021, Scientific Reports)

   Abstract Overdoses from non-medical use of opioids can lead to hypoxemic/hypercarbic respiratory failure, cardiac arrest, and death when left untreated. Opioid toxicity is readily reversed with naloxone, a competitive antagonist that can restore respiration. However, there remains a critical need for technologies to administer naloxone in the event of unwitnessed overdose events. We report a closed-loop wearable injector system that measures respiration and apneic motion associated with an opioid overdose event using a pair of on-body accelerometers, and administers naloxone subcutaneously upon detection of an apnea. Our proof-of-concept system has been evaluated in two environments: (i) an approved supervised injection facility (SIF) where people self-inject opioids under medical supervision and (ii) a hospital environment where we simulate opioid-induced apneas in healthy participants. In the SIF (n= 25), our system identified breathing rate and post-injection respiratory depression accurately when compared to a respiratory belt. In the hospital, our algorithm identified simulated apneic events and successfully injected participants with 1.2 mg of naloxone. Naloxone delivery was verified by intravenous blood draw post-injection for all participants. A closed-loop naloxone injector system has the potential to complement existing evidence-based harm reduction strategies and, in the absence of bystanders, help make opioid toxicity events functionally witnessed and in turn more likely to be successfully resuscitated. 

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3. Opioid overdose detection using smartphones

   https://doi.org/10.1126/scitranslmed.aau8914  

   Nandakumar, Rajalakshmi; Gollakota, Shyamnath; Sunshine, Jacob E. (January 2019, Science Translational Medicine)

   Early detection and rapid intervention can prevent death from opioid overdose. At high doses, opioids (particularly fentanyl) can cause rapid cessation of breathing (apnea), hypoxemic/hypercarbic respiratory failure, and death, the physiologic sequence by which people commonly succumb from unintentional opioid overdose. We present algorithms that run on smartphones and unobtrusively detect opioid overdose events and their precursors. Our proof-of- concept contactless system converts the phone into a short-range active sonar using frequency shifts to identify respiratory depression, apnea, and gross motor movements associated with acute opioid toxicity. We develop algorithms and perform testing in two environments: (i) an approved supervised injection facility (SIF), where people self-inject illicit opioids, and (ii) the operating room (OR), where we simulate rapid, opioid-induced overdose events using routine induction of general anesthesia. In the SIF ( n = 209), our system identified postinjection, opioid-induced central apnea with 96% sensitivity and 98% specificity and identified respiratory depression with 87% sensitivity and 89% specificity. These two key events commonly precede fatal opioid overdose. In the OR, our algorithm identified 19 of 20 simulated overdose events. Given the reliable reversibility of acute opioid toxicity, smartphone-enabled overdose detection coupled with the ability to alert naloxone-equipped friends and family or emergency medical services (EMS) could hold potential as a low-barrier, harm reduction intervention. 

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4. Championing awareness of the opioid epidemic through a service-learning module for non-STEM biology majors

   https://doi.org/10.3389/feduc.2023.1155659  

   Fleming, Ryleigh; Adkins, Sarah J.; Esteban, Marco; Cross, Cinnamin; Chatham, Amy Hutson; Raut, Samiksha A. (December 2023, Frontiers in Education)

   Over 50,000 people die annually from opioid overdoses in the United States leading to what has become known as the “opioid epidemic.” This is of heightened concern in states like Alabama that experience higher rates of overall drug use and overdose deaths. Thus, it is increasingly important for college students in Alabama to learn about how the opioid epidemic is affecting their communities. Previous studies have demonstrated that engaging non-majors in innovative active-learning oriented pedagogies like service-learning can enhance their understanding and awareness about contemporary societal issues. Despite its pedagogical potential, the impact of opioid-related service-learning, particularly for non-majors, continues to remain unexplored. In this study, we describe the implementation of a service-learning module centered on opioid addiction. Students in a non-major biology course learned the science behind opioids, had Naloxone training, and engaged in active discussions with an opioid researcher, physician, and former illicit opioid user. Our assessment of the thematic analysis of pre- and post-reflection free-write data from 87 consenting students revealed 10 categories that students reported in the post- but not pre-reflections (essay gain), pre- and post-reflections (neutral), and pre- but not post-reflections (essay loss). We found essay gains in students humanizing addiction and awareness of the cultural context of opioid addiction and essay losses from students indicating that non-major students had a low level of awareness related to these issues. Eight one-on-one, semi-structured interviews revealed that students were personally impacted by the epidemic and valued its curricular inclusion. Our data supports that service-learning can increase non-major biology student’s awareness and contextual understanding about the opioid epidemic, enabling much-needed advocacy to further enhance its awareness among the public. 

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5. Child Overdoses Amid the Deaths-of-Despair Epidemic: Racial and Ethnic Differences in Intergenerational and Network Diffusion

   Corina Graif, Christopher Seto (April 2022, Annual Meeting of the Population Association of America)

   Since the early 2000s, contributors to the deaths-of-despair epidemic such as alcohol and drug related deaths have more than doubled. Evidence of the role of patient networks in the diffusion of prescription behaviors among physicians and of intra-household diffusion of opioids use contribute to important new questions about the population level effects of workplace- and intergenerational networks. This study responds to this need by expanding the focus from households and opioids overdose risk to examine the role of intergenerational and commuting networks in the diffusion of overdose risk from alcohol and drugs more generally among children. Analyses using negative binomial regression combined with computational statistics approaches such as cross-validation and permutation indicated that exposures to extra-local network overdose risks were associated with local adult- and child overdose deaths. These associations remained significant after controlling for multiple socioeconomic and demographic factors. The results showed that the link between network overdose risk and local child overdose deaths was accounted for in large part by intergenerational effects. Above and beyond intergenerational and spatial diffusion, network effects remained significant for Black children. High concentrations of other white residents protected white children against overdose risk but none of the minority groups. In turn, higher concentration of minority residents protected Black and Hispanic children. Higher population density increased the risk of overdose deaths among adults of all racial and ethnic groups, consistent with expectations of social and economic strain. However, it decreased the risk among children, consistent with social control expectations. Implications for future research and policy are discussed. 

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