Take-Home Naloxone and risk management among people who survived an opioid overdose; a qualitative study informed by drug, set and setting

Author: Elin Holmén Martin Kåberg Anders Hammarberg Jessica Storbjörk

Theme: Clinical Research Year: 2022

Sweden has one of the highest rates of overdose mortality in Europe. Take-Home-Naloxone
programs were introduced nationwide in 2018. This qualitative study builds on international research
that has expanded a previously narrow, medical focus on overdose deaths, exploring the role of
naloxone among overdose survivors in a context of severe stigmatization of people who inject drugs
The study uses Zinberg’s theoretical framework to look beyond the role of the drug in order to
include the attitudes and personality of the person (set) and contextual factors (setting). Face to face
semi-structured interviews were conducted with 22 individuals who had survived an opioid
overdose, recruited from the clients of the Stockholm needle exchange. All participants had received
naloxone in an overdose situation, usually from a peer (though sometimes self-administered).
The interviews were processed through thematic analysis using deductive and inductive coding.
Interviewees represented both genders and a mix of drug use (opioids and stimulants). Participants
described an everyday existence characterized by uncertainty, stress and social exclusion. While most
participants attributed their latest opioid overdose to drug, many shared narratives of hopelessness
leading to increased risk taking, acknowledging set as a contributing factor to overdoses. A stressful
setting directly caused some overdoses, with public drug use frequently reported. Though PWID have
incorporated Take-Home-Naloxone into their practices of handling overdose emergencies, they also
reported controversial actions such as administering stimulants. Most participants denied firmly that
the presence of naloxone encouraged riskier behaviour. Despite harsh withdrawal symptoms
accompanying naloxone revival, participants retained an overwhelmingly positive attitude towards
The complex circumstances described in participants overdose reporting illustrate the intertwining
effect of drug, set and setting. Harm reduction interventions focussed on individuals have to be
accompanied by structural changes in order to lessen risks and reduce the incidence of overdose
Disclosure of Interest Statement:
No disclosure of interests.

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