Naloxone Knowledge and Attitudes Towards Overdose Response Among Family Members of People Who Misuse Opioids

Background and Purpose: Naloxone, an opioid agonist medication that can rapidly reverse opioid overdoses, prevented over 26,000 overdose deaths between 1996 and 2004 in the U.S. (Wheeler et al., 2015). Providing access to naloxone for family members and friends of individuals with opioid use disorders (OUD) is a practical and cost-effective way to reduce overdose deaths (Coffin & Sullivan, 2013). However, research suggests community naloxone programs are not reaching the family and friends of people with OUD. Understanding the reasons for the limited use of naloxone among family and friends of individuals with OUDs is vital to preventing fatal opioid overdoses. The current study examines factors associated with knowledge and attitudes toward naloxone among adults with a close family who misused opioids.

Methods: Adults with a close family member (parent, step-parent, child, spouse, sibling, or step-sibling) who misused opioids (N=260) were recruited through treatment providers, community groups, and social media to complete a web-based survey. The self-administered survey included questions about their knowledge of naloxone administration and attitude (i.e., self-efficacy, readiness) toward overdose response (5 items for each scale). Other measures assessed demographics (age, gender, race, education, marital status, and income), completion of naloxone training, attitude toward medications for addiction treatment (e.g., methadone, buprenorphine), and whether their loved one had experienced an overdose. Multiple regression was used to identify factors associated with naloxone knowledge (model 1) and attitudes (model 2) toward overdose response. Analysis was conducted in Mplus and used Full Information Maximum Likelihood Estimation to handle missing data.

Results: Individuals who identified as a person of color (B=-.369, p=.023) had lower levels of naloxone knowledge. Individuals who had a loved one who had experienced a drug overdose (B=0.305, p=.003) had greater knowledge. Age, naloxone training, and attitude toward medications for addiction treatment were significantly associated with attitudes toward overdose response. Older age (B=.12, p<.001), completion of naloxone training (B = 2.63, p < .001), and more positive attitude toward medications for addiction treatment (B=1.26, p=.017) were associated with more positive attitudes toward overdose response.

Conclusion & Implications: Results highlight how naloxone training provides practical information on administering the medication and can improve self-efficacy and readiness to respond to a drug overdose. Family members may be underutilized allies in the response to the opioid overdose epidemic and broader efforts may be needed to educate family members about naloxone. Individuals who were aware their loved one experienced a previous overdose had greater naloxone knowledge. Naloxone training is essential for family members regardless of substance use severity. Findings related to race suggest the need for greater naloxone education among families of color. Public health approaches to educating family members and the broader populace about naloxone may help to further reduce overdose deaths among those who misuse opioids. Future research should further examine the effectiveness of naloxone education for affected family members across socio-demographic groups. These findings may point to where education and distribution efforts may focus to increase knowledge and improve attitudes among those closest to people with OUD.