Opioid Overdose Competency and Concerns Among Rural Alabamians: Implications for Developing Tailored Intervention Strategies

Background: Fatal and nonfatal opioid overdose rates increased sharply during the COVID-19 pandemic In 2021, 106,699 people in the US died of drug overdose, a 51% increase from 2019, and 75% involved opioids.¹ Rural communities were heavily affected due to factors like a lack of health care providers, longer distances to care, and lower socioeconomic status. Effective and timely administrative of rescue medication can greatly reduce overdose harms. Naloxone, an opioid antagonist which can prevent death by overdose, is increasingly available in the community and can be administered successfully by non-medical individuals. However, stigma associated with opioid consumption and police involvement may impede its administration and create concerns in its use. This study aims to investigate competencies and concerns regarding managing opioid overdose and factors affecting them in a rural area in Alabama.

Methods: Study participants were 110 community members, professionals, and individuals in drug treatment and recovery from three rural counties in northwest Alabama recruited by purposive and convenience sampling in 2019. All completed a survey that measured their attitudes toward opioid overdose management, including competency and concerns, and items asking if they were bothered by pain, had witnessed an opioid overdose, or had fears associated with opioid use. The relationships between the independent and demographic variables and dependent variables (competency of managing an opioid overdose and concerns of managing an opioid overdose) were examined by bivariate analyses. Multivariate linear regression were used to examine factors predicting competency and concerns about managing opioid overdose.

Results: Among 110 respondents, 84.5% were female and 88.2% were white. Respondents reported a moderate level of perceived competence and a low level of concern overall. They showed low levels of confidence to deal with an overdose effectively, including the ability to check someone’s breathing or the recovery position. Concerns included using syringes and needle sticks, handling withdrawal symptoms, and hurting or being hurt by the person overdosing. Over half (51.8%) reported being bothered by pain, and a third (35.2%) of the sample had witnessed an opioid overdose. Concerning fears, the most significant was potential side effects of opioid use, followed by becoming an addict. A moderate level of fear of death was reported. Respondents who were older, had witnessed an opioid overdose, or had fear of not achieving the desired results when using opioids had higher opioid overdose management competencies. Females, respondents who were bothered by pain, and participants who had witnessed an opioid overdose reported higher level of concerns about managing an opioid overdose.

Discussion/Conclusion: The findings suggest that although participants reported being ready to intervene and having low levels of concerns regarding assisting with an overdose, actual perceived competence was moderate. In general, individuals wanted to assist in the case of an opioid overdose, but needed more education and training on how to act effectively. Many concerns regarding other harm reduction barriers (i.e., syringes and needle sticks) and how to handle withdrawal symptoms are easily addressed with proper training that includes hands-on Naloxone experience to improve perceived competency.