Drug and alcohol dependence · 2025
Higher levels of naloxone protection are associated with lower risk-taking: A longitudinal analysis of New York City residents using unprescribed opioids.
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Elliott Luther, Harris Adrian, Crasta Dev, Goodman Melody S, Chen Yuyu, Rouhani Saba, Frank David, Bather Jemar R, Bennett Alex S
Аннотация
OBJECTIVE: To apply risk compensation theory to naloxone peer access and evaluate whether reported naloxone protection-having naloxone and someone to administer it present when using unprescribed opioids-correlated with greater opioid overdose risk behaviors.
METHODS: Longitudinal cohort of 422 NYC residents using unprescribed opioids who completed at least three monthly surveys over 24 months. Mixed-effects models estimated unadjusted and adjusted associations between naloxone protection and both opioid risk and overdose events and were used to test whether race/ethnicity and gender modified the relationship between naloxone protection and risk behaviors.
RESULTS: Being protected 75 % of the time or more was identified as a meaningful cutoff in the sample and was associated with fewer opioid risk behaviors and overdose events. Race/ethnicity, but not gender, was found to be a significant effect modifier of naloxone protection.
CONCLUSIONS: Findings indicate no support for the risk compensation-derived hypothesis that people who use opioids while protected by naloxone pursue more overdose-associated risk behaviors than those unprotected.
POLICY IMPLICATIONS: Concerns about how naloxone may disinhibit people who use opioids, leading to greater risk-taking, appear unfounded, reaffirming the importance of universal naloxone access.
METHODS: Longitudinal cohort of 422 NYC residents using unprescribed opioids who completed at least three monthly surveys over 24 months. Mixed-effects models estimated unadjusted and adjusted associations between naloxone protection and both opioid risk and overdose events and were used to test whether race/ethnicity and gender modified the relationship between naloxone protection and risk behaviors.
RESULTS: Being protected 75 % of the time or more was identified as a meaningful cutoff in the sample and was associated with fewer opioid risk behaviors and overdose events. Race/ethnicity, but not gender, was found to be a significant effect modifier of naloxone protection.
CONCLUSIONS: Findings indicate no support for the risk compensation-derived hypothesis that people who use opioids while protected by naloxone pursue more overdose-associated risk behaviors than those unprotected.
POLICY IMPLICATIONS: Concerns about how naloxone may disinhibit people who use opioids, leading to greater risk-taking, appear unfounded, reaffirming the importance of universal naloxone access.