Young Adults Often Know Signs of Opioid Overdose, but Not How To Give Naloxone

A majority of young adults can correctly identify at least one sign of opioid overdose, but relatively few know how to administer naloxone, a study in JAMA Pediatrics has found.

Christina E. Freibott, M.P.H., of the Boston University School of Public Health and colleagues examined data from 7,071 young adults aged 18 to 25 attending an institution of higher learning who participated in the 2021-2022 Healthy Minds study. The participants answered four questions adapted from the Opioid Overdose Knowledge Scale and the Opioid Overdose Attitudes Scale about the following:

• What naloxone is used for.
• What the signs of opioid overdose are.
• Whether the participants knew how to use naloxone.
• Whether participants would be concerned about calling emergency services during an overdose event in case they got into trouble with their school or the police came.

The researchers found the following:

• 30.2% of participants correctly identified what naloxone is used for.
• 61.9% of participants correctly identified at least one sign of opioid overdose.
• 14.2% of participants reported knowing how to administer naloxone.
• 66.8% of participants felt comfortable calling emergency services during an overdose event.

There were significant differences in responses to all four questions based on race and ethnicity, gender identity, and sexual orientation. For example, participants who identified as Alaska Native or Pacific Islander were more likely to be knowledgeable about naloxone, correctly identify a sign of overdose, and be willing to intervene in an emergency than other racial and ethnic groups. Participants who identified as transgender or gender-expansive were more knowledgeable about naloxone compared with people who identified as males or females, but less likely to call emergency services. People who identified as lesbian, gay, bisexual, or queer were more knowledgeable about naloxone than heterosexual participants, but also less likely to call emergency services.

“Future research should explore person-centered approaches, clustering [young adults] into clinically meaningful subgroups to inform prevention and educational initiatives for a population experiencing increases in overdose fatalities,” Freibott and colleagues concluded.

For related information, see the Psychiatric News article “AMA Backs Making Overdose Reversal Meds Accessible in Schools.”

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Tackling Overdose Epidemic Will Require Addressing Disparities in SUD Prevention, Care

Despite efforts to address the epidemic of deaths from drug overdose in the United States, drug-overdose deaths are rising faster in Black, Latinx, and American Indian and Alaska Native populations than in the White population.

“Numerous trials have documented the efficacy of medications for opioid use disorder and other SUD interventions. But such treatments are often less available to members of historically marginalized groups than to White patients,” noted Carlos Blanco, M.D., Ph.D., of the National Institute on Drug Abuse (NIDA), Elisabeth U. Kato, M.D., M.R.P., of the Agency for Healthcare Research and Quality, and others in a Perspective piece in the New England Journal of Medicine.

“Ensuring that all people with SUD receive evidence-based treatment will require overcoming barriers to high-quality care, such as lower rates of adequate health insurance among Black, Latinx, and American Indian and Alaska Native populations than among White populations; a dearth of community-based clinicians who treat uninsured and underinsured people; stigma surrounding SUDs; underinvestment by the public sector in historically marginalized communities; and limited access to digital tools in many of these communities,” they continued.

Addressing such disparities also requires research, including studies to further the understanding of the effects of social determinants of health (for example, housing and employment) on patients’ engagement with treatment for substance use disorders and advances in data collection.

The authors wrote, “Ensuring that research reduces disparities will require multiple steps,” including the following:

• Include members of underrepresented groups in the development of preventive interventions and treatments.
• Recruit study participants from historically underrepresented groups, including those with varying levels of education. Ensure that studies are large enough to measure differences in outcomes according to race and ethnic group.
• Establish equitable partnerships with people who have or have had substance use disorders and their families, clinicians, policymakers, payers, and advocates. Share study findings with participating communities.
• Diversify the scientific workforce.
• Measure the effects of policies and interventions on equity.

“Applying an equity lens to efforts to address the worsening overdose epidemic and other SUD-related harms is critical to eliminating racial and ethnic disparities and improving health outcomes,” the authors concluded. “Such an approach could also serve as a framework for narrowing disparities in other patient populations.”

For related information, see the Psychiatric News article “Opioid Overdose Death Rate Rose Faster for People of Color.”

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Rewards for Behavioral Change May Be Effective for Alcohol Use Disorder in Native Populations

Contingency management, in which patients are rewarded for behavioral change, may be an effective strategy for increasing alcohol abstinence in American Indian and Alaska Native adults, a study in JAMA Psychiatry has found.

Michael G. McDonnell, Ph.D., of the Elson S. Floyd College of Medicine at Washington State University, Spokane, and colleagues analyzed data from 158 American Indian and Alaska Native adults who had at least one or more days of high alcohol use (more than three drinks) within the last 30 days and a current diagnosis of alcohol dependence. All patients in the study submitted urine samples twice per week for 12 weeks after a four-week observation period and completed follow-up interviews at one, two, and three months afterward. All patients received treatment as usual, which included culturally adapted individual and group addiction counseling on an outpatient basis, or referral for intensive outpatient addiction treatment that was not culturally adapted. Cultural adaptations included receiving care from tribal members and receiving materials in the patients’ native languages.

Patients were divided into two groups: the contingency management group and the control group. Those in the contingency management group received incentives through prize drawings when their urine samples indicated alcohol abstinence. Those in the control group drew for prizes each time they submitted a urine sample regardless of whether the sample indicated abstinence from alcohol. Prizes included positive affirmations; $1, $20, and $80 cash rewards; gift cards; and more.

At 16 weeks, 59.4% of patients in the contingency management group submitted an alcohol-negative urine sample, compared with 38.3% in the control group. Those in the contingency management group had a 1.70-fold higher likelihood of submitting alcohol-abstinent urine samples than those in the control group.

“Our findings demonstrate that contingency management is a low-cost, feasible, and culturally adaptable incentive program that leads to modest improvements in alcohol abstinence during a 12-week intervention period,” McDonnell and colleagues wrote. “Policymakers and health care professionals may consider investing in contingency management as a strategy for improving the treatment of alcohol use disorder among American Indian and Alaska Native adults.”

For related information, see the American Journal of Psychiatry article “A Randomized Controlled Trial of Ethyl Glucuronide-Based Contingency Management for Outpatients With Co-Occurring Alcohol Use Disorders and Serious Mental Illness.”

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Report Finds Rates of U.S. Deaths From Alcohol Use ‘Accelerating’

Deaths in the United States due to alcohol consumption appear to be rising, according to a report in JAMA Network Open.

“The rate of alcohol-induced deaths, largely due to alcoholic liver disease, increased substantially among men and women in the United States from 2000 to 2016, especially in more recent years,” wrote Susan Spillane, Ph.D., of the National Institutes of Health and colleagues.

Spillane and colleagues analyzed data from the death certificates of U.S. residents (older than 15 years) who died between 2000 and 2016. The authors defined alcohol-induced deaths as those “due to alcohol consumption … [that] could be avoided if alcohol were not involved,” such as alcoholic liver disease, alcohol related mental and behavioral disorders, and accidental poisoning by alcohol.

Between 2000 and 2016, 425,045 alcohol-induced deaths occurred, the authors reported. The rate of death due to alcohol-induced causes increased overall from 2000 to 2016 at an average annual percentage change of 1.4% among men and 3.1% among women.

The largest increases in alcohol-induced deaths were observed among American Indian and Alaska Native men (average annual percentage change, 3.3%), American Indian and Alaska Native women (average annual percentage change, 4.2%), and white women (average annual percentage change, 4.1%).

“Although declines occurred among black women from 2000 to 2007, black men from 2000 to 2012, and Latino men from 2000 to 2013, these promising trends reversed course, and rates of alcohol-induced mortality increased from 2013 to 2016 in all examined racial/ethnic groups,” the authors wrote.

Spillane and colleagues continued, “[A]lcohol consumption levels are unlikely to fully explain mortality trends. Lack of access to high quality care for alcohol misuse and alcohol-associated diseases plays an important role in mortality vs. morbidity. … Because many of the consequences of alcohol consumption occur later in life, large increases in alcohol-induced deaths among younger age groups portend substantial future increases in alcohol-related disease.”

For related information, see the American Journal of Psychiatry article “Neurofunctional Domains Derived From Deep Behavioral Phenotyping in Alcohol Use Disorder.”

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