| Title: |
“I wanted to close the chapter completely … and I feel like that [carrying naloxone] would keep it open a little bit”: Refusal to carry naloxone among newly-abstinent opioid users and 12-step identity |
| Authors: |
Bowles, JM; Smith, LR; Mittal, ML; Harding, RW; Copulsky, E; Hennessy, G; Dunkle, A; Davidson, PJ; Wagner, KD |
| Source: |
International Journal of Drug Policy, vol 94 |
| Publisher Information: |
eScholarship, University of California |
| Publication Year: |
2021 |
| Collection: |
University of California: eScholarship |
| Subject Terms: |
4407 Policy and Administration (for-2020); 4206 Public Health (for-2020); 42 Health Sciences (for-2020); 44 Human Society (for-2020); Prevention (rcdc); Drug Abuse (NIDA only) (rcdc); Substance Misuse (rcdc); Physical Injury - Accidents and Adverse Effects (rcdc); Opioids (rcdc); Neurosciences (rcdc); Opioid Misuse and Addiction (rcdc); Behavioral and Social Science (rcdc); 3 Good Health and Well Being (sdg); Analgesics; Opioid (mesh); Drug Overdose (mesh); Humans (mesh); Naloxone (mesh); Narcotic Antagonists (mesh); Opioid-Related Disorders (mesh); Opioids; Overdose; Harm reduction; Drug treatment; Abstinence; Social identity theory; Qualitative methods; 11 Medical and Health Sciences (for); 16 Studies in Human Society (for) |
| Description: |
BACKGROUND: 12-step programs aim to address drug-related harms, like opioid overdose, via abstinence. However, abstaining from opioids can diminish tolerance, which increases risk for overdose death upon resumption. A recent study found that desire to abstain from drugs inhibited willingness to participate in take-home naloxone programming, which was linked to perceptions of harm reduction strategies being tied to drug use. In the present study, we uncovered a similar phenomenon occurring among newly-abstinent participants who were refusing to carry naloxone. METHODS: This study is an analysis of broader qualitative data collected throughout Southern California among persons who use opioids, including those recently abstinent. Preliminary analysis revealed that those newly abstinent refused to accept naloxone at the end of interviews, and so we began probing about this (N=44). We used thematic analysis and author positionality to explicate the emergent phenomenon and applied social identity theory to conceptualize findings. RESULTS: Mechanisms underlying naloxone refusal included its tie to a drug-using identity that newly-abstinent participants were attempting to retire. Carrying naloxone was also viewed as pointless due to doubt of witnessing an overdose again. Furthermore, the thought of being equipped with naloxone was not believed to be congruent with an abstinent identity, e.g. "me carrying it [naloxone] is making me feel like I'm going to be hanging out with people that are doing it [using drugs]." CONCLUSION: Recent detoxification heightens vulnerability to overdose, which other newly-abstinent peers might be positioned to respond to as bonds are formed through 12-step identity formation. However, naloxone is often refused by this group due to perceived 12-step identity clash. While some treatment spaces distribute naloxone, 12-step identity associated behavioral expectations appear to conflict with this strategy. Reframing these disconnects is essential for expanding the lifesaving naloxone community ... |
| Document Type: |
article in journal/newspaper |
| File Description: |
application/pdf |
| Language: |
unknown |
| Relation: |
qt2qs084jc; https://escholarship.org/uc/item/2qs084jc; https://escholarship.org/content/qt2qs084jc/qt2qs084jc.pdf |
| DOI: |
10.1016/j.drugpo.2021.103200 |
| Availability: |
https://escholarship.org/uc/item/2qs084jc; https://escholarship.org/content/qt2qs084jc/qt2qs084jc.pdf; https://doi.org/10.1016/j.drugpo.2021.103200 |
| Rights: |
public |
| Accession Number: |
edsbas.DEC20058 |
| Database: |
BASE |