People Who Use Heroin Do Not Increase Use After Receipt of Naloxone Rescue Training

Equipping people who use opioids with naloxone rescue kits has emerged as a key strategy to reducing fatal opioid overdose. However, there is concern that this may lead to risk compensation –  an increase in risky behaviors by reducing perceived negative consequences of opioid use. This prospective study examined whether self-reported drug use behavior and the Addiction Severity Index (ASI) drug score changed in response to opioid overdose education and naloxone training among people who use heroin who were receiving or not receiving methadone or buprenorphine treatment.

  • Among people who use heroin who were not receiving opioid agonist treatment, daily heroin use and ASI drug score decreased at 1 and 3 months after receiving overdose education and naloxone training.
  • No significant change in use of more than one drug use was detected.
  • Among people treated with methadone or buprenorphine, no significant change in self-reported drug use at 1 and 3 months was detected.

Comments: This study provides reassurance that overdose prevention education and naloxone rescue kit distribution do not increase drug use. The pre-post design of this study is a limitation. Nevertheless, such information is helpful for providers treating patients with opioid use disorders, naloxone distribution programs. The findings may help to allay the fears about state initiatives that are facing resistance to supporting overdose prevention education and distributing naloxone rescue kits due to concerns of risk compensation.

Jessica Gray, MD and Alexander Y. Walley, MD, MSc

Contributing editorial intern and Addiction Medicine Fellow, Boston Medical Center/Boston University School of Medicine

Reference: Jones JD, Campbell A, Metz VE, Comer SD. No evidence of compensatory drug use risk behavior among heroin users after receiving take-home naloxone. Addict Behav. 2017;71:104–106.

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