Harm reduction behaviors are associated with carrying naloxone among patients on methadone treatment.

Despite the widespread availability of naloxone, U.S. opioid overdose rates continue to rise. The 'Cascade of Care' (CoC) is a public health approach that identifies steps in achieving specific outcomes. Previous reports have used the CoC framework to identify gaps in naloxone carry among individuals with opioid use disorder (OUD). We sought to extend this framework to treatment-seeking populations with OUD, a population that may be more inclined to participate in harm reduction behaviors. We hypothesized that rates of naloxone carry would be higher in treatment-seeking individuals, and particularly, in those who regularly practice other forms of harm reduction.

Patients were recruited via convenience sampling from an urban methadone program to complete a survey. We assessed naloxone familiarity, availability, obtainability, training and possession (previously identified CoC domains), as well as naloxone carry rates, demographics, and harm reduction behaviors. A multivariate logistic regression model was used to examine the association of naloxone carry with various individual-level factors.

The sample (n=97) was majority male (59%) with a mean age of 48 (SD=12), 27% had college education or higher, 64% indicated injection drug use, and 84% reported past naloxone training. Similar to previous findings, 100% of participants endorsed familiarity with naloxone, but only 42% regularly carried naloxone. The following were independently associated with carrying naloxone (aOR, 95% CI): White race (4.00, 1.25-12.78), lower education (0.33, 0.12-0.95), history of naloxone training (5.16, 1.08-24.74), and total number of self-reported harm reduction behaviors (1.55, 1.05-2.30).

Even in seemingly perfect conditions for naloxone distribution, we found low rates of carry among methadone-treated participants. Methadone programs provide ample opportunities for naloxone interventions, which should target racial/ethnic minorities, individuals with lower education, and those who have not received naloxone training. The spectrum of harm reduction behaviors should be explicitly encouraged among these populations in order to enhance naloxone carry.