A network-based, mixed methods study to identify and support multiple overdose responders and inform overdose prevention interventions

The goal of this proposal is to identify strategies to improve the effectiveness and sustainability of naloxone distribution programs for people who use drugs (PWUD). Research suggests that some PWUD enthusiastically take up the role of “overdose responder”, responding to multiple overdoses over relatively short periods of time. Others, however, respond to few or no overdoses. We seek to determine the factors that influence overdose response behavior, with the goal of identifying intervention targets to improve the overall capacity of PWUD to respond to overdoses. To answer these questions, we propose a longitudinal mixed methods study with 300 PWUDs recruited in Reno, Nevada to address the following aims: 1. Identify the characteristics of OD responders (relative to those who do not carry or do not use the naloxone they have), including substance use behaviors, size and composition of social networks, personal factors, and geographic factors. 2. Qualitatively describe the positive and negative experiences of responding to ODs and identify (a) the support or services needed by PWUDs to sustainably respond to ODs in their communities, and (b) the barriers to response among those who do not respond or stop responding. 3. Assess feasibility and acceptability of interventions to improve sustainability of responders and increase initiation of response behavior among non-responders.