Naloxone distribution amidst shifting drug use patterns: Insights from a needs-based syringe services program

Abstract

Objective

In the context of rising overdose deaths among people smoking opioids and stimulants nationally, we aimed to evaluate naloxone distribution within a needs-based syringe services program in Southern California.

Methods

Using service delivery data spanning January–June 2024, we examined the distribution of pipes for safer smoking, sterile syringes, and naloxone. Modified Poisson regression estimated prevalence ratios (PRs) of encounters involving pipes only, syringes only, pipes and syringes together, and neither pipes nor syringes, and whether these encounters included naloxone. Negative binomial regression examined relationships between supplies acquired by participants and the number of overdoses to which they responded with naloxone in the past 14 days.

Results

Among 1260 service delivery encounters, 50 % involved pipes only, 33 % involved pipes/syringes distributed together, 11 % involved syringes only and 7 % involved neither pipes nor syringes. Overall, nearly half (44 %) of encounters included naloxone. Compared to encounters involving pipe-only distribution, encounters involving syringe-only distribution (PR=1.41; 95 % confidence interval [CI]: 1.12, 1.78), combined pipe/syringe distribution (PR=1.90; 95 % CI: 1.64, 2.20), and neither (PR=2.39; 95 % CI: 1.92, 2.99) were more likely to include naloxone. There was no significant relationship between supply type and the 14-day rate of overdose responses involving naloxone.

Conclusion

Harm reduction service delivery encounters involving pipe-only distribution were less likely to involve naloxone than other types of encounters in this setting. To curb overdose deaths in communities shifting from injecting to smoking unregulated substances, specific strategies may be needed to promote naloxone uptake.