Overdose, Naloxone Receipt, and Willingness to Distribute Naloxone Among People Who Use Drugs on An American Indian Reservation of a Tribal Nation in the Southern Plains of the United States.

Abstract

Background: Indigenous populations in the United States experience disproportionate substance use and opioid overdose burdens. Yet, little is known about naloxone distribution in Indigenous communities on Tribal reservation lands.

Methods: We used survey data from 209 people who use drugs (PWUD), collected on the reservation lands of a southern plains Tribal Nation to understand the prevalence of overdose, naloxone receipt, and interest in participating in secondary naloxone distribution. We assessed bivariate associations between each outcome of interest and sociodemographics, drug use, witnessing overdoses, and drug use stigma.

Results: The average age of participants was 42, 57% were men, 54% identified as Indigenous, and 27% were currently experiencing homelessness. One third had witnessed a non-fatal overdose in the past 6 months and 15% had witnessed a fatal overdose. 19% had experienced an overdose in the past 6 months. Witnessing both fatal and non-fatal overdoses and high drug use stigma scores were associated with increased prevalence of overdose. One quarter had received naloxone in the past 6 months. Receiving naloxone was more common among those who witnessed fatal and non-fatal overdoses and who had experienced overdoses themselves. The majority (61%) of participants were willing to distribute naloxone to others. Willingness to distribute naloxone was more common among participants who had witnessed non-fatal overdoses and who had higher drug use stigma scores.

Conclusions: There is a pressing need to enhance naloxone coverage for PWUD in Indigenous communities. Secondary naloxone distribution may be a promising strategy to address this need.