Post-overdose interventions triggered by calling 911: Centering the perspectives of people who use drugs (PWUDs)

Autoři: Karla D. Wagner aff001;  Robert W. Harding aff001;  Richard Kelley aff002;  Brian Labus aff003;  Silvia R. Verdugo aff004;  Elizabeth Copulsky aff005;  Jeanette M. Bowles aff005;  Maria Luisa Mittal aff005;  Peter J. Davidson aff005
Působiště autorů: School of Community Health Sciences, University of Nevada, Reno, Nevada, United States of America aff001;  Nevada Center for Applied Research, University of Nevada, Reno, Nevada, United States of America aff002;  School of Public Health, University of Nevada, Las Vegas, Nevada, United States of America aff003;  FirstWatch, Inc., Carlsbad, California, United States of America aff004;  Division of Infectious Disease and Global Public Health, Department of Medicine, University of California, San Diego, California, United States of America aff005
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article



Opioid overdose deaths have increased exponentially in the United States. Bystander response to opioid overdose ideally involves administering naloxone, providing rescue breathing, and calling 911 to summon emergency medical assistance. Recently in the US, public health and public safety agencies have begun seeking to use 911 calls as a method to identify and deliver post-overdose interventions to opioid overdose patients. Little is known about the opinions of PWUDs about the barriers, benefits, or potential harms of post-overdose interventions linked to the 911 system. We sought to understand the perspectives of PWUDs about a method for using 911 data to identify opioid overdose cases and trigger a post-overdose intervention.

Methods and findings

We conducted three focus groups with 11 PWUDs in 2018. Results are organized into 4 categories: willingness to call 911 (benefits and risks of calling), thoughts about a technique to identify opioid overdoses in 911 data (benefits and concerns), thoughts about the proposed post-overdose intervention (benefits and concerns), and recommendations for developing an ideal post-overdose intervention. For most participants, calling 911 was synonymous with “calling the police” and law enforcement-related fears were pervasive, limiting willingness to engage with the 911 system. The technique to identify opioid overdoses and the proposed post-overdose intervention were identified as potentially lifesaving, but the benefits were balanced by concerns related to law enforcement involvement, intervention timing, and risks to privacy/reputation. Nearly universally, participants wished for a way to summon emergency medical assistance without triggering a law enforcement response.


The fact that the 911 system in the US inextricably links emergency medical assistance with law enforcement response inherently problematizes calling 911 for PWUDs, and has implications for surveillance and intervention. It is imperative to center the perspectives of PWUDs when designing and implementing interventions that rely on the 911 system for activation.

Klíčová slova:

Critical care and emergency medicine – Drug research and development – Law enforcement – Opioids – Police – Public and occupational health – Safety – Nevada


1. Jalal H, Buchanich JM, Roberts MS, Balmert LC, Zhang K, Burke DS. Changing dynamics of the drug overdose epidemic in the United States from 1979 through 2016. Science. 2018;361(6408).

2. Hedegaard M, Miniño A, Warner M. NCHS Data Brief: No. 329: November 2018: Drug overdose deaths in the United States, 1999–2017. 2018.

3. Kariisa M. Drug Overdose Deaths Involving Cocaine and Psychostimulants with Abuse Potential—United States, 2003–2017. MMWR Morbidity and mortality weekly report. 2019;68.

4. Tyndall MJ, Craib KJ, Currie S, Li K, O'Shaughnessy MV, Schechter MT. Impact of HIV Infection on Mortality in a Cohort of Injection Drug Users. Journal of Acquired Immune Deficiency Syndromes. 2001;28(4):351–7. doi: 10.1097/00126334-200112010-00008 11707672

5. Maxwell S, Bigg D, Stanczykiewicz K, Carlberg-Racich S. Prescribing naloxone to actively injecting heroin users: a program to reduce heroin overdose deaths. J Addict Dis. 2006;25(3):89–96. doi: 10.1300/J069v25n03_11 16956873.

6. Wheeler E, Jones TS, Gilbert MK, Davidson PJ, Centers for Disease C, Prevention. Opioid Overdose Prevention Programs Providing Naloxone to Laypersons—United States, 2014. MMWR Morb Mortal Wkly Rep. 2015;64(23):631–5. 26086633.

7. Boyer EW. Management of Opioid Analgesic Overdose. New England Journal of Medicine. 2012;367(2):146–55. doi: 10.1056/NEJMra1202561 22784117.

8. Institute of Medicine. Emergency Medical Services: At the Crossroads. Washington, DC: The National Academies Press; 2007.

9. Skolarus LE, Murphy JB, Zimmerman MA, Bailey S, Fowlkes S, Brown DL, et al. Individual and community determinants of calling 911 for stroke among African Americans in an urban community. Circ Cardiovasc Qual Outcomes. 2013;6(3):278–83. doi: 10.1161/CIRCOUTCOMES.111.000017 23674311; PubMed Central PMCID: PMC3779662.

10. Sasson C, Haukoos JS, Ben-Youssef L, Ramirez L, Bull S, Eigel B, et al. Barriers to calling 911 and learning and performing cardiopulmonary resuscitation for residents of primarily Latino, high-risk neighborhoods in Denver, Colorado. Ann Emerg Med. 2015;65(5):545–52 e2. doi: 10.1016/j.annemergmed.2014.10.028 25481112; PubMed Central PMCID: PMC4866505.

11. Strang J, Best D, Man L, Noble A, Gossop M. Peer-initiated Overdose Resuscitation: Fellow Drug Users Could Be Mobilised to Implement Resuscitation. International Journal of Drug Policy. 2000;11(6):437–45. 11099924

12. Tobin KE, Davey MA, Latkin CA. Calling Emergency Medical Services During Drug Overdose: An Examination of Individual, Social and Setting Correlates. Addiction. 2005;100(3):397–404. doi: 10.1111/j.1360-0443.2005.00975.x 15733253

13. Ambrose G, Amlani A, Buxton JA. Predictors of seeking emergency medical help during overdose events in a provincial naloxone distribution programme: a retrospective analysis. BMJ open. 2016;6(6):e011224. doi: 10.1136/bmjopen-2016-011224 27329442

14. Pollini RA, McCall L, Mehta SH, Celentano DD, Vlahov D, Strathdee SA. Response to Overdose Among Injection Drug Users. American Journal of Preventive Medicine. 2006;31(3):261–4. doi: 10.1016/j.amepre.2006.04.002 16905039

15. Wagner KD, Valente TW, Casanova M, Partovi SM, Mendenhall BM, Hundley JH, et al. Evaluation of an overdose prevention and response training programme for injection drug users in the Skid Row area of Los Angeles, CA. Int J Drug Policy. 2010;21(3):186–93. doi: 10.1016/j.drugpo.2009.01.003 19268564; PubMed Central PMCID: PMC4291458.

16. Darke S, Ross J, Zador D, Sunjic S. Heroin-related deaths in new south wales, Australia, 1992–1996. Drug and alcohol dependence. 2000;60(2):141–50. doi: 10.1016/s0376-8716(99)00147-7 10940541

17. Karamouzian M, Kuo M, Crabtree A, Buxton JA. Correlates of seeking emergency medical help in the event of an overdose in British Columbia, Canada: Findings from the Take Home Naloxone program. Int J Drug Policy. 2019. Epub 2019/01/25. doi: 10.1016/j.drugpo.2019.01.006 30691944.

18. Davis C, Webb D, Burris S. Changing law from barrier to facilitator of opioid overdose prevention. J Law Med Ethics. 2013;41 Suppl 1:33–6. Epub 2013/04/23. doi: 10.1111/jlme.12035 23590737.

19. Lankenau SE, Wagner KD, Silva K, Kecojevic A, Iverson E, McNeely M, et al. Injection drug users trained by overdose prevention programs: responses to witnessed overdoses. J Community Health. 2013;38(1):133–41. Epub 2012/08/01. doi: 10.1007/s10900-012-9591-7 22847602; PubMed Central PMCID: PMC3516627.

20. Latimore AD, Bergstein RS. "Caught with a body" yet protected by law? Calling 911 for opioid overdose in the context of the Good Samaritan Law. Int J Drug Policy. 2017;50:82–9. Epub 2017/10/16. doi: 10.1016/j.drugpo.2017.09.010 29040841.

21. Bohnert AS, Nandi A, Tracy M, Cerda M, Tardiff KJ, Vlahov D, et al. Policing and risk of overdose mortality in urban neighborhoods. Drug Alcohol Depend. 2011;113(1):62–8. doi: 10.1016/j.drugalcdep.2010.07.008 20727684; PubMed Central PMCID: PMC3008306.

22. Koester S, Mueller SR, Raville L, Langegger S, Binswanger IA. Why are some people who have received overdose education and naloxone reticent to call Emergency Medical Services in the event of overdose? Int J Drug Policy. 2017;48:115–24. doi: 10.1016/j.drugpo.2017.06.008 28734745.

23. Formica SW, Apsler R, Wilkins L, Ruiz S, Reilly B, Walley AY. Post opioid overdose outreach by public health and public safety agencies: Exploration of emerging programs in Massachusetts. Int J Drug Policy. 2018;54:43–50. Epub 2018/02/08. doi: 10.1016/j.drugpo.2018.01.001 29414484.

24. Wagner KD, Bovet LJ, Haynes B, Joshua A, Davidson PJ. Training law enforcement to respond to opioid overdose with naloxone: Impact on knowledge, attitudes, and interactions with community members. Drug Alcohol Depend. 2016;165:22–8. doi: 10.1016/j.drugalcdep.2016.05.008 27262898.

25. Schiff DM, Drainoni ML, Weinstein ZM, Chan L, Bair-Merritt M, Rosenbloom D. A police-led addiction treatment referral program in Gloucester, MA: Implementation and participants' experiences. J Subst Abuse Treat. 2017;82:41–7. Epub 2017/09/09. doi: 10.1016/j.jsat.2017.09.003 29021114.

26. McNeil R, Kerr T, Pauly B, Wood E, Small W. Advancing patient-centered care for structurally vulnerable drug-using populations: a qualitative study of the perspectives of people who use drugs regarding the potential integration of harm reduction interventions into hospitals. Addiction (Abingdon, England). 2016;111(4):685–94. Epub 01/08. doi: 10.1111/add.13214 26498577.

27. Patton MQ. Qualitative Research & Evaluation Methods. Thousand Oaks, CA: Sage Publications, Inc.; 2002.

28. Lofland J, Lofland LH. Analyzing Social Settings: A Guide to Qualitative Observation and Analysis. 3 ed: Wadsworth; 1995.

29. Forge J. A note on the definition of “dual use”. Science and Engineering Ethics. 2010;16(1):111–8. doi: 10.1007/s11948-009-9159-9 19685170

30. Brunson RK. “Police don't like black people”: African‐American young men's accumulated police experiences. Criminology & public policy. 2007;6(1):71–101.

31. Wagner KD, Davidson PJ, Iverson E, Washburn R, Burke E, Kral AH, et al. "I felt like a superhero": the experience of responding to drug overdose among individuals trained in overdose prevention. Int J Drug Policy. 2014;25(1):157–65. Epub 2013/08/13. doi: 10.1016/j.drugpo.2013.07.003 23932166; PubMed Central PMCID: PMC3946806.

32. Seal KH, Thawley R, Gee L, Bamberger J, Kral AH, Ciccarone D, et al. Naloxone Distribution and Cardiopulmonary Resuscitation Training for Injection Drug Users to Prevent Heroin Overdose Death: A Pilot Intervention Study. Journal of Urban Health. 2005;82(2):303–11. doi: 10.1093/jurban/jti053 15872192

33. LaSalle L. An Overdose Death is not Murder: Why Drug-induced homicide laws are counterproductive and inhumane. The Drug Policy Alliance, 2017.

34. Institute of Medicine. Crossing the Quality Chasm: A New Health system for the 21st Century. Washington, D.C.: National Academy Press, 2001.

35. Gerteis M. Through the patient's eyes: understanding and promoting patient-centered care. 1993.

36. Green TC, Heimer R, Grau LE. Distinguishing Signs of Opioid Overdose and Indication for Naloxone: An Evaluation of Six Overdose Training and Naloxone Distribution Programs in the United States. Addiction. 2008;103(6):979–89. Epub 2008 Apr 16. doi: 10.1111/j.1360-0443.2008.02182.x 18422830

37. Behar E, Santos G-M, Wheeler E, Rowe C, Coffin PO. Brief overdose education is sufficient for naloxone distribution to opioid users. Drug and Alcohol Dependence. 2015;148(0):209–12.

38. Sussman S, Burton D, Dent CW, Stacy AW, Flay BR. Use of Focus Groups in Developing a Adolescent Tobacco Use Cessation Program: Collective Norm Effects. Journal of Applied Social Psychology. 1991;21(21):1772–82.

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2019 Číslo 10
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