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

Background: 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 and has been used to identify gaps in naloxone carry among individuals with opioid use disorder (OUD). We sought to apply this framework to a treatment-seeking population with OUD that may be more inclined to engage in harm reduction behaviors. Methods: Patients were recruited from an urban methadone program to complete a survey. We assessed naloxone familiarity, availability, obtainability, training, and possession, as well as naloxone carry rates, demographics, and harm reduction behaviors. A multivariable logistic regression examined associations between naloxone carry and individual-level factors. Results: Participants (n=97) were 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. All participants endorsed familiarity with naloxone, but only 42% regularly carried naloxone. The following variables were associated with carrying naloxone: white race (aOR=4.00, 95% CI 1.25-12.78), lower education (aOR=0.33, 95% CI 0.12-0.95), history of naloxone training (aOR=5.16, 95% CI 1.08-24.74), and total number of self-reported harm reduction behaviors (aOR=1.55, 95% CI 1.05-2.30). Conclusion: We found low rates of naloxone carry among methadone-treated patients. Methadone programs provide opportunities for naloxone interventions and 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 encouraged among these populations to enhance naloxone carry.