Mapping needles, reducing harm: Findings from a geospatial, community-based needle collection and naloxone training initiative in Saskatchewan, Canada

Mapping needles, reducing harm: Findings from a geospatial, community-based needle collection and naloxone training initiative in Saskatchewan, Canada | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Mapping needles, reducing harm: Findings from a geospatial, community-based needle collection and naloxone training initiative in Saskatchewan, Canada Nelson Pang, Shiny Mary Varghese, Vidya Dhar Reddy, Tashia Acoose, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5836079/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background The opioid crisis is a major public health issue in Canada, with prairie provinces such as Saskatchewan experiencing particularly high rates of opioid-related harms. Factors contributing to this crisis include an unstable drug supply, limited access to harm reduction services, and structural challenges such as poverty and housing instability. The rise of fentanyl has further exacerbated overdose risks, particularly among people who use drugs. Harm reduction programs, such as opioid overdose education and naloxone distribution, have proven effective in reducing overdose fatalities and improving community health. While geospatial analysis has shown promise in identifying areas of high need for targeted harm reduction interventions, its integration into harm reduction strategies remains underexplored. Methods This study utilized data from 44 participants who completed pop-up naloxone training sessions in Regina, Saskatchewan, between August 2023 and September 2024. Additionally, data sources include geospatial information on discarded needles from the ReportNeedles.ca platform and survey responses evaluating opioid overdose and naloxone administration using a modified Opioid Overdose Knowledge Scale. Naloxone training sessions were targeted to areas with a high number of discarded needles determined by the ReportNeedles.ca platform. Geospatial analyses were conducted using ArcGIS to map needle prevalence and assess the accessibility of harm reduction services based on walk-time buffers. Results Between August 2023 and August 2024, 315 reports on ReportNeedles.ca led to the disposal of 2,836 needles. Geospatial analysis revealed clustering of discarded needles in Regina's city center, with some seasonal variation. Pop-up training sites expanded the accessibility of naloxone services, with 70% of participants reporting living within a 15-minute walk to pop-up Naloxone trainings. However, geospatial analysis revealed gaps in service accessibility specifically in suburban areas. Participants in pop-up naloxone trainings demonstrated strong knowledge of overdose recognition and naloxone administration. Conclusions This study the potential benefit in integrating geospatial analysis with harm reduction interventions to address the opioid crisis. By identifying needle prevalence hotspots and utilizing pop-up naloxone training service providers can improve service accessibility. Harm reduction Naloxone training Geospatial injection drug use Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Background The opioid crisis is a major public health issue globally including Canada, the United States and Europe ( 1 – 4 ). Between 2019 and 2021, the annual number of opioid-toxicity deaths in Canada more than doubled, comprising more than 25% of deaths among young Canadians ( 5 ). The opioid overdose crisis in Canada has resulted in a substantial increase in deaths, hospital admissions, and blood-borne infections associated with substance use ( 6 , 7 ). While fatal overdoses have sharply risen nationwide, Western Canada has been predominantly impacted by this epidemic ( 5 ). In particular, Saskatchewan has reported a nearly 300% increase in opioid-toxicity deaths between 2010 and 2020 ( 8 ). The rise in overdose rates in Saskatchewan has been further accelerated by reduced access to harm reduction services and an increasingly unstable, illicit drug market ( 5 ). The high rates of opioid-related harms including illness, hospitalization, and death underscores the urgent need for expanded access to healthcare, social services, and harm reduction programs. The risks associated with opioid use are particularly acute for people who use drugs, especially people who inject drugs. Research suggests that approximately one-in-five people who inject drugs is at risk of a non-fatal overdose each year ( 9 ). The factors that mediate risk of overdose are complex and multifaceted, encompassing social, biological, political, and environmental dimensions. Structural vulnerabilities, such as poverty, housing instability, punitive policies (e.g., criminalization of drug use, restriction on harm reduction programs), and historical oppression, limit a person’s ability to engage in risk-reduction practices (e.g., needle exchange) and access interventions (e.g., substance use treatment) ( 10 ). Additionally, people who experience incarceration, homelessness, and sex work are disproportionately affected by poorer physical and psychological health outcomes ( 11 ). In many cases, substance use becomes a coping mechanism for these challenging conditions furthering the increase risk of overdose ( 12 ). The COVID-19 pandemic exacerbated the vulnerabilities faced by people who use drugs. Specifically, the public health measures during the COVID-19 pandemic may have led to a more adulterated, illicit drug supply ( 5 , 13 ). Border closures, which disrupted the supply of conventional methamphetamines and opioids, have reportedly resulted in greater contamination of illicit drugs with synthetic opioids, specifically fentanyl ( 13 ). Fentanyl is rapid-acting yet short-lasting, which in combination with high potency and an extremely narrow margin of safety, increases risk of addiction, withdrawal, and overdose ( 14 ). While many people who use drugs are aware of fentanyl and its risks, this population has little agency in detecting and avoiding fentanyl-adulterated substances due to an unpredictable drug supply ( 15 , 16 ). For example, in a study of 313 individuals who inject drugs in New York City, only 20% of participants reported recent, intentional fentanyl use, but 83% of subjects tested positive for fentanyl ( 15 ). Repeated, unintentional exposure to fentanyl may lead to physical dependence on the opioid and aversion to drugs with higher margins of safety, resulting in increased risk of overdose and other opioid-related harms ( 15 ). In response to the rise of opioid-related overdoses and deaths, harm reduction strategies have become essential public health interventions aimed at reducing the negative impacts of opioid use. As part of overdose prevention efforts, opioid overdose prevention education and naloxone distribution (OEND) programs have been developed. These brief interventions commonly detail the risk factors for overdose, signs and symptoms of an opioid overdose, steps to take in an overdose, and instructions on how to appropriately administer naloxone, which is subsequently accompanied by the provision of a naloxone kit to the participant ( 17 ). Naloxone is an opioid antagonist that reverses opioid-induced respiratory depression and prevents fatal overdose by displacing opioid agonists from receptor sites ( 18 , 19 ). The literature has demonstrated that naloxone training initiatives produce successful outcomes at the individual and community level. Numerous studies have highlighted the efficacy of OEND programs in providing people who use drugs and the general public knowledge to respond effectively to overdose ( 18 , 20 – 22 ). For example, Winhusen et al., reported that a harm reduction intervention increased knowledge of overdose, decreased perceived treatment barriers, and reduced overdose-risk behaviours ( 23 ). Similarly, Gaston et al., found that naloxone training significantly boosted participants’ confidence and willingness to intervene in overdose situations, with many reporting knowledge retention and a willingness to train others in overdose management months after the intervention ( 17 ). PWUD have additionally reported improvements in personal health, safety, and self-efficacy after receiving OEND training ( 24 ). Likewise, prior research suggests that greater feelings of hope elicited by the ability to reverse overdose has also been linked to willingness to engage in Human Immunodeficiency Virus (HIV) and Hepatitis C testing, demonstrating the substantial benefical effects of naloxone training on high-risk individuals ( 24 ). Beyond individual benefits, population-level impacts of naloxone programs have been observed. Communities implementing OEND initiatives have experienced substantial reductions in fatal overdose rates ( 24 , 25 ). Maxwell et al., reported that the implementation of naloxone training initiatives in Cook County, Chicago reversed a trend of increasing heroin overdose deaths and reduced overdose fatalities by 20% ( 24 ). Overall, naloxone training programs pose considerable benefits for individuals and communities, particularly people who use drugs. Geospatial Analysis and Harm Reduction Geographic information systems (GIS) can capture, store, analyze, and display spatial data ( 26 ). Geospatial analysis is a vital tool for visualizing health research, due to its ability to examine associations between location, environment, and disease ( 26 ). By mapping disease clusters in a given community, GIS can inform targeted investigations, allowing resources and interventions to be strategically deployed where they are most needed ( 26 ). In the context of the opioid crisis in North America, geospatial analysis has been employed to study spatial and demographic trends of opioid-related overdose. For example, Des Jarlais et al., identified hotspots for drug overdose and HIV transmission in New York City by mapping participants’ geographic patterns of high-risk behaviour according to zip or postal codes ( 27 ). On a larger scale, several American studies have utilized zip code data in electronic medical record databases to decipher areas with elevated opioid-related healthcare visits, opioid poisoning diagnoses, and emergency medical service use, improving understanding of geographic healthcare utilization patterns ( 28 – 30 ). Outside of tracking opioid-toxicity deaths, geospatial analysis can be equipped to analyze the distribution of harm reduction resources in a given area. Wong et al. measured the distance between the residences of methadone clinic clients and treatment centres in Hong Kong to assess the spatial distribution of patients and their access to treatment ( 31 ). Similarly, Abell-Hart et al. calculated the distance between opioid-overdose patients’ addresses to the nearest pharmacy that provided naloxone and buprenorphine ( 32 ). The authors discovered that areas without nearby naloxone-dispensing pharmacies significantly overlapped with the locations of many opioid-overdose patients. However, geospatial analysis based on patients’ zip codes may be insufficient in determining target sites for prevention efforts ( 32 ). People do not necessarily use opioids where they live, therefore targeting resources to home addresses may fail to amend a community’s opioid-related risk ( 28 ). Furthermore, many people who use drugs are homeless or transient, resulting in the undercounting and exclusion of this population under conventional address-based analysis ( 30 , 32 ). Consequently, innovative methods are needed to accurately deliver resources to marginalized, high risk populations. Project ReportNeedles.ca ReportNeedles.ca is a web-based platform developed by AIDS Programs South Saskatchewan (APSS) in Canada that was designed to address challenges surrounding community needle prevalence. Launched in April 2021, the platform allows community members to report the presence of discarded needles in public spaces. In fall 2022, APSS and the Eaton Lab at the University of Regina commenced a community-based research partnership for a rapid assessment and response system for harm reduction and HIV and sexually transmitted and blood borne infection (STBBI) prevention ( 33 ). These reports allow for the creation of geospatial data that can be utilized to map community needle incidence. Over time, these data can identify discarded used needle hotspots in Regina, enabling targeted harm reduction interventions, including Naloxone training in areas of highest need. By integrating community-sourced data with geospatial analysis, ReportNeedles.ca enhances the ability to deploy resources and develop targeted harm reduction strategies where they are most needed. We explore the integration of ReportNeedles.ca into harm reduction strategies in Regina, focusing on three key areas: needle collection, geospatial mapping of community needle incidence, and targeted Naloxone training. Through a comprehensive analysis of the data collected via ReportNeedles.ca and its application in harm reduction, this study aims to provide insights into the effectiveness of data-driven interventions in mitigating the impacts of the opioid crisis. Methods Data Sources Data were collected from 44 participants who completed pop-up Naloxone trainings between September 2023 and September 2024. The pop-up trainings occurred indoors at shopping centres and outdoors in parks. The team would arrive and setup the training area with signage and resources, then begin the training after approximately 15 minutes had passed as people congregated to participate. Survey data were collected at pop-up sites with pen and paper and later inputted and managed using Qualtrics software, a cloud-based software platform that allows for the creation, storage, and analysis of surveys. All participants who participated in Naloxone trainings completed a survey. By completing the survey, participants were provided with an honorarium of $ 10 Canadian. The study received ethics approval from the Research Ethics Board at the University of Regina (#236), and informed consent was obtained from all participants verbally. Measures Naloxone knowledge. A modified version of the Opioid Overdose Knowledge Scale (OOKS) was administered to evaluate knowledge of opioid overdose risk factors and deployment of naloxone ( 34 ). The OOKS consists of 61 true-false questions regarding 1) risk factors of overdose; 2) signs of overdose; 3) appropriate actions to take when managing an overdose; 4) knowledge of naloxone; and 5) administration of naloxone. Questions were re-worded with community consultation to focus on fentanyl usage which is more relevant to the current opioid crisis in Saskatchewan, Canada. Sociodemographic variables. Sociodemographic variables included race/ethnicity, gender (cisgender woman, cisgender man, transgender and gender expansive), sexual orientation, and housing. Geospatial data. Geospatial data were created from reported needles and needle pickup data from ReportNeedles.ca. The data included the location of where discarded needles were found in Regina, Saskatchewan. Analysis The analysis involved the creation of maps to explore geographic clusters of discarded needles in Regina, a non-walkable city ( 33 ). To examine the coverage of care and services, distance and walk time will be used as a proxy for access to services. A buffer analysis was conducted to create zones around APSS using walk time. To examine proximity to care walk time buffers were created within the ArcGIS software. A 30- minute walk buffer was created for APSS and pop-up sites. This approach of creating buffers allows us to analyze the accessibility of these centers based on walk time. Descriptive statistics using proportions were used to summarize Naloxone trainee knowledge. Geospatial analysis was conducted using ArcGIS and statistical analysis was conducted using R Statistical Software. Descriptive statistics using means, standard deviations, and frequencies were used to describe the sample. Results Between August 2023 and August 2024, a total of 328 reports were submitted on reportneedles.ca, of which 315 were successful resulting in the disposal of 2,836 needles (see Figs. 1 and 2 ). The mapping of reported needles revealed spatial clustering of discarded needles (see Fig. 1 ). This map shows the clustering of reported needles in particular neighbourhoods focused in the city centre such as Warehouse (n = 62), North Central (n = 57), Heritage (n = 28), Downtown (n = 12). However, needles were also reported in the surrounding suburbs. Similarly, the number of needles disposed of were highest in the city centre (See Fig. 2 ). Between two 6-month periods (Winter months [November - April] vs summer months [May - August]) we examined how needles report locations changed (See Fig. 3 ). Based on visual inspections of the maps it appears that discarded needles were still primarily reported in the city centre. However, during the summer months it appears that there is more variation in where needles are reported and multiple reports in suburban areas. Whereas, in the winter the needle reports were more concentrated in the city centre with few reports in suburban areas. Access to care was analyzed by examining a 15-minute walk time buffer to APSS and pop-up trainings (see Figs. 4 and 5 ). Based on visual inspections of the maps examining proximity to care the pop-up trainings allowed APSS to expand the reach of their services. Currently APSS is accessible by a 15-minute walk to primarily three neighbourhoods and is not accessible to many areas where needle have been reported. By expanding and offering pop-up sites for Naloxone trainings APSS is able to expand the accessibility of their services to cover more neighbourhoods and area. However, given the large number of needles and the city centre and limited resources naloxone trainings were not held in suburban areas. A total of 7 pop-up trainings occurred between August 2023 and August 2024. Pop-up trainings were focused on areas with high needle prevalence. A total of 44 participants were trained in overdose recognition and naloxone administration between August 2023 and September 2024. Participants were predominantly cisgender women (59.1%; n = 26) or cisgender men (29.5%; n = 13). The majority of participants were Indigenous (63.7%; n = 28) or White (34.1%; n = 15). The participants who attended the training had a mean age of 41.6 (SD = 14.6; Range: 17–73). Approximately 70% of the sample reported that the harm reduction centre was within a 15-minute walk of their residence. Results from the OOKS showed that participants were knowledgeable on opioid overdose and naloxone administration (See Table 1 for training results). The majority of participants (70.2%) correctly determined the risk factors of an opioid overdose. Training participants were largely successful at indicating signs of an opioid overdose (75.6%) but struggled to discern at least one incorrect symptom ( 39.3%). Regarding naloxone administration, the majority of participants were able to recognize the appropriate actions to take (83.7%) and inappropriate actions to avoid (93.8%) when managing an opioid overdose. While majority of the sample indicated the correct use of naloxone for opioid overdose (90.9%), a greater proportion erroneously suggested that naloxone could also reverse the effects of a stimulant (95.5%) and Benzodiazepines (93.2%). Over 93% of subjects successfully identified the administration route of naloxone and over 90% understood that naloxone injection should be delivered through thighs or upper arms. The majority of the sample accurately determined the length of onset (81.8%) and duration of naloxone (61.4%). Table 1 Opioid Overdose Knowledge Scale Items (n = 44) N Correct % Correct Risk Factors of Opioid Overdose Risk Which of the following factors increase the risk of a fentanyl (opioid) overdose? Taking larger than usual doses of fentanyl. 36 81.8% Switching from smoking to injecting fentanyl 28 63.6% Using heroin with other substances, such as alcohol or sleeping pills 32 72.7% Increase in fentanyl purity 27 61.4% Using fentanyl again after not having used for a while 35 79.5% Using fentanyl when no one else is present around 31 70.5% A long history of fentanyl use 30 68.2% Using heroin again soon after release from prison or from a detox treatment 28 63.6% Signs of Overdose Having blood-shot eyes (F) 9 20.5% Slow/shallow breathing 39 88.6% Lips, hands or feet turning blue 39 88.6% Loss of consciousness 39 88.6% Unresponsive 39 88.6% Seizures or convulsions 16 36.3% Deep snoring 27 61.4% Very small pupils 34 77.3% Agitated behaviour (F) 16 36.4% Rapid heartbeat (F) 18 60.9% Naloxone Knowledge and Administration Which of the following should be done when managing an opioid overdose? Call an ambulance 43 97.7% Stay with the person until an ambulance arrives. 39 88.6% Inject the person with salt solution or milk. (F) 42 95.5% Mouth to mouth resuscitation. 28 63.6% Give stimulants (e.g. cocaine or black coffee). (F) 40 90.9% Place the person in the recovery position (on their side with mouth clear). 35 79.5% Give Naloxone (opioid antidote). 41 93.2% Put the person in a bath of cold water. (F) 40 90.9% Check for breathing. 37 84.1% Check for blocked airways (nose and mouth). 35 79.5% Put the person in bed to sleep it off. (F) 43 97.3% What is naloxone used for? To reverse the effects of a fentanyl overdose (e.g. heroin, methadone). 40 90.9% To reverse the effects of a stimulant (e.g., crystal meth, cocaine) overdose. (F) 42 95.5% To reverse the effects of Benzodiazepines (e.g. Xanax, Ativan. (F) 41 93.2% How can naloxone be administered? Into a muscle (intramuscular) 41 93.2% Into a vein (intravenous) 2 4.5% Under the skin (subcutaneous) 4 9.1% Swallowing liquid/tablet (F) 43 97.3% Where is the most recommended place for non-expert to administer naloxone? Outside of thighs or upper arms 40 90.9% Any vein (F) 43 97.3% Heart (F) 0 0% By mouth (F) 43 97.3% How long does naloxone take to start having an effect? 2–5 minutes 36 81.8% 6–10 minutes (F) 4 9.1% 11–20 minutes (F) 1 2.3% 21–40 minutes (F) 0 0% How long do the effects of naloxone last for? Less than 20 minutes (F) 5 11.4% About 1 hour 27 61.4% 1 to 6 hours (F) 3 6.8% 6 to 12 hours (F) 0 Tick each correct statement If the first dose of naloxone has no effect a second dose can be given (T) 38 86.4% There is no need to call for an ambulance if I know how to manage an overdose (F) 38 86.4% Someone can overdose again even after having received naloxone (T) 37 84.1% The effect of naloxone is shorter than the effect of heroin and methadone (T) 21 47.7% After recovering from an opioid overdose, the person must not take any heroin, but it is OK for them to drink alcohol or take sleeping tablets (F) 42 95.5% Naloxone can provoke withdrawal symptoms (T) 21 47.7% T = True; F = False Discussion The study results suggest that pop-up brief opioid education and naloxone training interventions are a feasible approach to promoting knowledge about opioid overdose management and naloxone administration. Following the training participants demonstrated strong knowledge of opioid overdose and awareness of appropriate procedures to follow in the event of an overdose. Recent studies corroborate findings that naloxone trainings significantly improve subjects’ awareness, knowledge, and confidence regarding overdose management ( 22 , 23 , 35 ). Prior research suggest that participants show consistent retention of overdose management knowledge of up to 6 months after interventions ( 17 ). In our study, multiple naloxone training sessions occurred on or within walking distance of an urban reserve in Regina. This enabled the pilot study to successfully recruit a majority Indigenous sample, fostering skills in overdose management and naloxone administration in a community that is disproportionately vulnerable to drug-related harms. Prior research has shown that Indigenous Canadians are more likely to have opioids use disorders, and are at higher risk of drug-toxicity deaths, and are more vulnerable to HIV/STBBI infections, but reportedly view harm reduction programming as culturally incompatible ( 36 , 37 ). In the literature, few studies appear to specifically focus on naloxone training initiatives directed at Indigenous populations. Levine et al. describes how Indigenous-led “Not-Just-Naloxone" workshops in British Columbia provided culturally relevant harm reduction education and training, increasing knowledge, awareness, and self-efficacy among First Nations participants ( 38 ). In our study, most participants lived within walking distance of the pop-up naloxone trainings. Prior research has found that transportation is a common barrier to the initiation and engagement of substance use treatment ( 39 ). Regina is a non-walkable, car-centric city, which limits the ability of made marginalized populations to access healthcare services ( 33 ). As depicted in the map data, there are moderate levels of community needle prevalence in Regina’s surrounding neighbourhoods, far from the city’s harm reduction services. Conversely, approximately 70% of this study’s sample reported that the pop-up naloxone training session was within a 15-minute walk to their residence. Pop-up interventions may increase access to and uptake of harm reduction services among underserved communities with limited transportation options. GIS mapping in the health science literature has been utilized to map the distribution of resources and identify regional health inequities ( 28 , 30 , 32 , 40 ). While prior studies have been largely retrospective and have not integrated GIS into health programming, the findings of this study demonstrate that real-time geospatial data on community needle prevalence can successfully facilitate targeted harm reduction interventions in areas of highest need. Additionally, previous studies, particularly in Canada, have largely mapped overdose-related data onto cities ( 41 , 42 ). Geospatial analysis enables the creation of tailored community-based interventions for underserved populations, specifically people who use drugs, who may not access conventional healthcare services for a variety of reasons. People who use drugs who are transient have barriers to accessing healthcare ( 30 , 32 ). Geospatial analysis of needle prevalence data enables health interventions to adapt to the migratory patterns of transient populations. GIS-informed, community-based education, screening, and treatment interventions may increase engagement in care as well as reduce rates of overdose and HIV/STBBI transmission. Future directions on this research should focus on naloxone misconceptions to improve training outcomes. A large proportion of participants in this study incorrectly reported that naloxone can be used to reverse a stimulant or Benzodiazepine-related overdose. Additionally, many subjects erroneously indicated that calling an ambulance is unnecessary after administering naloxone, which may be attributed to poor experiences with healthcare and policing among PWUD and Indigenous peoples ( 43 , 44 ). Belief in naloxone misconceptions may result in inappropriate and detrimental use. Furthermore, neglecting to alert emergency services after an overdose may lead to the oversight of overdose-related complications, such as heart irregularities and pneumonia ( 45 ). Future research can investigate the prevalence of naloxone misconceptions among people who use drugs and guide OEND interventions to dispel these myths. Further work is also needed to rebuild the relationship between healthcare services, police, and PWUD, specifically Indigenous individuals who use substances. More naloxone trainings should be targeted for Indigenous populations in Canada, who are at higher risk of overdose. Indigenous populations in Canada are overrepresented within drug toxicity deaths, HIV/STBBI infections, and Hepatitis C cases ( 8 , 46 ). Additionally, greater involvement of Indigenous people, specifically those with lived and living experience of drug use, within research is essential in developing culturally tailored initiatives and increasing engagement in preventative health services. Utilizing GIS analysis to target interventions to underserved populations, specifically people who use drugs is a novel approach that shows promise. Recent studies have utilized geospatial analysis to target HIV/STBBI testing interventions ( 47 ). This study demonstrates how geospatial analysis of community needle prevalence can guide harm reduction interventions to reach transient, marginalized populations. Future studies may explore the application of geospatial analysis for other infectious diseases and health interventions. Additionally, there is a limited focus on the suburbs (i.e., residential areas that are located on the outskirts or periphery of a central city or urban area.) in the literature. Drug-related harms may be overlooked in these regions, even though these communities have similarly limited access to harm reduction supports as more rural areas. Pop-up interventions can expand the reach of harm reduction organizations and improve the availability of overdose prevention services for “hidden” populations in need. Limitations This study contains several limitations. Firstly, no pre-test and follow-up assessments were conducted, meaning that changes in or retention of knowledge regarding overdose and naloxone administration cannot be determined. Without a pre-test it is unclear whether participants had prior familiarity with opioid overdose management and naloxone administration making it difficult to assess the effectiveness and utility of the training. However, the focus of this study was on the implementation of the geospatial approach as prior research has shown the effectiveness of Naloxone trainings. Another limitation of this study is related to sampling. The training sessions likely attracted a self-selected group of individuals who were willing and able to participate. This bias potentially results in a group different that the broader population of people who use substances. For example, those with less familiarity with naloxone may be underrepresented. Additionally, despite the wide distribution of discarded needles in Regina suburbs, pop-up interventions were limited to areas of highest need, due to limited resources. Furthermore, the research team did not inquire participants on their history of drug use. Therefore, while the pop-up naloxone training sessions aimed to reach individuals who use substances in areas of high drug activity, it remains unclear whether people who use drugs, who are best positioned to benefit from naloxone training and reverse overdoses, engaged in the OEND interventions. Lastly, ReportNeedles.ca is a tool that depends on user reports of discarded needles in the community. Consequently, ReportNeedles.ca may be impacted by reporting bias and underreporting, since users may be unequally distributed within Regina, leading to certain regions having more comprehensive and up-to-date data than other areas ( 33 ). Conclusion This article presents promising results from a geospatial, community-based needle collection and naloxone training initiative. In one non-walkable, medium-sized Canadian city, injection drug use is dispersed throughout the city and outside walking distance to healthcare and harm reduction services. Developing strategies for culturally tailored, geo-located street-outreach may help intervene during drug-related crises. Abbreviations OEND Opioid Overdose Prevention Education and Naloxone Distribution HIV Human Immunodeficiency Virus STBBI Sexually Transmitted and Blood Borne Infection Declarations Author Contribution NP conceptualized the study, conducted the data cleaning and analysis, drafted the manuscript, and edited the manuscript. SV, VR conceptualized the study, and provided critical revision of the manuscript. AE conceptualized the study, contributed to the analysis, drafted and provided critical revision of the manuscript, and provided supervision. 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Can we prevent drug related deaths by training opioid users to recognise and manage overdoses? Harm Reduct J. 2009;6(1):26. Lott DC, Rhodes J. Opioid overdose and naloxone education in a substance use disorder treatment program. Am J Addict. 2016;25(3):221–6. Wenger LD, Doe-Simkins M, Wheeler E, Ongais L, Morris T, Bluthenthal RN, et al. Best practices for community-based overdose education and naloxone distribution programs: results from using the Delphi approach. Harm Reduct J. 2022;19(1):55. Rowe C, Santos GM, Vittinghoff E, Wheeler E, Davidson P, Coffin PO. Predictors of participant engagement and naloxone utilization in a community-based naloxone distribution program. Addict Abingdon Engl. 2015;110(8):1301–10. Pietrusza LM, Puskar KR, Ren D, Mitchell AM. Evaluation of an Opiate Overdose Educational Intervention and Naloxone Prescribing Program in Homeless Adults Who Use Opiates. J Addict Nurs. 2018;29(3):188–95. Black E, Monds LA, Chan B, Brett J, Hutton JE, Acheson L, et al. Overdose and take-home naloxone in emergency settings: A pilot study examining feasibility of delivering brief interventions addressing overdose prevention with ‘take-home naloxone’ in emergency departments. Emerg Med Australas. 2022;34(4):509–18. Winhusen T, Walley A, Fanucchi LC, Hunt T, Lyons M, Lofwall M, et al. The Opioid-overdose Reduction Continuum of Care Approach (ORCCA): Evidence-based practices in the HEALing Communities Study. Drug Alcohol Depend. 2020;217:108325. Maxwell S. Prescribing Naloxone to Actively Injecting Heroin Users. J Addict Dis [Internet]. 2006 Oct 17 [cited 2024 Dec 13]; Available from: https://www.tandfonline.com/doi/abs/10.1300/J069v25n03_11 Walley AY, Xuan Z, Hackman HH, Quinn E, Doe-Simkins M, Sorensen-Alawad A, et al. Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis. BMJ. 2013;346:f174. Trooskin SB, Poceta J, Towey CM, Yolken A, Rose JS, Luqman NL, et al. Results from a Geographically Focused, Community-Based HCV Screening, Linkage-to-Care and Patient Navigation Program. J Gen Intern Med. 2015;30(7):950–7. Des Jarlais D, Uuskula A, Talu A, Barnes DM, Raag M, Arasteh K, et al. Implementing an Updated Break the Cycle Intervention to Reduce Initiating Persons into Injecting Drug Use in an Eastern European and a US opioid epidemic Setting. AIDS Behav. 2019;23(9):2304–14. Dworkis DA, Taylor LA, Peak DA, Bearnot B. Geospatial analysis of emergency department visits for targeting community-based responses to the opioid epidemic. PLoS ONE. 2017;12(3):e0175115. Dworkis DA, Weiner SG, Liao VT, Rabickow D, Goldberg SA. Geospatial Clustering of Opioid-Related Emergency Medical Services Runs for Public Deployment of Naloxone. West J Emerg Med. 2018;19(4):641–8. Chen X, Hou W, Rashidian S, Wang Y, Zhao X, Leibowitz GS, et al. A large-scale retrospective study of opioid poisoning in New York State with implications for targeted interventions. Sci Rep. 2021;11:5152. Wong NS, Lee SS, Lin H. Assessing the spatial distribution of methadone clinic clients and their access to treatment. Harm Reduct J. 2010;7:14. Abell-Hart K, Rashidian S, Teng D, Rosenthal RN, Wang F. Where Opioid Overdose Patients Live Far From Treatment: Geospatial Analysis of Underserved Populations in New York State. JMIR Public Health Surveill. 2022;8(4):e32133. Eaton AD, Pang N, Varghese SM, Reddy VD, Ross S, Novotna G et al. ReportNeedles. ca: A real-time needle collection tool to foster community health partnerships. Prog Community Health Partnersh. 2024. Williams AV, Strang J, Marsden J. Development of Opioid Overdose Knowledge (OOKS) and Attitudes (OOAS) Scales for take-home naloxone training evaluation. Drug Alcohol Depend. 2013;132(1):383–6. Ashrafioun L, Gamble S, Herrmann M, Baciewicz G. Evaluation of knowledge and confidence following opioid overdose prevention training: A comparison of types of training participants and naloxone administration methods. Subst Abuse. 2016;37(1):76–81. Wardman D, Quantz D. Harm reduction services for British Columbia’s First Nation population: a qualitative inquiry into opportunities and barriers for injection drug users. Harm Reduct J. 2006;3:30. Richer A, Roddy AL. Opioid use in indigenous populations: indigenous perspectives and directions in culturally responsive care. J Soc Work Pract Addict. 2022;22(3):255–63. Levine S, Medley A, Norton A. Putting Indigenous Harm Reduction to Work: Developing and Evaluating Not Just Naloxone. Int J Indig Health [Internet]. 2021 Jan 25 [cited 2024 Dec 13];16(2). Harwerth J. Transportation Barriers for Substance Abuse and Mental Health Outpatient Treatment Programs: a Scoping Review. Soc Work Theses [Internet]; 2020. Pang N, Nagata JM, Testa A, Ganson KT. Mapping eating disorders in adolescents and young adults: an investigation of geographic distribution and access to care in Ontario, Canada. J Eat Disord. 2024;12(1):136. Rammohan I, Gaines T, Scheim A, Bayoumi A, Werb D. Overdose mortality incidence and supervised consumption services in Toronto, Canada: an ecological study and spatial analysis. Lancet Public Health. 2024;9(2):e79–87. Amram O, Socías E, Nosova E, Kerr T, Wood E, DeBeck K, et al. Density of low-barrier opioid agonist clinics and risk of non-fatal overdose during a community-wide overdose crisis: A spatial analysis. Spat Spatio-Temporal Epidemiol. 2019;30:100288. Selfridge M, Greer A, Card KG, Macdonald S, Pauly B. It’s like super structural - Overdose experiences of youth who use drugs and police in three non-metropolitan cities across British Columbia. Int J Drug Policy. 2020;76:102623. Chan Carusone S, Guta A, Robinson S, Tan DH, Cooper C, O’Leary B, et al. Maybe if I stop the drugs, then maybe they’d care?—hospital care experiences of people who use drugs. Harm Reduct J. 2019;16:16. Dezfulian C, Orkin AM, Maron BA, Elmer J, Girotra S, Gladwin MT et al. Opioid-Associated Out-of-Hospital Cardiac Arrest: Distinctive Clinical Features and Implications for Health Care and Public Responses: A Scientific Statement From the American Heart Association. Circulation [Internet]. 2021 Apr 20 [cited 2024 Dec 16]. Public Health Agency of. Estimates of HIV incidence, prevalence and Canada’s progress on meeting the 90-90-90 HIV targets, 2020 [Internet]. 2022 Jul [cited 2024 Dec 16]. Available from: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/estimates-hiv-incidence-prevalence-canada-meeting-90-90-90-targets-2020.html Meyer-Rath G, McGillen JB, Cuadros DF, Hallett TB, Bhatt S, Wabiri N, et al. Targeting the right interventions to the right people and places: the role of geospatial analysis in HIV program planning. AIDS. 2018;32(8):957. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 21 Jan, 2025 Editor assigned by journal 16 Jan, 2025 Submission checks completed at journal 16 Jan, 2025 First submitted to journal 15 Jan, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5836079","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":409731839,"identity":"3ce09509-214f-480e-8b7e-d0bb9346a25e","order_by":0,"name":"Nelson Pang","email":"","orcid":"","institution":"University of Regina","correspondingAuthor":false,"prefix":"","firstName":"Nelson","middleName":"","lastName":"Pang","suffix":""},{"id":409731841,"identity":"d5dabc29-369b-4442-a1e2-2fe326f03d73","order_by":1,"name":"Shiny Mary Varghese","email":"","orcid":"","institution":"AIDS Programs South Saskatchewan","correspondingAuthor":false,"prefix":"","firstName":"Shiny","middleName":"Mary","lastName":"Varghese","suffix":""},{"id":409731842,"identity":"d64a6bba-715c-44fe-a9b1-1f8b666f8786","order_by":2,"name":"Vidya Dhar Reddy","email":"","orcid":"","institution":"AIDS Programs South Saskatchewan","correspondingAuthor":false,"prefix":"","firstName":"Vidya","middleName":"Dhar","lastName":"Reddy","suffix":""},{"id":409731844,"identity":"88c8f410-36dd-4b74-9a11-a08028860915","order_by":3,"name":"Tashia Acoose","email":"","orcid":"","institution":"AIDS Programs South Saskatchewan","correspondingAuthor":false,"prefix":"","firstName":"Tashia","middleName":"","lastName":"Acoose","suffix":""},{"id":409731846,"identity":"6fa67bcc-2648-47e5-9e63-59fa7183e415","order_by":4,"name":"Erin Hidlebaugh","email":"","orcid":"","institution":"AIDS Programs South Saskatchewan","correspondingAuthor":false,"prefix":"","firstName":"Erin","middleName":"","lastName":"Hidlebaugh","suffix":""},{"id":409731847,"identity":"c84a6f2b-740e-47b0-aa67-218863cb3e73","order_by":5,"name":"Sandra Kwan","email":"","orcid":"","institution":"University of Regina","correspondingAuthor":false,"prefix":"","firstName":"Sandra","middleName":"","lastName":"Kwan","suffix":""},{"id":409731850,"identity":"972e76d5-d22d-4990-baea-662aa447c2d8","order_by":6,"name":"Megan Rowe","email":"","orcid":"","institution":"University of Regina","correspondingAuthor":false,"prefix":"","firstName":"Megan","middleName":"","lastName":"Rowe","suffix":""},{"id":409731852,"identity":"4219f954-aa85-4376-836d-5e9df8058429","order_by":7,"name":"Priscilla Medeiros","email":"","orcid":"","institution":"University of Toronto","correspondingAuthor":false,"prefix":"","firstName":"Priscilla","middleName":"","lastName":"Medeiros","suffix":""},{"id":409731854,"identity":"bf449100-ccb4-45ee-b9ac-35dbd78526b1","order_by":8,"name":"Paul Shuper","email":"","orcid":"","institution":"Centre for Addiction and Mental Health","correspondingAuthor":false,"prefix":"","firstName":"Paul","middleName":"","lastName":"Shuper","suffix":""},{"id":409731856,"identity":"a0ba0857-f069-46df-80a0-70fa0f98cf44","order_by":9,"name":"Francisco Ibáñez-Carrasco","email":"","orcid":"","institution":"University of Toronto","correspondingAuthor":false,"prefix":"","firstName":"Francisco","middleName":"","lastName":"Ibáñez-Carrasco","suffix":""},{"id":409731857,"identity":"93f7fc1f-fac0-49a9-aac7-4447acb2c236","order_by":10,"name":"Daniel Grace","email":"","orcid":"","institution":"University of Toronto","correspondingAuthor":false,"prefix":"","firstName":"Daniel","middleName":"","lastName":"Grace","suffix":""},{"id":409731859,"identity":"934cc41a-24d6-4ca2-b1dd-d8d279e03df6","order_by":11,"name":"Andrew Eaton","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/UlEQVRIiWNgGAWjYHACAwTzA4hgJloLGwMD4wyStTDzEOMq/tnN2z58bGOQ45/ffOyxbds9OXl33oMfGGrscGqRuHOseObMNgZjiWNs6ca5bcXGhof5kiUYjiXjtuZGjjEz7zaGxIZjPGbSuW0JiRubeQwkGBtw+0gepOXvNob6+SAtlm0J9UAtxj8YG+pxajEAaWHcxpBgANLC2JaQIM/MYwa05TBOLYY30ooZe/9JGG48lpYm2XMuwXADUItFwrHjOLXI3UjezPDjjI283OHDxyR+lCXIy/efMb7xoaYat/chQALJqQeARAIhDShAvoEk5aNgFIyCUTACAAB+F0vGWmCzywAAAABJRU5ErkJggg==","orcid":"","institution":"University of Regina","correspondingAuthor":true,"prefix":"","firstName":"Andrew","middleName":"","lastName":"Eaton","suffix":""}],"badges":[],"createdAt":"2025-01-15 16:23:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5836079/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5836079/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":76631814,"identity":"77e72742-287f-431e-a23d-c2bc7c61a3e5","added_by":"auto","created_at":"2025-02-19 06:51:43","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":51693,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eLocation of Reported Needles between August 2023 - August 2024\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5836079/v1/65804b2efb097a69b760bb30.jpg"},{"id":76632977,"identity":"c1001f7d-53f5-4a0b-9912-d8d039737280","added_by":"auto","created_at":"2025-02-19 06:59:43","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":54394,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eNumber of reported needles picked up\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Picture2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5836079/v1/4bdcb25ab11240705294ae4c.jpg"},{"id":76631479,"identity":"44672bbd-6a97-4095-aae0-9d22f7af8e15","added_by":"auto","created_at":"2025-02-19 06:43:43","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":33861,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eReported Needles by Season\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Picture3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5836079/v1/639d8107c178befa6f5843af.jpg"},{"id":76631480,"identity":"bbdb018c-d92a-4390-8ce3-1ab10f817c8c","added_by":"auto","created_at":"2025-02-19 06:43:43","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":22967,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e15 Minute Walk Buffer to APSS\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Picture4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5836079/v1/6498f272c395168ff0230316.jpg"},{"id":76631484,"identity":"659380e6-726a-4df0-a961-5acdf3223283","added_by":"auto","created_at":"2025-02-19 06:43:43","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":29264,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e15 Minute Walk Buffer to Popup\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Picture5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5836079/v1/50e9226e52fb016052a471eb.jpg"},{"id":76633466,"identity":"472f567e-9b37-43e7-9d44-00c49f235909","added_by":"auto","created_at":"2025-02-19 07:07:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1212991,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5836079/v1/9ffa3c4b-aa66-40b2-a2fb-1d13f4c6268d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Mapping needles, reducing harm: Findings from a geospatial, community-based needle collection and naloxone training initiative in Saskatchewan, Canada","fulltext":[{"header":"Background","content":"\u003cp\u003eThe opioid crisis is a major public health issue globally including Canada, the United States and Europe (\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Between 2019 and 2021, the annual number of opioid-toxicity deaths in Canada more than doubled, comprising more than 25% of deaths among young Canadians (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The opioid overdose crisis in Canada has resulted in a substantial increase in deaths, hospital admissions, and blood-borne infections associated with substance use (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). While fatal overdoses have sharply risen nationwide, Western Canada has been predominantly impacted by this epidemic (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). In particular, Saskatchewan has reported a nearly 300% increase in opioid-toxicity deaths between 2010 and 2020 (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The rise in overdose rates in Saskatchewan has been further accelerated by reduced access to harm reduction services and an increasingly unstable, illicit drug market (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The high rates of opioid-related harms including illness, hospitalization, and death underscores the urgent need for expanded access to healthcare, social services, and harm reduction programs.\u003c/p\u003e \u003cp\u003eThe risks associated with opioid use are particularly acute for people who use drugs, especially people who inject drugs. Research suggests that approximately one-in-five people who inject drugs is at risk of a non-fatal overdose each year (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The factors that mediate risk of overdose are complex and multifaceted, encompassing social, biological, political, and environmental dimensions. Structural vulnerabilities, such as poverty, housing instability, punitive policies (e.g., criminalization of drug use, restriction on harm reduction programs), and historical oppression, limit a person\u0026rsquo;s ability to engage in risk-reduction practices (e.g., needle exchange) and access interventions (e.g., substance use treatment) (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Additionally, people who experience incarceration, homelessness, and sex work are disproportionately affected by poorer physical and psychological health outcomes (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). In many cases, substance use becomes a coping mechanism for these challenging conditions furthering the increase risk of overdose (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe COVID-19 pandemic exacerbated the vulnerabilities faced by people who use drugs. Specifically, the public health measures during the COVID-19 pandemic may have led to a more adulterated, illicit drug supply (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Border closures, which disrupted the supply of conventional methamphetamines and opioids, have reportedly resulted in greater contamination of illicit drugs with synthetic opioids, specifically fentanyl (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Fentanyl is rapid-acting yet short-lasting, which in combination with high potency and an extremely narrow margin of safety, increases risk of addiction, withdrawal, and overdose (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). While many people who use drugs are aware of fentanyl and its risks, this population has little agency in detecting and avoiding fentanyl-adulterated substances due to an unpredictable drug supply (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). For example, in a study of 313 individuals who inject drugs in New York City, only 20% of participants reported recent, intentional fentanyl use, but 83% of subjects tested positive for fentanyl (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Repeated, unintentional exposure to fentanyl may lead to physical dependence on the opioid and aversion to drugs with higher margins of safety, resulting in increased risk of overdose and other opioid-related harms (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn response to the rise of opioid-related overdoses and deaths, harm reduction strategies have become essential public health interventions aimed at reducing the negative impacts of opioid use. As part of overdose prevention efforts, opioid overdose prevention education and naloxone distribution (OEND) programs have been developed. These brief interventions commonly detail the risk factors for overdose, signs and symptoms of an opioid overdose, steps to take in an overdose, and instructions on how to appropriately administer naloxone, which is subsequently accompanied by the provision of a naloxone kit to the participant (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Naloxone is an opioid antagonist that reverses opioid-induced respiratory depression and prevents fatal overdose by displacing opioid agonists from receptor sites (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). The literature has demonstrated that naloxone training initiatives produce successful outcomes at the individual and community level.\u003c/p\u003e \u003cp\u003eNumerous studies have highlighted the efficacy of OEND programs in providing people who use drugs and the general public knowledge to respond effectively to overdose (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). For example, Winhusen et al., reported that a harm reduction intervention increased knowledge of overdose, decreased perceived treatment barriers, and reduced overdose-risk behaviours (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Similarly, Gaston et al., found that naloxone training significantly boosted participants\u0026rsquo; confidence and willingness to intervene in overdose situations, with many reporting knowledge retention and a willingness to train others in overdose management months after the intervention (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). PWUD have additionally reported improvements in personal health, safety, and self-efficacy after receiving OEND training (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Likewise, prior research suggests that greater feelings of hope elicited by the ability to reverse overdose has also been linked to willingness to engage in Human Immunodeficiency Virus (HIV) and Hepatitis C testing, demonstrating the substantial benefical effects of naloxone training on high-risk individuals (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Beyond individual benefits, population-level impacts of naloxone programs have been observed. Communities implementing OEND initiatives have experienced substantial reductions in fatal overdose rates (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Maxwell et al., reported that the implementation of naloxone training initiatives in Cook County, Chicago reversed a trend of increasing heroin overdose deaths and reduced overdose fatalities by 20% (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Overall, naloxone training programs pose considerable benefits for individuals and communities, particularly people who use drugs.\u003c/p\u003e\n\u003ch3\u003eGeospatial Analysis and Harm Reduction\u003c/h3\u003e\n\u003cp\u003eGeographic information systems (GIS) can capture, store, analyze, and display spatial data (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Geospatial analysis is a vital tool for visualizing health research, due to its ability to examine associations between location, environment, and disease (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). By mapping disease clusters in a given community, GIS can inform targeted investigations, allowing resources and interventions to be strategically deployed where they are most needed (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the context of the opioid crisis in North America, geospatial analysis has been employed to study spatial and demographic trends of opioid-related overdose. For example, Des Jarlais et al., identified hotspots for drug overdose and HIV transmission in New York City by mapping participants\u0026rsquo; geographic patterns of high-risk behaviour according to zip or postal codes (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). On a larger scale, several American studies have utilized zip code data in electronic medical record databases to decipher areas with elevated opioid-related healthcare visits, opioid poisoning diagnoses, and emergency medical service use, improving understanding of geographic healthcare utilization patterns (\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Outside of tracking opioid-toxicity deaths, geospatial analysis can be equipped to analyze the distribution of harm reduction resources in a given area. Wong et al. measured the distance between the residences of methadone clinic clients and treatment centres in Hong Kong to assess the spatial distribution of patients and their access to treatment (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Similarly, Abell-Hart et al. calculated the distance between opioid-overdose patients\u0026rsquo; addresses to the nearest pharmacy that provided naloxone and buprenorphine (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). The authors discovered that areas without nearby naloxone-dispensing pharmacies significantly overlapped with the locations of many opioid-overdose patients. However, geospatial analysis based on patients\u0026rsquo; zip codes may be insufficient in determining target sites for prevention efforts (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). People do not necessarily use opioids where they live, therefore targeting resources to home addresses may fail to amend a community\u0026rsquo;s opioid-related risk (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Furthermore, many people who use drugs are homeless or transient, resulting in the undercounting and exclusion of this population under conventional address-based analysis (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Consequently, innovative methods are needed to accurately deliver resources to marginalized, high risk populations.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eProject ReportNeedles.ca\u003c/h2\u003e \u003cp\u003eReportNeedles.ca is a web-based platform developed by AIDS Programs South Saskatchewan (APSS) in Canada that was designed to address challenges surrounding community needle prevalence. Launched in April 2021, the platform allows community members to report the presence of discarded needles in public spaces. In fall 2022, APSS and the Eaton Lab at the University of Regina commenced a community-based research partnership for a rapid assessment and response system for harm reduction and HIV and sexually transmitted and blood borne infection (STBBI) prevention (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). These reports allow for the creation of geospatial data that can be utilized to map community needle incidence. Over time, these data can identify discarded used needle hotspots in Regina, enabling targeted harm reduction interventions, including Naloxone training in areas of highest need. By integrating community-sourced data with geospatial analysis, ReportNeedles.ca enhances the ability to deploy resources and develop targeted harm reduction strategies where they are most needed. We explore the integration of ReportNeedles.ca into harm reduction strategies in Regina, focusing on three key areas: needle collection, geospatial mapping of community needle incidence, and targeted Naloxone training. Through a comprehensive analysis of the data collected via ReportNeedles.ca and its application in harm reduction, this study aims to provide insights into the effectiveness of data-driven interventions in mitigating the impacts of the opioid crisis.\u003c/p\u003e \u003c/div\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData Sources\u003c/h2\u003e \u003cp\u003eData were collected from 44 participants who completed pop-up Naloxone trainings between September 2023 and September 2024. The pop-up trainings occurred indoors at shopping centres and outdoors in parks. The team would arrive and setup the training area with signage and resources, then begin the training after approximately 15 minutes had passed as people congregated to participate. Survey data were collected at pop-up sites with pen and paper and later inputted and managed using Qualtrics software, a cloud-based software platform that allows for the creation, storage, and analysis of surveys. All participants who participated in Naloxone trainings completed a survey. By completing the survey, participants were provided with an honorarium of \u003cspan\u003e$\u003c/span\u003e10 Canadian. The study received ethics approval from the Research Ethics Board at the University of Regina (#236), and informed consent was obtained from all participants verbally.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cp\u003e \u003cb\u003eNaloxone knowledge.\u003c/b\u003e A modified version of the Opioid Overdose Knowledge Scale (OOKS) was administered to evaluate knowledge of opioid overdose risk factors and deployment of naloxone (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). The OOKS consists of 61 true-false questions regarding 1) risk factors of overdose; 2) signs of overdose; 3) appropriate actions to take when managing an overdose; 4) knowledge of naloxone; and 5) administration of naloxone. Questions were re-worded with community consultation to focus on fentanyl usage which is more relevant to the current opioid crisis in Saskatchewan, Canada.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSociodemographic variables.\u003c/b\u003e Sociodemographic variables included race/ethnicity, gender (cisgender woman, cisgender man, transgender and gender expansive), sexual orientation, and housing.\u003c/p\u003e \u003cp\u003e \u003cb\u003eGeospatial data.\u003c/b\u003e Geospatial data were created from reported needles and needle pickup data from ReportNeedles.ca. The data included the location of where discarded needles were found in Regina, Saskatchewan.\u003c/p\u003e\n\u003ch3\u003eAnalysis\u003c/h3\u003e\n\u003cp\u003eThe analysis involved the creation of maps to explore geographic clusters of discarded needles in Regina, a non-walkable city (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). To examine the coverage of care and services, distance and walk time will be used as a proxy for access to services. A buffer analysis was conducted to create zones around APSS using walk time. To examine proximity to care walk time buffers were created within the ArcGIS software. A 30- minute walk buffer was created for APSS and pop-up sites. This approach of creating buffers allows us to analyze the accessibility of these centers based on walk time. Descriptive statistics using proportions were used to summarize Naloxone trainee knowledge. Geospatial analysis was conducted using ArcGIS and statistical analysis was conducted using R Statistical Software. Descriptive statistics using means, standard deviations, and frequencies were used to describe the sample.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eBetween August 2023 and August 2024, a total of 328 reports were submitted on reportneedles.ca, of which 315 were successful resulting in the disposal of 2,836 needles (see Figs.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The mapping of reported needles revealed spatial clustering of discarded needles (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). This map shows the clustering of reported needles in particular neighbourhoods focused in the city centre such as Warehouse (n\u0026thinsp;=\u0026thinsp;62), North Central (n\u0026thinsp;=\u0026thinsp;57), Heritage (n\u0026thinsp;=\u0026thinsp;28), Downtown (n\u0026thinsp;=\u0026thinsp;12). However, needles were also reported in the surrounding suburbs. Similarly, the number of needles disposed of were highest in the city centre (See Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eBetween two 6-month periods (Winter months [November - April] vs summer months [May - August]) we examined how needles report locations changed (See Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Based on visual inspections of the maps it appears that discarded needles were still primarily reported in the city centre. However, during the summer months it appears that there is more variation in where needles are reported and multiple reports in suburban areas. Whereas, in the winter the needle reports were more concentrated in the city centre with few reports in suburban areas.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAccess to care was analyzed by examining a 15-minute walk time buffer to APSS and pop-up trainings (see Figs.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e and \u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Based on visual inspections of the maps examining proximity to care the pop-up trainings allowed APSS to expand the reach of their services. Currently APSS is accessible by a 15-minute walk to primarily three neighbourhoods and is not accessible to many areas where needle have been reported. By expanding and offering pop-up sites for Naloxone trainings APSS is able to expand the accessibility of their services to cover more neighbourhoods and area. However, given the large number of needles and the city centre and limited resources naloxone trainings were not held in suburban areas.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eA total of 7 pop-up trainings occurred between August 2023 and August 2024. Pop-up trainings were focused on areas with high needle prevalence. A total of 44 participants were trained in overdose recognition and naloxone administration between August 2023 and September 2024. Participants were predominantly cisgender women (59.1%; n\u0026thinsp;=\u0026thinsp;26) or cisgender men (29.5%; n\u0026thinsp;=\u0026thinsp;13). The majority of participants were Indigenous (63.7%; n\u0026thinsp;=\u0026thinsp;28) or White (34.1%; n\u0026thinsp;=\u0026thinsp;15). The participants who attended the training had a mean age of 41.6 (SD\u0026thinsp;=\u0026thinsp;14.6; Range: 17\u0026ndash;73). Approximately 70% of the sample reported that the harm reduction centre was within a 15-minute walk of their residence.\u003c/p\u003e \u003cp\u003eResults from the OOKS showed that participants were knowledgeable on opioid overdose and naloxone administration (See Table\u0026nbsp;1 for training results). The majority of participants (70.2%) correctly determined the risk factors of an opioid overdose. Training participants were largely successful at indicating signs of an opioid overdose (75.6%) but struggled to discern at least one incorrect symptom \u003cem\u003e(\u003c/em\u003e39.3%). Regarding naloxone administration, the majority of participants were able to recognize the appropriate actions to take (83.7%) and inappropriate actions to avoid (93.8%) when managing an opioid overdose. While majority of the sample indicated the correct use of naloxone for opioid overdose (90.9%), a greater proportion erroneously suggested that naloxone could also reverse the effects of a stimulant (95.5%) and Benzodiazepines (93.2%). Over 93% of subjects successfully identified the administration route of naloxone and over 90% understood that naloxone injection should be delivered through thighs or upper arms. The majority of the sample accurately determined the length of onset (81.8%) and duration of naloxone (61.4%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOpioid Overdose Knowledge Scale Items (n\u0026thinsp;=\u0026thinsp;44)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN \u003c/p\u003e \u003cp\u003eCorrect\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e% \u003c/p\u003e \u003cp\u003eCorrect\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRisk Factors of Opioid Overdose Risk\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhich of the following factors increase the risk of a fentanyl (opioid) overdose?\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTaking larger than usual doses of fentanyl.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSwitching from smoking to injecting fentanyl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUsing heroin with other substances, such as alcohol or sleeping pills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncrease in fentanyl purity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUsing fentanyl again after not having used for a while\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUsing fentanyl when no one else is present around\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA long history of fentanyl use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUsing heroin again soon after release from prison or from a detox treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSigns of Overdose\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHaving blood-shot eyes (F)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSlow/shallow breathing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLips, hands or feet turning blue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLoss of consciousness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnresponsive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeizures or convulsions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeep snoring\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery small pupils\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAgitated behaviour (F)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRapid heartbeat (F)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNaloxone Knowledge and Administration\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhich of the following should be done when managing an opioid overdose?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCall an ambulance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStay with the person until an ambulance arrives.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInject the person with salt solution or milk. (F)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMouth to mouth resuscitation.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGive stimulants (e.g. cocaine or black coffee). (F)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlace the person in the recovery position (on their side with mouth clear).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGive Naloxone (opioid antidote).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePut the person in a bath of cold water. (F)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCheck for breathing.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCheck for blocked airways (nose and mouth).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePut the person in bed to sleep it off. (F)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat is naloxone used for?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTo reverse the effects of a fentanyl overdose (e.g. heroin, methadone).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTo reverse the effects of a stimulant (e.g., crystal meth, cocaine) overdose. (F)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTo reverse the effects of Benzodiazepines (e.g. Xanax, Ativan. (F)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHow can naloxone be administered?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInto a muscle (intramuscular)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInto a vein (intravenous)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnder the skin (subcutaneous)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSwallowing liquid/tablet (F)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhere is the most recommended place for non-expert to administer naloxone?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutside of thighs or upper arms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny vein (F)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart (F)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBy mouth (F)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHow long does naloxone take to start having an effect?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026ndash;5 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026ndash;10 minutes (F)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u0026ndash;20 minutes (F)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u0026ndash;40 minutes (F)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHow long do the effects of naloxone last for?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 20 minutes (F)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbout 1 hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 to 6 hours (F)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6 to 12 hours (F)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTick each correct statement\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIf the first dose of naloxone has no effect a second dose can be given (T)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThere is no need to call for an ambulance if I know how to manage an overdose (F)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSomeone can overdose again even after having received naloxone (T)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe effect of naloxone is shorter than the effect of heroin and methadone (T)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfter recovering from an opioid overdose, the person must not take any heroin, but it is OK for them to drink alcohol or take sleeping tablets (F)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNaloxone can provoke withdrawal symptoms (T)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eT\u0026thinsp;=\u0026thinsp;True; F\u0026thinsp;=\u0026thinsp;False\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study results suggest that pop-up brief opioid education and naloxone training interventions are a feasible approach to promoting knowledge about opioid overdose management and naloxone administration. Following the training participants demonstrated strong knowledge of opioid overdose and awareness of appropriate procedures to follow in the event of an overdose. Recent studies corroborate findings that naloxone trainings significantly improve subjects\u0026rsquo; awareness, knowledge, and confidence regarding overdose management (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Prior research suggest that participants show consistent retention of overdose management knowledge of up to 6 months after interventions (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn our study, multiple naloxone training sessions occurred on or within walking distance of an urban reserve in Regina. This enabled the pilot study to successfully recruit a majority Indigenous sample, fostering skills in overdose management and naloxone administration in a community that is disproportionately vulnerable to drug-related harms. Prior research has shown that Indigenous Canadians are more likely to have opioids use disorders, and are at higher risk of drug-toxicity deaths, and are more vulnerable to HIV/STBBI infections, but reportedly view harm reduction programming as culturally incompatible (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). In the literature, few studies appear to specifically focus on naloxone training initiatives directed at Indigenous populations. Levine et al. describes how Indigenous-led \u0026ldquo;Not-Just-Naloxone\" workshops in British Columbia provided culturally relevant harm reduction education and training, increasing knowledge, awareness, and self-efficacy among First Nations participants (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn our study, most participants lived within walking distance of the pop-up naloxone trainings. Prior research has found that transportation is a common barrier to the initiation and engagement of substance use treatment (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Regina is a non-walkable, car-centric city, which limits the ability of made marginalized populations to access healthcare services (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). As depicted in the map data, there are moderate levels of community needle prevalence in Regina\u0026rsquo;s surrounding neighbourhoods, far from the city\u0026rsquo;s harm reduction services. Conversely, approximately 70% of this study\u0026rsquo;s sample reported that the pop-up naloxone training session was within a 15-minute walk to their residence. Pop-up interventions may increase access to and uptake of harm reduction services among underserved communities with limited transportation options.\u003c/p\u003e \u003cp\u003eGIS mapping in the health science literature has been utilized to map the distribution of resources and identify regional health inequities (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). While prior studies have been largely retrospective and have not integrated GIS into health programming, the findings of this study demonstrate that real-time geospatial data on community needle prevalence can successfully facilitate targeted harm reduction interventions in areas of highest need. Additionally, previous studies, particularly in Canada, have largely mapped overdose-related data onto cities (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). Geospatial analysis enables the creation of tailored community-based interventions for underserved populations, specifically people who use drugs, who may not access conventional healthcare services for a variety of reasons. People who use drugs who are transient have barriers to accessing healthcare (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Geospatial analysis of needle prevalence data enables health interventions to adapt to the migratory patterns of transient populations. GIS-informed, community-based education, screening, and treatment interventions may increase engagement in care as well as reduce rates of overdose and HIV/STBBI transmission.\u003c/p\u003e \u003cp\u003eFuture directions on this research should focus on naloxone misconceptions to improve training outcomes. A large proportion of participants in this study incorrectly reported that naloxone can be used to reverse a stimulant or Benzodiazepine-related overdose. Additionally, many subjects erroneously indicated that calling an ambulance is unnecessary after administering naloxone, which may be attributed to poor experiences with healthcare and policing among PWUD and Indigenous peoples (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). Belief in naloxone misconceptions may result in inappropriate and detrimental use. Furthermore, neglecting to alert emergency services after an overdose may lead to the oversight of overdose-related complications, such as heart irregularities and pneumonia (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e). Future research can investigate the prevalence of naloxone misconceptions among people who use drugs and guide OEND interventions to dispel these myths. Further work is also needed to rebuild the relationship between healthcare services, police, and PWUD, specifically Indigenous individuals who use substances. More naloxone trainings should be targeted for Indigenous populations in Canada, who are at higher risk of overdose. Indigenous populations in Canada are overrepresented within drug toxicity deaths, HIV/STBBI infections, and Hepatitis C cases\u003c/p\u003e \u003cp\u003e(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e). Additionally, greater involvement of Indigenous people, specifically those with lived and living experience of drug use, within research is essential in developing culturally tailored initiatives and increasing engagement in preventative health services. Utilizing GIS analysis to target interventions to underserved populations, specifically people who use drugs is a novel approach that shows promise. Recent studies have utilized geospatial analysis to target HIV/STBBI testing interventions (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). This study demonstrates how geospatial analysis of community needle prevalence can guide harm reduction interventions to reach transient, marginalized populations. Future studies may explore the application of geospatial analysis for other infectious diseases and health interventions. Additionally, there is a limited focus on the suburbs (i.e., residential areas that are located on the outskirts or periphery of a central city or urban area.) in the literature. Drug-related harms may be overlooked in these regions, even though these communities have similarly limited access to harm reduction supports as more rural areas. Pop-up interventions can expand the reach of harm reduction organizations and improve the availability of overdose prevention services for \u0026ldquo;hidden\u0026rdquo; populations in need.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eThis study contains several limitations. Firstly, no pre-test and follow-up assessments were conducted, meaning that changes in or retention of knowledge regarding overdose and naloxone administration cannot be determined. Without a pre-test it is unclear whether participants had prior familiarity with opioid overdose management and naloxone administration making it difficult to assess the effectiveness and utility of the training. However, the focus of this study was on the implementation of the geospatial approach as prior research has shown the effectiveness of Naloxone trainings. Another limitation of this study is related to sampling. The training sessions likely attracted a self-selected group of individuals who were willing and able to participate. This bias potentially results in a group different that the broader population of people who use substances. For example, those with less familiarity with naloxone may be underrepresented. Additionally, despite the wide distribution of discarded needles in Regina suburbs, pop-up interventions were limited to areas of highest need, due to limited resources. Furthermore, the research team did not inquire participants on their history of drug use. Therefore, while the pop-up naloxone training sessions aimed to reach individuals who use substances in areas of high drug activity, it remains unclear whether people who use drugs, who are best positioned to benefit from naloxone training and reverse overdoses, engaged in the OEND interventions. Lastly, ReportNeedles.ca is a tool that depends on user reports of discarded needles in the community. Consequently, ReportNeedles.ca may be impacted by reporting bias and underreporting, since users may be unequally distributed within Regina, leading to certain regions having more comprehensive and up-to-date data than other areas (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis article presents promising results from a geospatial, community-based needle collection and naloxone training initiative. In one non-walkable, medium-sized Canadian city, injection drug use is dispersed throughout the city and outside walking distance to healthcare and harm reduction services. Developing strategies for culturally tailored, geo-located street-outreach may help intervene during drug-related crises.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOEND\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOpioid Overdose Prevention Education and Naloxone Distribution\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHIV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHuman Immunodeficiency Virus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSTBBI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSexually Transmitted and Blood Borne Infection\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eNP conceptualized the study, conducted the data cleaning and analysis, drafted the manuscript, and edited the manuscript. SV, VR conceptualized the study, and provided critical revision of the manuscript. AE conceptualized the study, contributed to the analysis, drafted and provided critical revision of the manuscript, and provided supervision. SK drafted the manuscript, and provided critical revision of the manuscript. TA, EH, MR, PM, FI, DG provided critical revision of the manuscript. All authors approve the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eThis work is funded by an Impact Grant from the Saskatchewan Health Research Foundation (SHRF #6322) with in-kind support from the Canadian Institutes for Health Research (CIHR) Pan-Canadian Network for HIV and STBBI Clinical Trials Research (CTN+ #343).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKrausz RM, Westenberg JN, Tai AMY, Fadakar H, Seethapathy V, Mathew N, et al. A Call for an Evidence-Based Strategy Against the Overdose Crisis. 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AIDS. 2018;32(8):957.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"harm-reduction-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"harj","sideBox":"Learn more about [Harm Reduction Journal](http://harmreductionjournal.biomedcentral.com/)","snPcode":"12954","submissionUrl":"https://submission.nature.com/new-submission/12954/3","title":"Harm Reduction Journal","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Harm reduction, Naloxone training, Geospatial, injection drug use","lastPublishedDoi":"10.21203/rs.3.rs-5836079/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5836079/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe opioid crisis is a major public health issue in Canada, with prairie provinces such as Saskatchewan experiencing particularly high rates of opioid-related harms. Factors contributing to this crisis include an unstable drug supply, limited access to harm reduction services, and structural challenges such as poverty and housing instability. The rise of fentanyl has further exacerbated overdose risks, particularly among people who use drugs. Harm reduction programs, such as opioid overdose education and naloxone distribution, have proven effective in reducing overdose fatalities and improving community health. While geospatial analysis has shown promise in identifying areas of high need for targeted harm reduction interventions, its integration into harm reduction strategies remains underexplored.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study utilized data from 44 participants who completed pop-up naloxone training sessions in Regina, Saskatchewan, between August 2023 and September 2024. Additionally, data sources include geospatial information on discarded needles from the ReportNeedles.ca platform and survey responses evaluating opioid overdose and naloxone administration using a modified Opioid Overdose Knowledge Scale. Naloxone training sessions were targeted to areas with a high number of discarded needles determined by the ReportNeedles.ca platform. Geospatial analyses were conducted using ArcGIS to map needle prevalence and assess the accessibility of harm reduction services based on walk-time buffers.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eBetween August 2023 and August 2024, 315 reports on ReportNeedles.ca led to the disposal of 2,836 needles. Geospatial analysis revealed clustering of discarded needles in Regina's city center, with some seasonal variation. Pop-up training sites expanded the accessibility of naloxone services, with 70% of participants reporting living within a 15-minute walk to pop-up Naloxone trainings. However, geospatial analysis revealed gaps in service accessibility specifically in suburban areas. Participants in pop-up naloxone trainings demonstrated strong knowledge of overdose recognition and naloxone administration.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThis study the potential benefit in integrating geospatial analysis with harm reduction interventions to address the opioid crisis. By identifying needle prevalence hotspots and utilizing pop-up naloxone training service providers can improve service accessibility.\u003c/p\u003e","manuscriptTitle":"Mapping needles, reducing harm: Findings from a geospatial, community-based needle collection and naloxone training initiative in Saskatchewan, Canada","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-19 06:43:39","doi":"10.21203/rs.3.rs-5836079/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-01-21T21:36:40+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-01-16T10:03:22+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-01-16T10:02:01+00:00","index":"","fulltext":""},{"type":"submitted","content":"Harm Reduction Journal","date":"2025-01-15T16:09:51+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"harm-reduction-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"harj","sideBox":"Learn more about [Harm Reduction Journal](http://harmreductionjournal.biomedcentral.com/)","snPcode":"12954","submissionUrl":"https://submission.nature.com/new-submission/12954/3","title":"Harm Reduction Journal","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6b1c3b47-51bf-43ac-a1c7-016d3b13bcba","owner":[],"postedDate":"February 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T22:23:12+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-19 06:43:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5836079","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5836079","identity":"rs-5836079","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}