Table 4.
User Barriers to Naloxone Use and Acceptance
| Subtheme | Illustrative Quote |
|---|---|
| Misunderstanding of naloxone use | |
| Uncertainty about how to administer naloxone | I wouldn’t know how to do it [administer naloxone] myself. I would be scared. I wouldn’t know. [opioid user] |
| Misguided alternatives to reverse opioid overdose | You always see flyers about [naloxone], and this and that, but you always have to travel to go get it. They were making it so expensive to buy in pharmacies and stuff that somebody who’s an addict is not going to go spend that money on Narcan when they can go buy drugs, because being an addict you find these ways like splash water on them, put them in really cold water to shock their body, inject them with coke because it will reverse the effects. We kind of found ways to bring somebody back. [opioid user] |
| Distribution barriers | |
| Cost | Nobody is gonna spend, especially if they have a problem, $50 is more than they have… They are already spending too much money on this drug. $50 is unlikely. [opioid user] |
| Lack of knowledge regarding where to access | It’s like one of those things that kind of just shows up. Sometimes when you need it and sometimes when it doesn’t show up. I don’t really know how people get this s***. It’s just sometimes there and sometimes it’s not. [opioid user] |
| User/responder relations | |
| Legal concerns | Nobody wanted to call the cops because they didn’t want to be involved in it, because people were selling drugs out of there. Luckily somebody else in the building found them, and they were able to save them. [opioid user] |
| Lack of trust | I don’t think they [medical provders] would give it [naloxone] to a strung-out addict who is just gonna overdose and try to bring himself back. [opioid user] |
| Stigma | A lot of the doctors that regulate it are very… I wouldn’t say choosy on who they give it to, but their standards are pretty high and they’re very judgmental. [opioid user] |
| User experiences with overdose and naloxone | |
| Witnessing overdose as more traumatic than individual experiences with overdose | It’s the other people that realise how much effort’s going into waking you up and s***. That’s the scary part… It’s the ones that sit around and watch him f***ing turn blue and fall down… Those are the people that get f***ing traumatised by s***. [opioid user] |
| Resistance to naloxone use due to withdrawal symptoms | Bang, here’s some Narcan. We’re going to kick all the f***ing dope off your receptors instantly… instead of gradually letting them fall off, like a tree. You have a tree and the apples fall off the tree on their own, or you can go up the tree and shake the s*** out of it and they all fall down… Like being in your mother’s womb and being f***ing ripped out of it, and thrown on the table… That’s how bad it hurts… It’s like taking a caterpillar out of its cocoon and throwing it on the ground, you know? Before it’s ready to hatch. [opioid user] |