Table 3.

Trust-based considerations related to opioid overdose response

Personal and group trust
Shared experiences	“I may run into, every day, about two people that overdose. It's just every day.”
Peers	“They're out there, they're using. They can save each other, and they do… I’ve seen it happen more than once. And I talk to them, and they tell me, they're ready to help each other.”
Sharing naloxone	“I have one gentleman in particular… who has over 40 [saves]… he never looks at it like this is my dose. He looks at it like that's a life. And a lot of people on the street, that's how they look at it.”
	“Euphoria, you know, [saving someone] makes you feel good. Just knowing that something that I prepared for came through, you know what I mean? Like, just to take that precaution.”
Shared responsibility	“I wish somebody would do it for me if the roles were reversed.”
	“Yeah [multiple responders] would actually be way more comfortable, because all the responsibility is not on you … and maybe one of those people knows CPR.”
Responder safety	“You don't know who's in there or what is going to happen. I don't know if somebody will try to stab you when you're walking in, because you got money on you.”
	“They get pissed off. They really get pissed off, because you’re blowing their high … and some of them don’t really want to come out of there.”
Technological trust
Naloxone efficacy	“I wish that everybody in the community had [naloxone]… Like how they have fire extinguishers. That it was available for them all.”
	“I’ve brought back people that I’m very close to. I look at them now and I’m like, wow, look at you now. Look at what naloxone gave you. Look at you.”
Application misuse	“People knowing exactly where you are, and predators who rob people and stuff would know exactly where you are. That would be bad. Because say you’re at your family’s house or something, and then somebody knows exactly where your family lives, and can roll up on you.”
	“That's one of the concerns I would have. I wouldn't want to be set up to being robbed or anything like that.”
Social stigma	“If you put your picture on there, then that's pretty much openly saying that you use heroin… which could be detrimental.”
Social influence	“If people see that… look you weren't called this month, but this many calls came in, this many people went out, and this many people were helped. That could really be an incentive to say, ‘Oh, I'm part of something that’s working’.”
Trauma exposure	“I think it could affect some people. Especially if now they have the app, maybe people down here don’t see overdoses, but … they’re going to see a lot of them, if they have the app.”
Institutional trust
Community-based programs	“Well, I been coming… [to] Prevention Point for, like, 20 years I guess… I use as many of their services as I can.”
	“The app should have … a system that would teach you about the [naloxone] training. Better yet, somewhere they can go to a one-course class of how the [naloxone] can be administrated, and that would help them out a whole lot.”
Risk of prosecution	“If somebody has warrants, they're probably going to get taken away even though there is a Good Samaritan law.”
	“When I overdosed, my friend that was with me, even though there’s a Good Samaritan law, my friend had warrants out for his arrest. And they asked him his name, looked him up in the system, and actually took him to get processed.”
Perceived neglect	“The cops don't even [care] down here. They'll let you die.”
Professional response	“I would definitely like emergency medical services to be there. Police, not so much.”
	“I think it’s always better that emergency medical services comes because I would like them to go to the hospital, and I’d like them to get treatment. So if they’re not there, there’s not even that opportunity for them to go. So I would definitely like emergency medical services to be there. Police, not so much. But emergency medical services definitely.”