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Abstract

Background The aim of the study was to assess potential barriers and challenges to the implementation of take-home naloxone (THN) across ten prisons in one region of England. Methods Qualitative interviews deploying a grounded theory approach were utilised over a 12- to 18-month period that included an on-going structured dialogue with strategic and operational prison staff from the ten prisons and other key stakeholders (n = 17). Prisoner perceptions were addressed through four purposive focus groups belonging to different establishments (n = 26). Document analysis also included report minutes and access to management information and local performance reports. The data were thematically interpreted using visual mapping techniques. Results The distribution and implementation of THN in a prison setting was characterised by significant barriers and challenges. As a result, four main themes were identified: a wide range of negative and confused perceptions of THN amongst prison staff and prisoners; inherent difficulties with the identification and engagement of eligible prisoners; the need to focus on individual prison processes to enhance the effective distribution of THN; and the need for senior prison staff engagement. Conclusions The distribution of THN within a custodial setting requires consideration of a number of important factors which are discussed.

Keywords: Naloxone; Opiate-related overdose; Prison

59. An Initial Evaluation of Web-Based Opioid Overdose Education

Stephanie S. Roe & Caleb J. Banta-Green
Substance Use and Misuse 2016:51(2);268-275

Abstract

Background Fatal opioid overdose is a significant public health concern in the United States. One approach to reducing fatalities is expanding overdose response education to broader audiences. This study examined responses to a web-based overdose education tool. Methods The results of 422 anonymous surveys submitted on www.stopoverdose.orgwere analyzed for participant demographics, knowledge of opioid overdose recognition and response, and knowledge of Washington's Good Samaritan overdose law. Characteristics, knowledge, and planned behavior of respondents with professional versus personal interest in overdose education were compared. Results  Most respondents were age 35 or older (57%) and female (65%). The mean score on the knowledge quiz for overdose recognition and response items was 16.2 out of 18, and 1.5 out of 2 possible points for items concerning the law. Respondents indicating professional interest were significantly more likely to be 35 or older (p = .001) and to have received prior overdose education (p < .001), but less likely to know someone at risk for opioid overdose (p < .001) or report planning to obtain take-home naloxone (p < .001). No significant differences were found in overdose knowledge scores between groups. Conclusions  Online training may be effective among individuals with professional and personal interest in overdose, as general knowledge scores of overdose response were high among both groups. Lower scores reflecting knowledge of the law suggest that the web-based training may not have adequately presented this information. Overall, results suggest that a web-based platform may be a promising approach to basic overdose education.

Keywords: Heroin; opioid; overdose; online education

PARENTING
60. The Parental Bond and Alcohol Use Among Adolescents: The Mediating Role of Drinking Motives

Martina Smorti  & Silvia Guarnieri
Substance Use and Misuse 2015:50(13);560-1570
Abstract

Background  Alcohol use and alcohol-related problems represent a significant health concern. Few empirical researches focused on understanding the interrelationships and links between the parental bond, drinking motives, and alcohol use during adolescence.

Objectives: The present study examined the relationships between a supportive parental bond, drinking motives, and alcohol use, with a focus on the role of mediation. Methods  The sample comprised 298 adolescents, aged from 16 to 20 years. The technique of structural equation modelling (SEM) was used to assess the direct and indirect effects of the parental bond on alcohol use among adolescents through motives for drinking. Results  The relationship between the parental bond and frequency of alcohol use by adolescents was not mediated by any motives for drinking, neither for males nor females. Regarding the relationships between the parental bond and quantity of adolescent alcohol consumption, findings for females showed significant indirect effects of maternal bond on alcohol quantity, when coping, enhancement, and social drinking motives were entered as mediator variables. Rather, paternal bond did not predict drinking quantity, not even indirectly. On the contrary, results for males indicated that the parental bond was neither directly nor indirectly associated with adolescent alcohol use. Conclusions/Importance  Mothers are the relational fulcrum of the family, while fathers seem to maintain a more peripheral position. Gender differences are discussed on the basis of the different cultural and parental socialisation processes that operate for male and female adolescents.

Keywords: parental bond; drinking motives; alcohol use; adolescence; gender differences

PHARMACY

61. Community pharmacy services for people with drug problems over two decades in Scotland: Implications for future development

Catriona Matheson, Manimekalai Thiruvothiyur, Helen Robertson, Christine Bond

International Journal of Drug Policy 2016:27;105-112
Abstract

Background In Scotland community pharmacies are heavily involved in service delivery for people with drug problems (PWDP) as documented through surveys of all community pharmacies in 1995, 2000 and 2006. A further survey in 2014 enabled trends in service demand/provision to be analysed and provides insight into future development.

Methods The lead pharmacist in every Scottish pharmacy (n = 1246) was invited to complete a postal questionnaire covering attitudes towards PWDP and service provision and level of involvement in services (needle exchange, dispensing for PWDP and methadone supervision). Additional questions covered new services of take-home naloxone (THN) and pharmacist prescribing for opioid dependence. Telephone follow-up of non-responders covered key variables. A comparative analysis of four cross-sectional population surveys of the community pharmacy workforce (1995, 2000, 2006 and 2014) was undertaken.

Results Completed questionnaires were returned by 709 (57%) pharmacists in 2014. Key variables (questionnaire or telephone follow-up) were available from 873 (70%). The proportion of pharmacies providing needle exchange significantly increased from 1995 to 2014 (8.6%, 9.5%, 12.2%, 17.8%, p < 0.001) as did the proportion of pharmacies dispensing for the treatment of drug misuse (58.9%, 73.4%, 82.6% and 88%, p < 0.001). Methadone was dispensed to 16,406 individuals and buprenorphine to 1777 individuals (increased from 12,400 and 192 respectively in 2006). Attitudes improved significantly from 1995 to 2014 (p < 0.001). Being male and past training in drug misuse significantly predicted higher attitude scores (p < 0.05) in all four years. Attitude score was a consistently significant predictor in all four years for dispensing for the treatment of drug misuse [OR = 1.1 (1995 and 2006, CI 1.1–1.3, and 2014 CI 1.1–1.4) and 1.2 (2000), CI 1.3–1.5] and providing needle exchange [OR = 1.1 (1995 and 2006), CI 1.1–1.2, 1.1–1.3 and 1.2 (2000 and 2014), CI 1.1–1.3 and 1.1–1.5]. In 2014, 53% of pharmacists felt part of the addiction team and 27.7% did not feel their role was valued by them. Nine pharmacists prescribed for opioid dependence.

Conclusion It is possible for pharmacy workforce attitudes and service engagement to improve over time. Training was key to these positive trends. Communication with the wider addiction team could be further developed

Keywords: Pharmacy; Attitudes; Training; Workforce; Opiate replacement treatment; Drug misuse; Naloxone


PUBLIC INTERFACE
62. Understanding Americans’ views on opioid pain reliever abuse

Colleen L. Barry, Alene Kennedy-Hendricks, Sarah E. Gollust, Jeff Niederdeppe, Marcus A. Bachhuber, Daniel W. Webster and Emma E. McGinty