An Exploration of Narcan as a Harm Reduction Strategy and User's Attitudes toward Law Enforcement Involvement in Overdose Cases

Abstract

The street homeless, those who spend their nights either in shelters or unofficial camps, whether in tents on a street or in society's hidden spaces such as beneath an overpass, face multiple challenges beyond finding a safe place to sleep. Of further concern is how official actions can worsen these situations, through day-to-day activities or planned intervention strategies. In this paper we explore how a planned intervention may be negatively perceived-even as a form of "structural violence"-and may prevent Narcan (naloxone) use to stop an overdose related death in the Skid Row of Los Angeles. Data for this study consisted of a combination of Spatial Video Geonarratives (SVGs) and 325 incident reports from the Homeless Health Care Los Angeles Center for Harm Reduction (HHCLA-HRC) between November 2014 and December 2015. Chi-square and simple logistic regression models were used to examine the association between fear-of-arrest and other covariates of interest. Mapping results are presented with different sets of shapefiles created for (1) all Narcan uses, (2) all homeless, (3) all homeless with a worry about being arrested, (4) all Narcan uses where an ambulance attended, (5) and the same as 4 but also with police attendance. In the multivariable model, the estimated adjusted odds of fear-of-arrest is over three times higher among Narcan users ages 30-39 when compared to users under the age of 30. Analyzing the association of calling 9-1-1 on Narcan user demographics, socio-contextual characteristics, and overdose victim demographics, the crude estimated probability of calling 9-1-1 for Narcan users aged 50 and older is nearly three times higher when compared to Narcan users aged 19-29. Conclusion: Results suggest that the fear-of-arrest and calling 9-1-1 during an overdose is still a concern among Narcan users despite protective legislation and access to harm reduction resources.

Keywords: Narcan; harm reduction; homeless; naloxone; police; skid row; spatial video geonarratives.

Figure 1

The locations of all Narcan applications during the study period in the Skid Row of Los Angeles. Areas a and b indicate two primary hotspots of Narcan applications.

Figure 2

The locations of all Narcan reversals administered by a self-reporting homeless individual (A) who also expressed a worry about being arrested (hotspot area c) (B), where an ambulance attended the reported overdose (C) and lastly where the police also attended along with the ambulance (D).