ArticleThe International journal on drug policy2021
"I wanted to close the chapter completely … and I feel like that [carrying naloxone] would keep it open a little bit": Refusal to carry naloxone among newly-abstinent opioid users and 12-step identity.
Article in The International journal on drug policy, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it, 12 citations in OpenAlex.
- Transformation of identity in substance use as a pathway to recovery and the potential of treatment for hepatitis C: a systematic review.Addiction (Abingdon, England) · 2023Pooled it
- Learning from the Drug Policy Curriculum: People Who Use Drugs Policing in the Context of Decriminalization.Contemporary drug problems · 2026Article
- Perceptions of Buprenorphine With Naloxone Treatment and the Fear of Precipitated Withdrawal: A Qualitative Exploration With HIV Prevention Trials Network 094 INTEGRA Participants and Staff.Drug and alcohol review · 2026Article
- Article
- The potential use of digital technologies to enhance opioid agonist treatment in rural and remote communities of British Columbia, Canada.Harm reduction journal · 2025Article
- An interrupted time series analysis of fentanyl, naloxone, and opioid-involved deaths in five counties in Eastern Missouri.Journal of substance use and addiction treatment · 2025Article
- Agent-Based Model of Combined Community- and Jail-Based Take-Home Naloxone Distribution.JAMA network open · 2024Article
- Individual and social network correlates of responding to multiple overdoses among a cohort of people who use drugs.Drug and alcohol dependence reports · 2022Article
Corrections and comments
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Authors and funding
9 authors at 2 institutions in 2 countries.
Funding
Abstract
background12-step programs aim to address drug-related harms, like opioid overdose, via abstinence. However, abstaining from opioids can diminish tolerance, which increases risk for overdose death upon resumption. A recent study found that desire to abstain from drugs inhibited willingness to participate in take-home naloxone programming, which was linked to perceptions of harm reduction strategies being tied to drug use. In the present study, we uncovered a similar phenomenon occurring among newly-abstinent participants who were refusing to carry naloxone.
methodsThis study is an analysis of broader qualitative data collected throughout Southern California among persons who use opioids, including those recently abstinent. Preliminary analysis revealed that those newly abstinent refused to accept naloxone at the end of interviews, and so we began probing about this (N=44). We used thematic analysis and author positionality to explicate the emergent phenomenon and applied social identity theory to conceptualize findings.
resultsMechanisms underlying naloxone refusal included its tie to a drug-using identity that newly-abstinent participants were attempting to retire. Carrying naloxone was also viewed as pointless due to doubt of witnessing an overdose again. Furthermore, the thought of being equipped with naloxone was not believed to be congruent with an abstinent identity, e.g. "me carrying it [naloxone] is making me feel like I'm going to be hanging out with people that are doing it [using drugs]."
conclusionRecent detoxification heightens vulnerability to overdose, which other newly-abstinent peers might be positioned to respond to as bonds are formed through 12-step identity formation. However, naloxone is often refused by this group due to perceived 12-step identity clash. While some treatment spaces distribute naloxone, 12-step identity associated behavioral expectations appear to conflict with this strategy. Reframing these disconnects is essential for expanding the lifesaving naloxone community safety net.
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Registered trials
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