Dissertation
Opioid overdose among persons who inject drugs in Philadelphia: witnessed overdose responses, prevention program diffusion, and environmental risks
Doctor of Public Health (Dr.P.H.), Drexel University
May 2017
DOI:
https://doi.org/10.17918/etd-7720
Abstract
Introduction: In the United States, opioid overdose is an escalating public health issue resulting in untimely deaths. In Philadelphia, PA, the setting for this study, 907 overdose deaths occurred in 2016. Persons who inject drugs [PWIDs] often witness opioid overdoses. Towards this end, this thesis: 1) examined reactions to opioid overdoses among PWIDs; 2) investigated the diffusion and uptake of an Opioid Overdose Prevention Program [OOPP]; and 3) assessed the study's setting using the Risk Environment framework. Methods: Qualitative methodology was employed to achieve study aims. In depth interviews were conducted among 30 PWIDs categorized by three classifications: 1) those trained by OOPP [trained]; 2) those untrained but familiar with OOPP [untrained]; and 3) those unfamiliar with OOPP [unaware]. Interviews were transcribed, coded, and analyzed thematically to uncover patterns related to each research aim. Results: In Chapter 1, participants responded to witnessed opioid overdoses in a variety of ways including administering naloxone, calling 911, performing rescue breathing, and by using a multitude of folk remedies. In Chapter 2, those trained and untrained often participated in survival-based networks resulting in exposure to the OOPP, however, uptake was influenced by various factors. Unaware participants reported avoiding such networks which disrupted OOPP diffusion. In Chapter 3, prevailing features of the risk environment were described and included: 1) stress and distrust via described lived experiences; 2) drug consumption space options; 3) drug purchasing and marketing; and 4) strained relationships with police. Conclusion: This thesis examined factors associated with opioid overdose in Philadelphia and provides program and policy recommendations to reduce fatalities. For many participants, preventing an overdose was difficult due to inconsistent heroin quality and dangerous adulterants such as opioid-potent fentanyl. Nonetheless, many participants demonstrated lifesaving responses to witnessed overdoses which reveals the power within communities to prevent overdose fatalities.
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Details
- Title
- Opioid overdose among persons who inject drugs in Philadelphia
- Creators
- Jeanette M. Bowles - DU
- Contributors
- Stephen Lankenau (Advisor) - Drexel University (1970-)
- Awarding Institution
- Drexel University
- Degree Awarded
- Doctor of Public Health (Dr.P.H.)
- Publisher
- Drexel University; Philadelphia, Pennsylvania
- Number of pages
- iv, 115 pages
- Resource Type
- Dissertation
- Language
- English
- Academic Unit
- Dana and David Dornsife School of Public Health; Community Health and Prevention; Drexel University
- Other Identifier
- 7720; 991014632068204721