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October 3 -7, 2019
San Francisco, CA
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Drug Injectors Accept and Use Naloxone Offered at HCV Visits
  IDWeek, October 2-6, 2019, Washington, DC
Mark Mascolini
Injecting drug users with opioid use disorder accepted--and often ended up using--naloxone offered at HCV treatment visits [1]. High proportions of drug injectors who witnessed an overdose after accepting naloxone administered the potentially life-saving drug.
People who inject drugs shoulder an imposing burden of HCV-related morbidity and mortality. But researchers working in the ANCHOR study noted that threats related to ongoing injection--such as opioid overdose--could pose a more immediate danger. Yet HCV treatment programs often to do not address such threats. The researchers asked whether they could use HCV treatment as "a platform for harm reduction" in people who inject drugs.
ANCHOR is a single-center study at the University of Maryland evaluating treatment of HCV infection with sofosbuvir/velpatasvir in drug injectors. Health workers also offer trial participants optional buprenorphine to treat opioid use disorder and optional HIV PrEP. At each study visit, participants report whether they experienced or witnessed a drug overdose, and they are offered naloxone as an overdose rescue drug.
This analysis involved 100 drug injectors in ANCHOR, 76 of them (76%) men, 93 black, and 51 unstably house. The group had a median age of 56 years. Fifty-nine men injected daily or more often, 18 shared injecting equipment at least sometimes, and 40 reported hazardous alcohol drinking.
At the baseline study visit, 65 drug injectors reported experiencing an overdose themselves, 91 had witnessed an overdose, and 35 had ever administered naloxone. At week 12, 24, and 48 follow-up visits, 17, 21, and 28 participants witnessed an overdose, and 12, 18, and 17 administered naloxone. Among participants who witnessed an overdose, high proportions used naloxone at weeks 4 (59%), 8 (62%), 12 (71%), 24 (86%), and 48 (61%). All told, 66 participants witnessed an overdose, 65 received naloxone, 60 administered naloxone, and 54 administered naloxone for the first time.
Through 96 weeks of follow-up, 19 of 100 participants experienced an overdose themselves, for a rate of 12.8 per 100 person-years. Four of these 19 (21%) died from their overdose, for an overdose death rate of 2.7 per 100 person-years.
The ANCHOR team concluded that dispensing naloxone at HCV-related visits proved highly acceptable to people who inject drugs and resulted in high rates of naloxone use in the community. The researchers suggested that infectious disease providers consider prescribing naloxone for patients with opioid use disorder as part of a comprehensive harm-reduction package. They urged colleagues to "embrace comprehensive evidence-based harm reduction strategies to reduce morbidity and mortality in this highly vulnerable population."
1. Rosenthal ES, Nussdorf L, D'Amore A, et al. High rates of experienced and witnessed opioid overdose in PWID receiving HCV treatment: data from the ANCHOR study. IDWeek, October 2-6, 2019, Washington, DC. Abstract 2900.