Overdose Risk Management and Compensation in the Era of Naloxone

Summary of Proposed SupplementThis proposed research undertakes to evaluate the impact of the novel coronavirus pandemic on the parentstudy's sample of 576 adult-age people who use unprescribed opioids. Covid-19 infections in NYC hold thepotential to impact opioid-related overdose risk behaviors-the parent study's main outcome-by changingaccess to naloxone and related health services for people who use drugs. Evaluating the multiplephysiological, psychological, and social domains through which the pandemic can impact opioid-related risk isessential both to understanding the unique vulnerabilities of this population during public health crises and tomaintaining the empirical integrity of the parent grant's aims. Specifically, the population of people who usenonprescribed opioids in NYC is subject to disruptions in their access to naloxone, opioid agonist therapies,and syringe service programs, while social distancing is likely to result in greater incidence of socially isolatedopioid use, diminishing the opportunity for peers or other bystanders to administer naloxone and/or call 911 inthe event of an overdose. The parent study's participant cohort is currently being followed prospectively usingremote, web- and SMS-based survey instruments, which can be modified and expanded to include novelcoronavirus measures. This research supplement will utilize this capacity to achieve the following mixed-method aims which parallel the parent aims and guarantee that the parent grant findings are not confoundedby the enormous physiological and psychosocial impacts of the pandemic on study participants and their opioiduse: a) Examine the impact of the Covid-19 epidemic in NYC on participants' access to and utilization of theoverdose reversal drug, naloxone; b) Evaluate physiological, psychological, and social impacts of thecoronavirus epidemic in NYC as potential predictors of opioid-related overdose risk behavior; and c) Analyzeparticipant and treatment/service provider' perceptions of the processes whereby the coronavirus epidemic hasprecipitated changes in unprescribed opioid use and related overdose risk. By achieving these aims, thissupplementary inquiry will contribute important preliminary understandings of how multiple forms of riskmanagement overlap in the lives of low-income and largely unstably housed people who use opioids. Byproviding timely data on the unique vulnerabilities of this population during an emerging public health crisis, thestudy will be strongly positioned to contribute an empirical base to health policy that mitigates both diseasetransmission and mortality among this at-risk population.