Impact of a brief personally tailored opioid-overdose and medication for opioid use disorder education intervention on naloxone acceptance in peripartum individuals: A secondary exploratory analysis

Objectives: Despite drug overdose deaths increasing among peripartum persons, little is known about how to increase naloxone acceptance in this population. This study evaluated the effect of a brief 15-min computer facilitated personally-Tailored Opioid- overdose and Medication for opioid use disorder (MOUD) Educational intervention (TOME) on naloxone uptake and compared participant characteristics based on naloxone acceptance. Methods: This secondary analysis is from an outpatient randomized multisite trial with peripartum individuals receiving MOUD treatment. Participants were randomized to TOME or control. TOME participants met 1:1 with research staff to review a printout of missed pre-test opioid overdose and MOUD knowledge questions that explained the correct answer. Control participants received educational materials from the Substance Abuse and Mental Health Services Administration. Baseline demographics, treatment characteristics, opioid overdose and MOUD knowledge, and self-report MOUD stigma ratings were compared between participants who accepted versus declined free study-provided naloxone because they already had it or for other reasons. The intervention's effect on naloxone acceptance was evaluated after delivery of TOME or control among those accepting versus those declining naloxone for other reasons. Results: Of 111 participants, 90 accepted naloxone, 14 declined due to already having naloxone, and seven declined for other reasons (e.g., not affiliating with people who would need it, not wanting it in their house, allergy), These three groups significantly differed on past stigma from family (p = 0.007) and employers (p = 0.013) whereby participants declining naloxone due to already having it had the lowest stigma. Those accepting naloxone (n = 90) were nearly evenly split between TOME (n = 48) and control (n = 42). Six of the seven declining naloxone for other reasons were control participants. Among the 97 accepting naloxone or declining it for other reasons, TOME trended toward increasing naloxone acceptance (OR: 6.857, CI: 0.793, 59.291, Fisher Exact test p = 0.0592). There was a higher percentage of correct MOUD answers in the 90 accepting naloxone (66.8 %) vs. the 7 declining for other reasons (55.7 %; p = 0.0471). Conclusions: These preliminary results suggest the need for further work to determine if educational interventions can enhance naloxone acceptance and suggest that stigma and medication treatment knowledge may be important factors influencing naloxone acceptance.