(218) Perceptions on treatment utilization and risk of overdose among opioid users in Kolkata: A qualitative study

Background: The rate of opioid overdose among injectable drug users is high. West Bengal is among the top ten Indian states concerning the number of people who need help with opioid-use-related problems.

Objectives: To explore the perceptions of treatment utilization patterns and risk of overdose of both opioid users and their service providers in Kolkata, West Bengal, India.

Methods: This qualitative study was conducted between Sep and Dec 2023 in the only two authorized opioid substitution therapy (OST) centers and their respective field practice areas in Kolkata. Ten registered clients of the two OST centers were selected by purposive sampling. Additionally, ten opioid users dwelling and visiting selected hot-spot areas but not registered for OST were selected by convenience and snowball sampling. Six peer educators were also selected by purposive sampling. In-depth interviews of opioid users and key-informant interviews of peer educators were conducted. Focused topics that were covered included service treatment utilization for opioid use disorder and opioid overdose. The data collection continued until saturation. The validity and reliability of the findings were measured in terms of trustworthiness. The data were analyzed manually using an inductive thematic approach.

Results: Most opioid users and all peer educators acknowledged the risk of opioid overdose especially because of the high-risk behavior, adulteration in street opioids, and the absence of strict regulations on opioid use. Most opioid users expressed a high degree of satisfaction with OST due to the access to medication-assisted treatment, counseling, and social supportive services. The knowledge and attitude towards recognition and immediate assistance of opioid overdose was good for most of the opioid users registered to the OST centers. On the contrary, the opioid users who were not registered were unaware of the location, exact services, and cost of treatment provided by the OST centers. They were especially concerned about social stigma, legal issues, and administrative hassles in seeking treatment. These individuals also lacked sufficient knowledge about opioid overdose. The peer educators reinforced the requirement of raising awareness and training in recognizing and offering immediate assistance in instances of opioid overdose. Both opioid users and peer educators were unaware of naloxone, an opioid antidote.

Conclusions: Both opioid users and their peer educators were aware of the danger of opioid overdose. However, they lacked sufficient knowledge to recognize and offer immediate assistance in such situations, including administration of naloxone. These findings recognize the necessity of drawing and retaining opioid users in an efficient healthcare facility, such as OST centers.