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The ongoing opioid crisis presents a significant public health challenge particularly for people who use opioids (PWUO). Naloxone is an opioid antagonist crucial to reducing opioid overdose mortality. Inconsistencies exist among PWUO in obtaining, carrying, discussing, and administering naloxone. Using sequential mixed methods, this study was aimed at investigating the use of implementation intentions on naloxone use among PWUO. Semi-structured interviews were conducted with 83 PWUO to gather individual experiences with using naloxone and contextual details regarding its use. An essentialist thematic analysis with inductive coding revealed valuable insights into where, for whom, and when naloxone is implemented. The analysis identified major themes such as caring for others' needs, knowledge gaps, reinforcement through overdose experiences, duality of overdose and compassion, and stigma. Minor themes related to syringe services program implementation and drug use were identified. Building on these qualitative findings a quantitative analysis determined the impact of implementation intentions on naloxone implementation. Participants were randomly assigned to develop implementation intentions or goal intentions for the use of naloxone. Follow-up surveys assessed changes in participants' intentions to obtain, carry, discuss, and administer naloxone and their actual implementation over a 6-month period. At the 3-month follow-up the experimental condition exhibited statistically significant positive intentions to obtain naloxone and engage in discussions about naloxone in social contexts of drug use. Changes in the magnitude of naloxone implementation were observed at the 3- and 6-month timepoints. Specifically, the self-reported discussion of naloxone showed noticeable changes in implementation frequency over time. This suggests that while implementation intentions may not have statistically significant effects on the use of naloxone it had some influence on the frequency of discussing naloxone prior to drug use. This work makes a valuable contribution to the existing literature because of its attempt to apply the Theory of Planned Behavior and implementation intentions in a novel way. Though the experimental hypothesis was not supported statistically significant observations were made for some behaviors at the 3-month follow-up. The pragmatic nature of the setting enhances the relevance of the findings and provides valuable insights for future interventions supporting PWUO. / Doctor of Philosophy / The ongoing crisis of opioid addiction poses a significant public health challenge particularly for individuals who use opioids. Naloxone is a medication that can reverse opioid overdoses and it plays a crucial role in saving lives. People who use opioids often face difficulties in accessing, carrying, discussing, and using naloxone consistently. This study was aimed at investigating the use of naloxone by employing qualitative and quantitative methods. We conducted interviews with 83 individuals who use opioids to explore their experiences and gather insights into naloxone use. These interviews provided valuable information about when, where, and for whom naloxone is used. Several important themes emerged including the significance of helping others, knowledge gaps, the influence of personal experiences, the conflict between the fear of overdose and caring for others, and the stigma associated with drug use. We investigated the impact of a specific approach called "implementation intentions" in improving naloxone use. Participants were randomly assigned to create specific plans or general goals for naloxone use. Through surveys conducted over a 6-month period we examined changes in participants' intentions and actions related to naloxone use. Although the specific approach did not yield significant improvements, we observed changes in how people discussed naloxone over time. This study contributes to the existing research by introducing innovative ideas to support positive behavioral changes among individuals who use opioids. The real-world setting in which the study took place enhances the applicability of the findings and offers valuable insights for future programs supporting individuals who use opioids.

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The COVID-19 pandemic adversely affected the lives of most Americans. People with Substance Use Disorder (SUD) were particularly vulnerable to the negative effects brought on by the pandemic. This study explored the increase in deaths due to opioid overdose during the pandemic exacerbated by factors such as increased stress, decrease in treatment options due to social distancing requirements and facility closures, social isolation, and an increase in spare time. Access to treatment for opioid use disorder (OUD) was interrupted by the measures meant to mitigate the spread of COVID-19. Through a systematic review of current literature, it was demonstrated that existing patients were able to maintain access to care, while few new patients were able to initiate treatment. Telehealth proved to be a vital means of assuring PWUD were able to access life-saving treatment amid a pandemic. Further research is needed to determine whether SUD treatment measures during the COVID-19 pandemic warrants changing the policies long term.

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Accidental drug poisoning has tripled in Sweden since the start of the 21st century, and statistically the country has had one of the highest overdose death rates in Europe. To reverse an opioid overdose, which is the main cause of drug related death, the antidote naloxone has the capacity of breaking the effect, and it is widely recommended as a safe drug with limited side effects. Police forces around the world have started to use naloxone and there is proven connection between its introduction and a reduced number of drug related deaths. However, Swedish police has not started to use or, as far as we know, investigate use of naloxone despite proven benefits. Since police sometimes are the first to arrive at the scene of an overdose, naloxone in a police context is important to study. This survey had its origin in the Theory of Planned Behavior, in accordance with the research instruments Opioid Overdose Knowledge Scale (OOKS), Opioid Overdose Attitude Scale (OOAS) and Naloxone-Related Risk Compensation Beliefs (NaRRC-B). This quantitative study had the purpose to measure and create knowledge about Swedish police officers' attitudes towards introducing and administering naloxone in police work, as well as their general knowledge regarding the antidote. The participants agreed that Swedish police officers should be equipped with naloxone to be able to save more lives (mean value = 3,9). The demonstrated benefits significantly outweigh the disadvantages of a possible implementation of naloxone within the Swedish police. Hence, it is essential that the Swedish Police Authority further investigates whether the use of naloxone can be a new working method to save more lives.