背景:北美正在努力应对持续的药物过量危机。虽然像带回家纳洛酮试剂盒这样的减少伤害的措施,和受监督的消费场所,有助于降低死亡率,需要采取其他策略来应对这一公共卫生紧急情况。好撒玛利亚人法律(GSL)为报告过量的个人提供法律保护,然而,由于对现有立法的担忧,使用药物(PWUS)的人可能仍然会犹豫寻求帮助.这项范围审查探讨了防止PWUS为过量用药拨打紧急服务的障碍,以及应对这一挑战的潜在解决方案和促进者。
方法:使用PRISMA-ScR作为指导进行本研究。健康科学图书馆员搜索Medline,Embase,心理信息,CINAHL,和SCOPUS来识别相关文章。六名审稿人通过Covidence筛选和提取了文章。两名评审员使用NVivo软件进行了主题分析,以确定关键障碍和促进者。
结果:最初的搜索发现了6275篇标题和摘要筛选文章,结果48项研究符合纳入标准。拨打911的主要障碍与对警察与其他急救人员一起到达的担忧有关,特别是关于他们在过量现场的存在和参与。随之而来的是法律后果,包括害怕被捕,监禁,和对驱逐的恐惧,在其他人中。一些研究指出,对GSL缺乏知识或信任,这阻碍了寻求医疗援助。其他障碍包括对隐私和机密性的担忧,偏好单独管理过量/接受另一个同伴的帮助,对纳洛酮有效性的信心,手机使用受限,同龄人的压力,不寻求帮助,识别为黑色,土著,或有色人种(BIPOC)。促进者包括提高PWUS和执法部门的GSL意识,扩大了对911来电者的法律保障,减少警察对过量案件的干预,并增强了纳洛酮在关键接入点的可用性。
结论:尽管GSL的意图很好,在用药过量的情况下,PWUS在呼叫紧急服务方面继续遇到重大障碍。了解这些障碍和关键促进者对于为未来的毒品政策和宣传工作提供信息是必要的。
BACKGROUND: North America is grappling with an ongoing drug overdose crisis. While harm reduction measures like take-home naloxone kits, and supervised consumption sites, have helped reduce mortality, other strategies to address this public health emergency are required. Good Samaritan Laws (GSLs) offer legal protection for individuals who report overdoses, yet people who use substances (PWUS) may still hesitate to seek help due to concerns about existing legislation. This scoping review explores barriers preventing PWUS from calling emergency services for overdoses, along with potential solutions and facilitators to address this challenge.
METHODS: PRISMA-ScR was used as a guide to conduct this study. Health sciences librarians searched Medline, Embase, PsychINFO, CINAHL, and SCOPUS to identify relevant articles. Six reviewers contributed to screening and extracting the articles through Covidence. Two reviewers performed thematic analysis using NVivo software to identify key barriers and facilitators.
RESULTS: An initial search found 6275 articles for title and abstract screening, resulting in 48 studies meeting the inclusion criteria. The primary barrier to calling 911 pertained to concerns about police arrivng with other first responders, especially regarding their presence and involvement at the scene of overdose. This was followed by legal repercussions, including fear of arrest, incarceration, and fear of eviction, amongst others. Some studies noted the lack of knowledge or trust in GSLs as a deterrent to seeking medical assistance. Additional barriers included concerns about privacy and confidentiality, preference to manage an overdose alone/receive help from another peer, confidence in naloxone effectiveness, limited access to cell phones, peer pressure to not call for help, and identifying as Black, Indigenous, or a Person of Colour (BIPOC). Facilitators include increased GSL awareness among PWUS and law enforcement, expanded legal safeguards for 911 callers, reduced police intervention in overdose cases, and enhanced naloxone availability at key access points.
CONCLUSIONS: Despite the good intentions of GSLs, PWUS continue to experience significant barriers to calling emergency services in the event of an overdose. Understanding these barriers and key facilitators is necessary to inform future drug policy and advocacy efforts.