Overdose risk and attitudes to take-home naloxone among opioid users in Prague and London: A survey comparison

Background: Take-home naloxone (THN) programmes have been introduced in many European countries. In the Czech Republic, where the incidence of the opioid-overdose deaths is below the European average, THN is not available. We assessed a) drug use and overdose history and b) attitudes regarding THN among people who use opioids (PWUO) in Prague and compare these outcomes with a reference sample of PWUO in London, where THN is available. Methods: This cross-sectional study was conducted in PWUO (age >= 18) attending three outpatient addiction clinics in Prague and one in London between April 2018 and June 2019. A purpose-developed questionnaire was administered in the local language. Results: In total, n=125 PWUO completed the questionnaire, consisting of 60 participants in Prague (37/60; 62.7% male) and 65 in London (59/65; 90.8% male). The Prague sample primarily used (diverted) buprenorphine (37/60; 62.7%), with significantly higher rates of lifetime injecting use (60/60, 100.0%; vs. London: 46/65; 70.8%; p<0.001) and personal overdose (38/60; 63.3%; vs. London: 29/65; 44.6%; p=0.036). Most participants across both samples had witnessed overdoses (Prague: 43/60, 71.7%; London: 51/65, 78.5%; p = n.s.). PWUO in Prague wished to have a THN kit (44/60; 74.6%) and considered naloxone training to be "extremely" or "very" important (43/60; 74.1%). Conclusions: PWUO in Prague are at least as likely to overdose themselves and witness opioid overdoses as their peers in London. They expressed strong interest in THN and opioid-overdose management training, suggesting that THN should be made available to Czech PWUO.