{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T19:56:01Z","timestamp":1785009361158,"version":"3.55.0"},"reference-count":49,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2024,7,18]],"date-time":"2024-07-18T00:00:00Z","timestamp":1721260800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["DA R01DA046653"],"award-info":[{"award-number":["DA R01DA046653"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Naloxone is critical for reversing opioid-related overdoses. However, there is a dearth of research examining how naloxone possession and carriage are impacted by time-varying individual and social determinants, and if this differed during the height of the COVID-related mitigation measures (e.g., shutdowns).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We utilized weekly ecological momentary assessments (EMA) to measure factors associated with naloxone possession and carriage among 40 people who use illicit opioids in New York City, for 24 months. Descriptive statistics were used to explore the frequency of weeks with consistent naloxone possession and carriage. Mixed effects binary and multivariable logistic regression was used to test for the impact of time-varying EMA- and baseline-level factors on each outcome.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Approximately 70% of weekly EMAs were associated with consistent naloxone possession or carriage. In multivariable models, compared to during the height of the COVID-related shutdowns (March 12, 2020-May 19, 2021), the time before was associated with lower odds of consistent possession (Odds Ratio (OR) = 0.05, 95% Confidence Interval (CI) = 0.01\u20130.15) and consistent carriage (OR = 0.06, CI = 0.01\u20130.25). Additionally, being female (OR = 11.15, CI = 2.85\u201343.42), being White versus being Black or Hispanic\/Latinx (OR = 8.05, CI = 1.96\u201333.06), and lifetime overdose (OR = 1.96, CI = 1.16\u201319.80) were associated with higher odds of consistent possession. Recent opioid injection (OR = 3.66, CI = 1.34\u20139.94), being female (OR = 7.91, CI = 3.91\u20138.23), and being White (OR = 5.77, CI = 1.35\u201324.55) were associated with higher odds of consistent carriage. Not wanting to be perceived as a drug user was reported in nearly one third (29.0%; 190\/656) of EMAs where inconsistent possession was reported.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Our findings paint a relatively positive picture of possession and carriage during COVID-related shutdowns, particularly among white and female participants, and highlight the importance of capturing time-varying factors to understand naloxone-related behavior. To curb growing disparities, outreach to equip Black and Hispanic\/Latinx people with naloxone is needed as well as interventions to reduce stigma as a barrier to naloxone engagement.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0307151","type":"journal-article","created":{"date-parts":[[2024,7,18]],"date-time":"2024-07-18T17:36:23Z","timestamp":1721324183000},"page":"e0307151","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["Exploration of weekly variation in naloxone possession and carriage among people who use opioids in New York City before, during, and after the COVID-19 pandemic"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7884-6901","authenticated-orcid":true,"given":"Alexis M.","family":"Roth","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4552-2585","authenticated-orcid":true,"given":"Kathleen M.","family":"Ward","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2267-1038","authenticated-orcid":true,"given":"Devon J.","family":"Hensel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luther","family":"Elliott","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex S.","family":"Bennett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,7,18]]},"reference":[{"key":"pone.0307151.ref001","author":"FB Ahmad","year":"2023","journal-title":"Provisional drug overdose death counts"},{"key":"pone.0307151.ref002","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.drugpo.2019.01.010","article-title":"The triple wave epidemic: Supply and demand drivers of the US opioid overdose crisis","volume":"71","author":"D. Ciccarone","year":"2019","journal-title":"Int J Drug Policy"},{"key":"pone.0307151.ref003","author":"New York State Department of Health","year":"2022","journal-title":"New York State\u2014County Opioid Quarterly Report."},{"key":"pone.0307151.ref004","article-title":"Unintentional Drug Poisoning (Overdose) Deaths in New York City in 2022.","volume":"2023","author":"New York City Department of Health","year":"2022"},{"key":"pone.0307151.ref005","doi-asserted-by":"crossref","first-page":"102872","DOI":"10.1016\/j.drugpo.2020.102872","article-title":"Addressing co-occurring public health emergencies: The importance of naloxone distribution in the era of COVID-19.","volume":"83","author":"AB Collins","year":"2020","journal-title":"Int J Drug Policy"},{"key":"pone.0307151.ref006","doi-asserted-by":"crossref","first-page":"109192","DOI":"10.1016\/j.drugalcdep.2021.109192","article-title":"Trends in pharmacy-based dispensing of buprenorphine, extended-release naltrexone, and naloxone during the COVID-19 pandemic by age and sex\u2013United States, March 2019 \u2013December 2020","volume":"232","author":"LJ Cremer","year":"2022","journal-title":"Drug and Alcohol Dependence"},{"key":"pone.0307151.ref007","volume-title":"A qualitative assessment of circumstances surrounding drug overdose deaths during the early stages of the COVID-19 pandemic.","author":"L Tanz","year":"2022"},{"issue":"23","key":"pone.0307151.ref008","first-page":"631","article-title":"Prevention. Opioid Overdose Prevention Programs Providing Naloxone to Laypersons\u2014United States, 2014","volume":"64","author":"E Wheeler","year":"2015","journal-title":"MMWR Morb Mortal Wkly Rep."},{"issue":"8","key":"pone.0307151.ref009","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.2105\/AJPH.2021.306306","article-title":"The Effect of Overdose Education and Naloxone Distribution: An Umbrella Review of Systematic Reviews.","volume":"111","author":"A Razaghizad","year":"2021","journal-title":"American Journal of Public Health"},{"issue":"1","key":"pone.0307151.ref010","doi-asserted-by":"crossref","first-page":"1","DOI":"10.7326\/0003-4819-158-1-201301010-00003","article-title":"Cost-Effectiveness of Distributing Naloxone to Heroin Users for Lay Overdose Reversal","volume":"158","author":"PO Coffin","year":"2013","journal-title":"Annals of Internal Medicine"},{"key":"pone.0307151.ref011","doi-asserted-by":"crossref","first-page":"f174","DOI":"10.1136\/bmj.f174","article-title":"Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis","volume":"346","author":"AY Walley","year":"2013","journal-title":"BMJ"},{"key":"pone.0307151.ref012","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.drugpo.2017.11.017","article-title":"Identifying gaps in the implementation of naloxone programs for laypersons in the United States.","volume":"52","author":"BH Lambdin","year":"2018","journal-title":"Int J Drug Policy."},{"key":"pone.0307151.ref013","doi-asserted-by":"crossref","first-page":"103298","DOI":"10.1016\/j.drugpo.2021.103298","article-title":"A systematic review and meta-analysis of the prevalence of take-home naloxone (THN) ownership and carriage.","volume":"96","author":"G Burton","year":"2021","journal-title":"International Journal of Drug Policy"},{"key":"pone.0307151.ref014","author":"Centers for Disease Control and Prevention","year":"2020","journal-title":"Increase in Fatal Drug Overdoses Across the United States Driven by Synthetic Opioids Before and During the COVID-19 Pandemic."},{"key":"pone.0307151.ref015","first-page":"1","article-title":"\u201cIt\u2019s Also Pushed People to a New Level of Desperation:\u201d COVID-19 Impacts on Experiences of Persons Who Use Illicit Opioids.","author":"K Sweeney","year":"2022","journal-title":"Journal of Psychoactive Drugs"},{"key":"pone.0307151.ref016","doi-asserted-by":"crossref","first-page":"109544","DOI":"10.1016\/j.drugalcdep.2022.109544","article-title":"Factors associated with self-reported avoidance of harm reduction services during the COVID-19 pandemic by people who use drugs in five cities in the United States and Canada","volume":"241","author":"KA Feder","year":"2022","journal-title":"Drug and Alcohol Dependence"},{"issue":"3","key":"pone.0307151.ref017","doi-asserted-by":"crossref","first-page":"e238","DOI":"10.1016\/S2468-2667(23)00023-3","article-title":"Synthesising evidence of the effects of COVID-19 regulatory changes on methadone treatment for opioid use disorder: implications for policy","volume":"8","author":"N Krawczyk","year":"2023","journal-title":"The Lancet Public Health"},{"key":"pone.0307151.ref018","doi-asserted-by":"crossref","first-page":"103253","DOI":"10.1016\/j.drugpo.2021.103253","article-title":"Rethinking \u2018carriage\u2019of take-home naloxone.","volume":"95","author":"R McDonald","year":"2021","journal-title":"International Journal of Drug Policy"},{"issue":"4","key":"pone.0307151.ref019","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1037\/a0017074","article-title":"Ecological momentary assessment (EMA) in studies of substance use.","volume":"21","author":"S. Shiffman","year":"2009","journal-title":"Psychological Assessment"},{"issue":"4","key":"pone.0307151.ref020","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1111\/add.14503","article-title":"Compliance with ecological momentary assessment protocols in substance users: a meta-analysis.","volume":"114","author":"A Jones","year":"2019","journal-title":"Addiction."},{"issue":"1","key":"pone.0307151.ref021","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1037\/a0030754","article-title":"Implicit and explicit drug-related cognitions during detoxification treatment are associated with drug relapse: an ecological momentary assessment study","volume":"81","author":"R Marhe","year":"2013","journal-title":"Journal of consulting and clinical psychology"},{"key":"pone.0307151.ref022","doi-asserted-by":"crossref","first-page":"103554","DOI":"10.1016\/j.drugpo.2021.103554","article-title":"The COVID-19 pandemic and the health of people who use illicit opioids in New York City, the first 12 months","volume":"101","author":"AS Bennett","year":"2022","journal-title":"International Journal of Drug Policy"},{"key":"pone.0307151.ref023","volume-title":"From shutdown to reopening: Here\u2019s a look at N.Y.C. schools\u2019 trek through the pandemic [Newspaper].November","author":"G. Heyward","year":"2021"},{"key":"pone.0307151.ref024","author":"New York City Press Office.","year":"2022","journal-title":"As COVID Cases Plummet and Vaccination Rates Reach New Heights, Mayor Adams Announces Next Phase of Pandemic Response"},{"key":"pone.0307151.ref025","author":"P Adcroft","year":"2021","journal-title":"Timeline: How COVID-19 Changed NYC Spectrum News NY1"},{"key":"pone.0307151.ref026","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.drugalcdep.2018.08.023","article-title":"End-of-day reports of daily hassles and stress in men and women with opioid-use disorder: Relationship to momentary reports of opioid and cocaine use and stress","volume":"193","author":"KL Preston","year":"2018","journal-title":"Drug and Alcohol Dependence"},{"key":"pone.0307151.ref027","doi-asserted-by":"crossref","first-page":"108672","DOI":"10.1016\/j.drugalcdep.2021.108672","article-title":"Socially-supportive norms and mutual aid of people who use opioids: An analysis of Reddit during the initial COVID-19 pandemic","volume":"222","author":"AM Bunting","year":"2021","journal-title":"Drug and Alcohol Dependence"},{"key":"pone.0307151.ref028","doi-asserted-by":"crossref","first-page":"103199","DOI":"10.1016\/j.drugpo.2021.103199","article-title":"A free mailed naloxone program in Philadelphia amidst the COVID-19 pandemic","volume":"94","author":"R French","year":"2021","journal-title":"International Journal of Drug Policy"},{"issue":"1","key":"pone.0307151.ref029","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.annemergmed.2019.07.014","article-title":"Predictors of Overdose Death Among High-Risk Emergency Department Patients With Substance-Related Encounters: A Data Linkage Cohort Study","volume":"75","author":"N Krawczyk","year":"2020","journal-title":"Ann Emerg Med"},{"issue":"1","key":"pone.0307151.ref030","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s12954-022-00604-w","article-title":"Naloxone protection, social support, network characteristics, and overdose experiences among a cohort of people who use illicit opioids in New York City.","volume":"19","author":"AS Bennett","year":"2022","journal-title":"Harm Reduction Journal"},{"key":"pone.0307151.ref031","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.drugpo.2019.09.012","article-title":"\u2018It\u2019s too much, I\u2019m getting really tired of it\u2019: Overdose response and structural vulnerabilities among harm reduction workers in community settings.","volume":"74","author":"G Kolla","year":"2019","journal-title":"International Journal of Drug Policy"},{"issue":"1","key":"pone.0307151.ref032","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.drugpo.2013.07.003","article-title":"\"I felt like a superhero\": the experience of responding to drug overdose among individuals trained in overdose prevention.","volume":"25","author":"KD Wagner","year":"2014","journal-title":"Int J Drug Policy"},{"issue":"3","key":"pone.0307151.ref033","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1080\/02791072.2018.1430409","article-title":"From Peers to Lay Bystanders: Findings from a Decade of Naloxone Distribution in Pittsburgh","volume":"50","author":"AS Bennett","year":"2018","journal-title":"PA. Journal of Psychoactive Drugs"},{"key":"pone.0307151.ref034","doi-asserted-by":"crossref","first-page":"103615","DOI":"10.1016\/j.drugpo.2022.103615","article-title":"Perceived availability and carriage of take-home naloxone and factors associated with carriage among people who inject drugs in England, Wales and Northern Ireland.","volume":"102","author":"C Spring","year":"2022","journal-title":"International Journal of Drug Policy"},{"key":"pone.0307151.ref035","doi-asserted-by":"crossref","first-page":"103236","DOI":"10.1016\/j.drugpo.2021.103236","article-title":"Pathways between COVID-19 public health responses and increasing overdose risks: A rapid review and conceptual framework","volume":"93","author":"T Nguyen","year":"2021","journal-title":"International Journal of Drug Policy"},{"key":"pone.0307151.ref036","doi-asserted-by":"crossref","first-page":"108759","DOI":"10.1016\/j.drugalcdep.2021.108759","article-title":"The naloxone delivery cascade: Identifying disparities in access to naloxone among people who inject drugs in Los Angeles and San Francisco, CA.","volume":"225","author":"EN Kinnard","year":"2021","journal-title":"Drug and Alcohol Dependence"},{"issue":"43","key":"pone.0307151.ref037","doi-asserted-by":"crossref","first-page":"967","DOI":"10.15585\/mmwr.mm6843a3","article-title":"Racial\/Ethnic and Age Group Differences in Opioid and Synthetic Opioid-Involved Overdose Deaths Among Adults Aged \u226518 Years in Metropolitan Areas\u2014United States, 2015\u20132017.","volume":"68","author":"KM Lippold","year":"2019","journal-title":"MMWR Morb Mortal Wkly Rep."},{"key":"pone.0307151.ref038","doi-asserted-by":"crossref","first-page":"108648","DOI":"10.1016\/j.jsat.2021.108648","article-title":"Persons from racial and ethnic minority groups receiving medication for opioid use disorder experienced increased difficulty accessing harm reduction services during COVID-19","volume":"132","author":"R Rosales","year":"2022","journal-title":"Journal of Substance Abuse Treatment"},{"issue":"3","key":"pone.0307151.ref039","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1080\/07418825.2016.1162320","article-title":"Do Precinct Characteristics Influence Stop-and-Frisk in New York City? A Multi-Level Analysis of Post-Stop Outcomes","volume":"34","author":"PJ Levchak","year":"2017","journal-title":"Justice Quarterly."},{"key":"pone.0307151.ref040","author":"The Network for Public Health Law","year":"2020","journal-title":"Harm Reduction Laws in the United States."},{"issue":"2","key":"pone.0307151.ref041","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.healthplace.2011.09.005","article-title":"Drug-related arrest rates and spatial access to syringe exchange programs in New York City health districts: Combined effects on the risk of injection-related infections among injectors.","volume":"18","author":"HLF Cooper","year":"2012","journal-title":"Health & Place."},{"issue":"1","key":"pone.0307151.ref042","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s12954-023-00736-7","article-title":"Racial\/ethnic disparities in opioid overdose prevention: comparison of the naloxone care cascade in White, Latinx, and Black people who use opioids in New York City.","volume":"20","author":"MR Khan","year":"2023","journal-title":"Harm Reduction Journal"},{"issue":"6","key":"pone.0307151.ref043","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1016\/j.drugpo.2007.07.006","article-title":"The effectiveness and safety of syringe vending machines as a component of needle syringe programmes in community settings","volume":"19","author":"MM Islam","year":"2008","journal-title":"International Journal of Drug Policy"},{"issue":"1","key":"pone.0307151.ref044","doi-asserted-by":"crossref","first-page":"2692","DOI":"10.1080\/07853890.2022.2121418","article-title":"Evaluating the impact of naloxone dispensation at public health vending machines in Clark County, Nevada","volume":"54","author":"ST Allen","year":"2022","journal-title":"Annals of Medicine"},{"issue":"4","key":"pone.0307151.ref045","doi-asserted-by":"crossref","first-page":"667","DOI":"10.2105\/AJPH.2020.306124","article-title":"NEXT Harm Reduction: An Online, Mail-Based Naloxone Distribution and Harm-Reduction Program.","volume":"111","author":"C Yang","year":"2021","journal-title":"Am J Public Health."},{"key":"pone.0307151.ref046","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1016\/j.drugalcdep.2018.06.009","article-title":"Frequent experience of discrimination among people who inject drugs: Links with health and wellbeing","volume":"190","author":"C Couto e Cruz","year":"2018","journal-title":"Drug and Alcohol Dependence"},{"key":"pone.0307151.ref047","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1016\/j.drugalcdep.2014.08.018","article-title":"Perceived discrimination and injecting risk among people who inject drugs attending Needle and Syringe Programmes in Sydney, Australia.","volume":"144","author":"H Wilson","year":"2014","journal-title":"Drug and Alcohol Dependence"},{"key":"pone.0307151.ref048","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.drugpo.2019.03.012","article-title":"Stigma and drug use settings as correlates of self-reported, non-fatal overdose among people who use drugs in Baltimore, Maryland.","volume":"68","author":"CA Latkin","year":"2019","journal-title":"International Journal of Drug Policy"},{"issue":"12","key":"pone.0307151.ref049","doi-asserted-by":"crossref","first-page":"e22411","DOI":"10.2196\/22411","article-title":"Reasons People Who Use Opioids Do Not Accept or Carry No-Cost Naloxone: Qualitative Interview Study.","volume":"4","author":"AS Bennett","year":"2020","journal-title":"JMIR formative research."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0307151","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,18]],"date-time":"2024-07-18T17:36:47Z","timestamp":1721324207000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0307151"}},"subtitle":[],"editor":[{"given":"Sairah","family":"Hafeez Kamran","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,7,18]]},"references-count":49,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2024,7,18]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0307151","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,18]]}}}