Perspectives of Mothers With Substance Use Disorder on Naloxone Education: "I'm Ready to Have Those Conversations About Who I Was, Because That's Not Who I Am".

Abstract

Approximately 3 million U.S. children live with a parent with an illicit or prescription substance use disorder (SUD) and may be at risk of witnessing an overdose. Parents with SUD offer valuable perspectives on how to facilitate conversations around overdose response. Our aim was to assess attitudes of parents with SUD towards discussing naloxone with their children. Parents with SUD were recruited from SUD treatment programs, social media, and a research website to participate in semistructured virtual focus groups facilitated by peers with lived experience of SUD while parenting. The interview guide was informed by study teams' clinical experiences. We used an inductive thematic analysis approach; transcripts were double-coded. Fifteen parents identifying as mothers participated in 4 focus groups. Four themes were identified. First, most mothers had not discussed naloxone use with their children, yet felt it was important to prepare them to respond to potential overdoses. Second, mothers highlighted that normalizing naloxone education through comparisons to other emergency responses may reduce stigma and expand learning opportunities. Third, mothers noted that overdose response involves physical, cognitive, and emotional processing skills that are acquired at different stages of child development. Fourth, mothers shared that naloxone discussions often require disclosing their own substance use, which was identified as a challenging conversation that mothers were variably ready to navigate. Mothers with SUD believed their children would benefit from naloxone education. Supporting parents navigating their own SUD disclosure and identifying developmentally appropriate tools are important steps in devising education strategies.