A rapid assessment of take-home naloxone provision during COVID-19 in Europe

McDonald, Rebecca; Eide, Desiree; Abel-Ollo, Katri; Barnsdale, Lee; Carter, Ben; Clausen, Thomas; Day, Ed; Fonseca, Francina; Holmén, Elin; Horsburgh, Kirsten; Kelleher, Mike; Kåberg, Martin; Ladenhauf, Martin; McAuley, Andrew; Metrebian, Nicola; Neale, Joanne; Parkin, Stephen; Ratcliffe, Kevin; Rintoul, Chris; Smith, Josie; Stifanoviciute, Viktorija; Torrens, Marta; Thiesen, Henrik; Strang, John

doi:10.1016/j.drugpo.2022.103787

Cited by 10 publications

(5 citation statements)

References 19 publications

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“…This included using a briefer form of a research tool (survey, questionnaire or interview proforma). 63 138 144 160 A variation on this was the use of group interviews as a substitute for individual interviews. 152 A proposal for an RCT using this principle of doing less at every stage was also identified.…”

Section: Resultsmentioning

confidence: 99%

Approaches to enabling rapid evaluation of innovations in health and social care: a scoping review of evidence from high-income countries

et al. 2022

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ObjectiveThe COVID-19 pandemic increased the demand for rapid evaluation of innovation in health and social care. Assessment of rapid methodologies is lacking although challenges in ensuring rigour and effective use of resources are known. We mapped reports of rapid evaluations of health and social care innovations, categorised different approaches to rapid evaluation, explored comparative benefits of rapid evaluation, and identified knowledge gaps.DesignScoping review.Data sourcesMEDLINE, EMBASE and Health Management Information Consortium (HMIC) databases were searched through 13 September 2022.Eligibility criteria for selecting studiesWe included publications reporting primary research or methods for rapid evaluation of interventions or services in health and social care in high-income countries.Data extraction and synthesisTwo reviewers developed and piloted a data extraction form. One reviewer extracted data, a second reviewer checked 10% of the studies; disagreements and uncertainty were resolved through consensus. We used narrative synthesis to map different approaches to conducting rapid evaluation.ResultsWe identified 16 759 records and included 162 which met inclusion criteria.We identified four main approaches for rapid evaluation: (1) Using methodology designed specifically for rapid evaluation; (2) Increasing rapidity by doing less or using less time-intensive methodology; (3) Using alternative technologies and/or data to increase speed of existing evaluation method; (4) Adapting part of non-rapid evaluation.The COVID-19 pandemic resulted in an increase in publications and some limited changes in identified methods. We found little research comparing rapid and non-rapid evaluation.ConclusionsWe found a lack of clarity about what ‘rapid evaluation’ means but identified some useful preliminary categories. There is a need for clarity and consistency about what constitutes rapid evaluation; consistent terminology in reporting evaluations as rapid; development of specific methodologies for making evaluation more rapid; and assessment of advantages and disadvantages of rapid methodology in terms of rigour, cost and impact.

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Section: Resultsmentioning

confidence: 99%

Approaches to enabling rapid evaluation of innovations in health and social care: a scoping review of evidence from high-income countries

et al. 2022

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“…Evaluating possible effects of COVID-19 on the study, which impacted half-way through, is not within the scope of this analysis. However, previous research conducted in the Stockholm NSP during the first year of COVID-19, showed that naloxone distribution remained at pre-pandemic levels [ 58 , 59 ].…”

Section: Discussionmentioning

confidence: 99%

Sweden’s first Take-Home Naloxone program: participant characteristics, dose endpoints and predictors for overdose reversals

Holmén

Warnqvist

Kåberg

2023

Subst Abuse Treat Prev Policy

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Background Opioid overdoses are a growing concern, particularly among people who inject drugs. Sweden, with a comparatively high proportion of drug-related mortality, introduced its first Take-Home Naloxone (THN) program in 2018, at the Stockholm needle and syringe program (NSP). In this study we compare THN participant characteristics regarding refills and overdose reversals as well as investigate predictors associated with number of reversals. We also investigate interventions performed in overdose situations and endpoints for naloxone doses. Methods This was a prospective open inclusion cohort study conducted between January 24th 2018 and March 31st 2022 at the Stockholm NSP. Participants received THN, free of charge, after a training session and provided data regarding drug use and overdose experiences. During refill visits, participants reported if the naloxone was used for overdose reversal and, if so, responded to a ten-item questionnaire which included stating whether the naloxone recipient was the participant themselves or somebody else. Questionnaire data was combined with NSP database demographic data. Zero-inflated Poisson regression was applied to analyse predictors for number of reported overdose reversals. Results Among study participants (n = 1,295), 66.5% stated opioids as their primary drug, and 61.4% and 81.0% had previous experience of a personal or witnessed overdose, respectively. Overall, 44.0% of participants reported a total of 1,625 overdose reversals and the victim was known to have survived in 95.6% of cases. Stimulant use (aIRR 1.26; 95% CI 1.01, 1.58), benzodiazepine use (aIRR 1.75; 95% CI 1.1, 2.78) and homelessness (aIRR 1.35; 95% CI 1.06, 1.73) were predictors associated with an increased number of reported overdose reversals. Mortality was higher among those who reported at least one overdose reversal (HR 3.4; 95% CI 2.2, 5.2). Conclusions An NSP’s existent framework can be utilised to effectively implement a THN program, provide basic training and reach numerous high-risk individuals. During the four-year study, THN participants reversed a sizeable number of potentially fatal overdoses, of which many were reported by participants whose primary drug was not opioids. Naloxone refill rate was high, indicating that participants were motivated to maintain a supply of naloxone in case of future overdose events.

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“…A greater focus on relatives and friends may be prudent to the success of THN provision in emergency settings, although a 2022 European study about attitudes and likelihood of using THN kits reported that opioid users were signi cantly more likely to witness an overdose and use a THN kit compared to the family. 31 Research conducted in the United States reported that nearly half of the kits distributed by emergency services were given to family members with the patients themselves being the second largest group to receive the kit. 32 A study assessing the acceptance of naloxone nasal spray in the ED reported similar ndings despite uptake being reported as low.…”

Section: Implications For Research Policy Practicementioning

confidence: 99%

Is a definitive trial of Take-Home Naloxone in emergency settings indicated? Results of a cluster randomised feasibility study

Snooks,

Jones,

Bell

et al. 2024

Preprint

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Background Opioids kill more people than any other class of drug. Naloxone is an opioid antagonist which can be distributed in kits for peer administration. We aimed to determine feasibility of undertaking a definitive randomised controlled trial (RCT) of Take-home Naloxone (THN) in emergency settings. Methods Using individual-level-routine health records (2015-21) we tested feasibility of developing a discriminant function to identify people at high-risk of fatal opioid poisoning for outcome comparisons. We undertook a clustered RCT on paired UK Emergency Department (ED) and ambulance service sites. At intervention sites, we recruited practitioners to administer THN to patients presenting with opioid overdose or related condition during ta 1year recruitment period, 2019 – 21. We assessed feasibility of intervention and trial methods against predetermined progression criteria. Results Within routine health records on the population of Wales (~3,200,000), we identified 1,105 adult deaths from opioid poisoning, of whom 307 (27.8%) had no ED or drugs service contacts in the year before death. At a predicted probability threshold of 0.0003, a discriminant function based on demographics and recent healthcare contacts identified 809 opioid related deaths within 1 year (sensitivity 74.7%) in 989,151 people, missing 274 cases. Lowering the threshold to 0.0002 increased sensitivity to 86.1% but included a further 608,191 non-cases; raising it to 0.0004 reduced sensitivity to 65.4% and inclusion of non-cases to 646,750. At two intervention sites, randomly selected from 4: 299/687 (43.5%) clinical staff were trained; 60/277 eligible patients (21.7%) were supplied with a THN kit and no adverse events were reported. Conclusion With a low incidence of opioid-related death and significant proportion with no contact with ED or drug services in the year before death, the numbers needed to reach a reasonable sensitivity was very high. This study did not meet progression criteria, a fully powered trial is not planned. Trial Registration ISRCTN13232859 (Registered 16/02/2018)

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A rapid assessment of take-home naloxone provision during COVID-19 in Europe

Cited by 10 publications

References 19 publications

Approaches to enabling rapid evaluation of innovations in health and social care: a scoping review of evidence from high-income countries

Approaches to enabling rapid evaluation of innovations in health and social care: a scoping review of evidence from high-income countries

Sweden’s first Take-Home Naloxone program: participant characteristics, dose endpoints and predictors for overdose reversals

Is a definitive trial of Take-Home Naloxone in emergency settings indicated? Results of a cluster randomised feasibility study

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