Community use of naloxone for opioid overdose

Jauncey, Marianne; Nielsen, Suzanne

doi:10.18773/austprescr.2017.043

Cited by 8 publications

(8 citation statements)

References 17 publications

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“…Finally, those who reported unstable housing in 2016 experienced a significantly lower mean number of overdoses onsite at MSIC. The positive association between the SIF attendance and having an overdose onsite has been described previously (Van Beek et al , 2004), but the finding that those who overdose at a SIF less frequently are those who are homeless seems novel and implies that PWID who report unstable housing should be targeted with naloxone training and its provision for peer delivery (Jauncey and Nielsen, 2017).…”

Section: Discussionmentioning

confidence: 77%

Homelessness among clients of Sydney’s supervised injecting facility

Salmon¹,

Běláčková²,

Schwanz

et al. 2017

DAT

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Purpose The Uniting Medically Supervised Injecting Centre (MSIC) opened in Sydney, Australia, in May 2001. Homelessness among people who inject drugs (PWID) in Australia has been increasing, and establishing how supervised injecting facilities (SIFs) might best support clients into housing is an important goal. The purpose of this paper is to update knowledge regarding the accommodation status of MSIC clients, thereby supporting a better understanding of the complex needs of these clients. Design/methodology/approach Client accommodation status at MSIC registration (first visit) and in a brief survey (conducted in May 2016) were compared; unstable accommodation was defined as rough sleeping, couch surfing, hostel, boarding house or crisis accommodation. The bivariate logistic regression analysis was used to explore the association between socio-demographics and accommodation status at both time points; a paired t-test was used to compare the visit records for those who reported stable and unstable accommodation in May 2016. Findings Of 232 clients who were present at MSIC during the week the Brief Survey was conducted, 107 participated. Most were male (79 per cent) with a mean age of 41.4 years. A total of 64 (60 per cent) identified as living in unstable accommodation; having increased from 40 per cent at the time of registration (first visit). There were significant positive associations between unstable accommodation status and unemployment, imprisonment and history of overdose, all measured at registration. In May 2016, unstable accommodation status was significantly associated with age of first injection and with unemployment status (as measured at registration); those living in unstable accommodation in May 2016 had a lower number of visits, a lower number of referrals to health and social services and a lower number of overdoses at MSIC than those living in a stable accommodation. Originality/value The rates of unstable accommodation among MSIC clients have been increasing. These findings highlight the importance of SIFs and drug consumption rooms as venue to address the essential needs of PWID, such as housing. The window of opportunity to support PWID who experience housing instability seems to be narrower than for those who live in stable accommodation.

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Section: Discussionmentioning

confidence: 77%

Homelessness among clients of Sydney’s supervised injecting facility

Salmon¹,

Běláčková²,

Schwanz

et al. 2017

DAT

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“…Overall increases in naloxone supply were mainly attributable to increases in prescriber bag naloxone from 2015. A possible contributing factor to this rise was training and education about opioid overdose in awareness‐raising campaigns during the rescheduling period, increasing prescriber confidence about carrying naloxone …”

Section: Discussionmentioning

confidence: 99%

Community pharmacy naloxone supply, before and after rescheduling as an over‐the‐counter drug: sales and prescriptions data, 2014–2018

Tse

Sanfilippo

Lam

et al. 2020

Medical Journal of Australia

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Objectives: To characterise the community pharmacy supply of naloxone by supply type -individual prescription, prescriber bag, and non-dispensed (supplied over the counter or expired) -during 2014-2018; to examine whether the 2016 rescheduling of naloxone as an over-the-counter drug influenced non-dispensed naloxone supply volume.Design, setting: Analysis of monthly naloxone prescriptions (Pharmaceutical Benefits Scheme) and sales data (IQVIA), 2014-2018, for Australia and by state and territory; time series analysis of non-dispensed naloxone supply to assess effect of rescheduling on naloxone supply. Major outcomes:Total naloxone supply to community pharmacies; prescribed and non-dispensed naloxone supply. Results:During 2014-2018, 372 351 400 μg units of naloxone were sold to community pharmacies: non-dispensed naloxone accounted for 205 866.5 units (55.3%), prescriber bags for 155 841 units (41.8%), and individual prescriptions for 10 643.5 units (2.9%). Populationadjusted national naloxone sales to community pharmacies increased between 2014 and 2018 (per year: incidence rate ratio [IRR], 1.15; 95% CI, 1.09-2.22). This increase was primarily attributable to increased volumes of prescriber bag naloxone (IRR, 1.63; 95% CI, 1.50-1.78) and, to a lesser extent, increased individual prescription supply (IRR, 2.04; 95% CI, 1.85-2.26). Non-dispensed naloxone supply volume was unchanged at the national level (IRR, 0.93; 95% CI, 0.85-1.01); changes in non-dispensed supply immediately following rescheduling and subsequently were not statistically significant in time series analyses for most jurisdictions. Conclusions:Total naloxone supply to community pharmacies in Australia increased between 2014 and 2018, but rescheduling that enabled over-the-counter access did not significantly influence the volume of non-dispensed naloxone.The known: Take home naloxone programs are effective for preventing opioid overdose deaths. Most overdoses in Australia involve pharmaceutical opioids, but little is known about how much naloxone is supplied in primary care, where most pharmaceutical opioids are prescribed.The new: The volume of naloxone supplied on individual prescriptions accounted for less than 3% of all naloxone supplied to pharmacies. Further, despite the 2016 scheduling change that permits naloxone supply without prescription, the over-thecounter supply of naloxone did not increase between 2014 and 2018.The implications: Although prescriptions are no longer a barrier to obtaining naloxone, further strategies are required to increase the supply of take home naloxone.

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“…Among opioid antagonists, naloxone is commonly used to reverse acute opioid overdose, thereby treating related respiratory depression and overdose deaths. Naloxone is effective for all opioid drugs, such as heroin, oxycodone, and fentanyl, and has a fast onset of action (13). While naloxone binds to all three opioid receptors (μ, κ, and γ), its binding to μ-receptor is the strongest.…”

Section: Introductionmentioning

confidence: 99%

Engineering Quick- and Long-acting Naloxone Delivery Systems for Treating Opioid Overdose

et al. 2021

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Purpose Opioids have been the main factor for drug overdose deaths in the United States. Current naloxone delivery systems are effective in mitigating the opioid effects only for hours. Naloxone-loaded poly(lactide-co-glycolide) (PLGA) microparticles were prepared as quick-and long-acting naloxone delivery systems to extend the naloxone effect as an opioid antidote. Methods The naloxone-PLGA microparticles were made using an emulsification solvent extraction approach with different formulation and processing parameters. Two PLGA polymers with the lactide:glycolide (L:G) ratios of 50:50 and 75:25 were used, and the drug loading was varied from 21% to 51%. Two different microparticles of different sizes with the average diameters of 23 μm and 50 μm were produced using two homogenization-sieving conditions. All the microparticles were critically characterized, and three of them were evaluated with β-arrestin recruitment assays. Results The naloxone encapsulation efficiency (EE) was in the range of 70-85%. The EE was enhanced when the theoretical naloxone loading was increased from 30% to 60%, the L:G ratio was changed from 50:50 to 75:25, and the average size of the particles was reduced from 50 μm to 23 μm. The in vitro naloxone release duration ranged from 4 to 35 days. Reducing the average size of the microparticles from 50 μm to 23 μm helped eliminate the lag phase and obtain the steadystate drug release profile. The cellular pharmacodynamics of three selected formulations were evaluated by applying DAMGO, a synthetic opioid peptide agonist to a μ-opioid receptor, to recruit β-arrestin 2. Conclusions Naloxone released from the three selected formulations could inhibit DAMGO-induced β-arrestin 2 recruitment. This indicates that the proposed naloxone delivery system is adequate for opioid reversal during the naloxone release duration. KEY WORDS β-arrestin 2 inhibition . DAMGO . drug loading . encapsulation efficiency . naloxone . opioid overdose . PLGA microparticles . zero-order release

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Community use of naloxone for opioid overdose

Cited by 8 publications

References 17 publications

Homelessness among clients of Sydney’s supervised injecting facility

Homelessness among clients of Sydney’s supervised injecting facility

Community pharmacy naloxone supply, before and after rescheduling as an over‐the‐counter drug: sales and prescriptions data, 2014–2018

Engineering Quick- and Long-acting Naloxone Delivery Systems for Treating Opioid Overdose

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