Cost-Effectiveness of Take-Home Naloxone for the Prevention of Overdose Fatalities among Heroin Users in the United Kingdom

Langham, Sue; Wright, Antony; Kenworthy, James; Grieve, Richard; Dunlop, W.

doi:10.1016/j.jval.2017.07.014

Cited by 53 publications

(59 citation statements)

References 27 publications

(58 reference statements)

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“…The current treatment of fentanyl overdose is naloxone, an opioid antagonist. Distribution of naloxone to high-risk populations is being expanded in the United States and has been shown to be a cost-effective strategy for decreasing overdose deaths in both the United States and UK (Wheeler et al, 2015;Langham et al, 2018). However, for naloxone to be effective, administration is required shortly after exposure and with proper technique.…”

Section: Introductionmentioning

confidence: 99%

A Fentanyl Vaccine Alters Fentanyl Distribution and Protects against Fentanyl-Induced Effects in Mice and Rats

Raleigh

Baruffaldi

Peterson

et al. 2018

J Pharmacol Exp Ther

107

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Fentanyl is an extremely potent synthetic opioid that has been increasingly used to adulterate heroin, cocaine, and counterfeit prescription pills, leading to an increase in opioid-induced fatal overdoses in the United States, Canada, and Europe. A vaccine targeting fentanyl could offer protection against the toxic effects of fentanyl in both recreational drug users and others in professions at risk of accidental exposure. This study focuses on the development of a vaccine consisting of a fentanyl-based hapten (F) conjugated to keyhole limpet hemocyanin (KLH) carrier protein or to GMP-grade subunit KLH (sKLH). Immunization with F-KLH in mice and rats reduced fentanyl-induced hotplate antinociception, and in rats reduced fentanyl distribution to the brain compared with controls. F-KLH did not reduce the antinociceptive effects of equianalgesic doses of heroin or oxycodone in rats. To assess the vaccine effect on fentanyl toxicity, rats immunized with F-sKLH or unconjugated sKLH were exposed to increasing subcutaneous doses of fentanyl. Vaccination with F-sKLH shifted the dose-response curves to the right for both fentanyl-induced antinociception and respiratory depression. Naloxone reversed fentanyl effects in both groups, showing that its ability to reverse respiratory depression was preserved. These data demonstrate preclinical selectivity and efficacy of a fentanyl vaccine and suggest that vaccines may offer a therapeutic option in reducing fentanyl-induced side effects.

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Section: Introductionmentioning

confidence: 99%

A Fentanyl Vaccine Alters Fentanyl Distribution and Protects against Fentanyl-Induced Effects in Mice and Rats

Raleigh

Baruffaldi

Peterson

et al. 2018

J Pharmacol Exp Ther

107

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“…Programmes are supported by World Health Organization guidelines [12] and endorsed by the United Nations [13]. Evidence suggests that providing people who use opioids with overdose training increases their knowledge of overdose risk factors, signs and responses [14][15][16][17][18][19], that people who use opioids can and will use naloxone to reverse overdoses when trained [18,[20][21][22] and that naloxone distribution to people who use opioids reduces mortality [23,24] and is cost-effective [25,26]. Despite this, most countries do not have naloxone programmes and countries that do have differing policies, training and provision that can be constrained by national and local legal and regulatory frameworks, as well as costs [27,28].…”

Section: Introductionmentioning

confidence: 99%

How competent are people who use opioids at responding to overdoses? Qualitative analyses of actions and decisions taken during overdose emergencies

et al. 2018

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Background and Aims Providing take-home naloxone (THN) to people who use opioids is an increasingly common strategy for reversing opioid overdose. However, implementation is hindered by doubts regarding the ability of people who use opioids to administer naloxone and respond appropriately to overdoses. We aimed to increase understanding of the competencies required and demonstrated by opioid users who had recently participated in a THN programme and were subsequently confronted with an overdose emergency. Design Qualitative study designed to supplement findings from a randomized controlled trial of overdose education and naloxone distribution. Interviews were audio-recorded, transcribed, systematically coded and analysed via Iterative Categorization. Setting New York City, USA. Participants Thirty-nine people who used opioids (32 men, 7 women; aged 22-58 years). Intervention Trial participants received brief or extended overdose training and injectable or nasal naloxone. Measurements The systematic coding frame comprised deductive codes based on the topic guide and more inductive codes emerging from the data. Findings In 38 of 39 cases the victim was successfully resuscitated; the outcome of one overdose intervention was unknown. Analyses revealed five core overdose response 'tasks': (1) overdose identification; (2) mobilizing support; (3) following basic first aid instructions; (4) naloxone administration; and (5) post-resuscitation management. These tasks comprised actions and decisions that were themselves affected by diverse cognitive, emotional, experiential, interpersonal and social factors over which lay responders often had little control. Despite this, participants demonstrated high levels of competency. They had acquired new skills and knowledge through training and brought critical 'insider' understanding to overdose events and the resuscitation actions which they applied. Conclusions People who use opioids can be trained to respond appropriately to opioid overdoses and thus to save their peers' lives. Overdose response requires both practical competency (e.g. skills and knowledge in administering basic first aid and naloxone) and social competency (e.g. willingness to help others, having the confidence to be authoritative and make decisions, communicating effectively and demonstrating compassion and care to victims post-resuscitation).

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“…Several agencies recommend expanding access to naloxone, including the US Department of Health and Human Services, the Surgeon General, the World Health Organization, the American Medical Association, the American Public Health Association, and the National Association of Boards of Pharmacy (30)(31)(32)(33)(34)(35). OEND programs have been shown to effectively train bystanders how to recognize an overdose and administer naloxone, reduce the number of fatal overdoses, and encourage recipients to reduce opioid use and enter treatment (36)(37)(38)(39)(40)(41)(42)(43). Several programs have been implemented in EMS systems across the country (44)(45)(46)(47).…”

Section: Discussionmentioning

confidence: 99%

Refusals After Prehospital Administration of Naloxone during the COVID-19 Pandemic

Glenn¹,

Rice²,

Primeau³

et al. 2020

Prehospital Emergency Care

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Objective: To determine if COVID-19 was associated with a change in patient refusals after Emergency Medical Services (EMS) administration of naloxone. Methods: This is a retrospective cohort study in which the incidence of refusals after naloxone administration in a single EMS system was evaluated. The number of refusals after naloxone administration was compared across the before-pandemic interval (01/01/20 to 02/15/20) and the duringpandemic interval (03/16/20 to 04/30/20). For comparison the incidence of all other patient refusals before and during COVID-19 as well as the incidences of naloxone administration before and during COVID-19 were also reported. Results: Prior to the widespread knowledge of the COVID-19 pandemic, 24 of 164 (14.6%) patients who received naloxone via EMS refused transport. During the pandemic, 55 of 153 (35.9%) patients who received naloxone via EMS refused transport. Subjects receiving naloxone during the COVID-19 pandemic were at greater risk of refusal of transport than those receiving naloxone prior to the pandemic (RR ¼ 2.45; 95% CI 1.6-3.76). Among those who did not receive naloxone, 2067 of 6956 (29.7%) patients were not transported prior to the COVID-19 pandemic and 2483 of 6016 (41.3%) were not transported during the pandemic. Subjects who did not receive naloxone with EMS were at greater risk of refusal of transport during the COVID-19 pandemic than prior to it (RR ¼ 1.39; 95% CI 1.32-1.46). Conclusion: In this single EMS system, more than a twofold increase in the rate of refusal after non-fatal opioid overdose was observed following the COVID-19 outbreak.

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Cost-Effectiveness of Take-Home Naloxone for the Prevention of Overdose Fatalities among Heroin Users in the United Kingdom

Cited by 53 publications

References 27 publications

A Fentanyl Vaccine Alters Fentanyl Distribution and Protects against Fentanyl-Induced Effects in Mice and Rats

A Fentanyl Vaccine Alters Fentanyl Distribution and Protects against Fentanyl-Induced Effects in Mice and Rats

How competent are people who use opioids at responding to overdoses? Qualitative analyses of actions and decisions taken during overdose emergencies

Refusals After Prehospital Administration of Naloxone during the COVID-19 Pandemic

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