Priority setting for Canadian Take-Home Naloxone best practice guideline development: an adapted online Delphi method

Abstract

Background Take-Home Naloxone (THN) is a core intervention aimed at addressing the toxic illicit opioid drug supply crisis. Although THN programs are available in all provinces and territories throughout Canada, there are currently no standardized guidelines for THN programs. The Delphi method is a tool for consensus building often used in policy development that allows for engagement of stakeholders. Methods We used an adapted anonymous online Delphi method to elicit priorities for a Canadian guideline on THN as a means of facilitating meaningful stakeholder engagement. A guideline development group generated a series of key questions that were then brought to a 15-member voting panel. The voting panel was comprised of people with lived and living experience of substance use, academics specializing in harm reduction, and clinicians and public health professionals from across Canada. Two rounds of voting were undertaken to score questions on importance for inclusion in the guideline. Results Nine questions that were identified as most important include what equipment should be in THN kits, whether there are important differences between intramuscular and intranasal naloxone administration, how stigma impacts access to distribution programs, how effective THN programs are at saving lives, what distribution models are most effective and equitable, storage considerations for naloxone in a community setting, the role of CPR and rescue breathing in overdose response, client preference of naloxone distribution program type, and what aftercare should be provided for people who respond to overdoses. Conclusions The Delphi method is an equitable consensus building process that generated priorities to guide guideline development.

Guidance on take-home naloxone distribution and use by community overdose responders in Canada

“…The recruitment strategy and the role of committees is detailed elsewhere. 43 Indigenous, Black and other racialized people, and 2SLGBTQIA+ individuals were explicitly invited in all Naloxone Guidance Development Group recruitment material and were represented in the final group (a list of all guidance development project members is available in Appendix 1).…”

“…We identified questions for the guidance development project to address by using a 2-step Delphi method, which allowed the Guidance Development Panel to prioritize a list of potential questions. 43 Further details are available in our publication on the process. 43 In Appendix 5, Supplemental Table 1 and Supplemental Table 2 (available at www.cmaj.ca/lookup/doi/10.1503/cmaj.230128/tab-related-content ) show a PICO (Patient/ Problem, Intervention, Comparison and Outcome) breakdown of the 3 questions included.…”

Document d’orientation sur la distribution et l’utilisation de trousses de naloxone à emporter par les intervenants et intervenantes communautaires en cas de surdose au Canada

“…Nous avons déterminé les questions sur lesquelles devait se pencher le projet d’élaboration du document d’orientation au moyen d’une méthode Delphi à 2 étapes, ce qui a permis au panel d’élaboration du document d’orientation de prioriser une liste de questions potentielles 43 . Notre publication sur le processus contient de plus amples informations 43 .…”

“…Nous avons déterminé les questions sur lesquelles devait se pencher le projet d’élaboration du document d’orientation au moyen d’une méthode Delphi à 2 étapes, ce qui a permis au panel d’élaboration du document d’orientation de prioriser une liste de questions potentielles 43 . Notre publication sur le processus contient de plus amples informations 43 . Les tableaux 1 et 2 de l’annexe 5 (accessible en anglais au www.cmaj.ca/lookup/doi/10.1503/cmaj.230128/tab-related-content ) présentent une ventilation PICO (Patient/Problem, Intervention, Comparaison et Outcome) des 3 questions abordées.…”

“…Bien que le financement actuel de ce projet ne permette pas d’actualiser ce document d’orientation stratégique, nous avons publié des détails sur d’autres questions que le groupe d’élaboration du document d’orientation sur la naloxone jugeait importantes d’inclure dans les directives canadiennes 43 . Nous avons en outre donné des précisions sur les méthodes de revue systématique qui nous ont servi à identifier les données probantes pertinentes dans les articles universitaires et la littérature grise (annexe 5), afin que de nouvelles informations puissent être recueillies à l’aide de méthodes rigoureuses et cohérentes.…”