Twenty years of take-home naloxone for the prevention of overdose deaths from heroin and other opioids—Conception and maturation

Abstract

Highlights Deaths from opioid overdose can be prevented by prompt administration of naloxone  It has been 20 years since take-home naloxone provision was first proposed  Take-home naloxone programs have recently overcome legal barriers in many countries  Take-home naloxone provision remains low compared to evident growing clinical need  The 'opt-out' model of required pre-provision may achieve wider naloxone coverage Abstract Background: Opioid overdose is a major cause of mortality, but injury and fatal outcomes can be prevented by timely administration of the opioid antagonist naloxone. Pre-provision of naloxone to opioid users and family members (take-home naloxone, THN) was first proposed in 1996, and WHO Guidelines were issued in 2014. While widespread in some countries, THN is minimally available or absent elsewhere. This review traces the development of THN over twenty years, from speculative harm reduction proposal to public health strategy.Method: Medline and PsycINFO were searched for peer-reviewed literature using Boolean queries: 1) "naloxone OR Narcan"; 2) "(opioid OR opiate) AND overdose AND prevention". Grey literature and specialist websites were also searched. Data were extracted and synthesized as narrative review, with key events presented as chronological timeline. Results Conclusions:Framed as a public health tool for harm reduction, THN has overcome social, clinical, and legal barriers in many jurisdictions. Nonetheless, the rising death toll of opioid overdose illustrates that current THN coverage is insufficient, and greater public investment in overdose prevention will be required if THN is to achieve its full potential impact.

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

“…Timely administration of the opioid antagonist naloxone can reverse respiratory depression related to opioid overdose, preventing fatalities [4]. Naloxone has been used in emergency settings for many years [5,6] and is now available to non-medically trained people, including people who use opioids, their friends and family [7][8][9]. Naloxone pre-provision, with instruction on management of the overdose crisis while awaiting emergency medical care, is known as take-home naloxone (THN).…”

“…THN programmes exist in many countries, including the United States [8,10,11]. Programmes are supported by World Health Organization guidelines [12] and endorsed by the United Nations [13].…”

Opioid users reflect on their experiences responding to suspected opioid overdoses using take-home naloxone

“…Respiratory depression caused by opioid overdose can be reversed by the timely administration of naloxone. THN programmes supply naloxone and advice in responding to opioid overdose crisis to non-medical professionals 1. Current provision does not appear to meet the clinical need 1.…”

“…THN programmes supply naloxone and advice in responding to opioid overdose crisis to non-medical professionals 1. Current provision does not appear to meet the clinical need 1. This study examines first-hand accounts from non-medically trained opioid users who were supplied with THN and subsequently responded to apparent opioid overdoses.…”

Prescribing wellness: comprehensive pain management outside specialist services

“…29 In some cases, providing limited dispensing and 'methadone-style' supervision may help to minimise harms such as abuse or overdose. It is important to consider safety strategies such as take-home naloxone for patients and families, 30 fentanyl patch exchanges 6 and the avoidance of benzodiazepine co-prescription.…”