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Naloxone Programmes

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Doe-Simkins, Bystander Administered Naloxone image

This section (alongside Section 5 above) focuses on one particular overdose intervention – naloxone (see above for a description of this medication). It includes academic research and evaluations of naloxone peer distribution schemes from the USA – often as integral components of broader overdose prevention programmes. In particular, the paper by Karl Sporer and Alex Kral is a useful review of these programmes, the successes, the lessons that can be learned and the unmet research needs. Although the USA has dominated research on this particular topic, US experiences are useful for existing and potential naloxone programmes across the world.

Doe-Simkins M, Walley AY, Epstein A, Moyer P. (2009) Saved by the nose: bystander-administered intranasal naloxone hydrochloride for opioid overdose. American Journal of Public Health, 99(5), pages 788 - 791.

This paper evaluates the success of an opioid overdose prevention programme that included intranasal naloxone education and distribution to potential overdose bystanders in Boston, USA. The researchers describe how after 15 months, the programme had provided training and intranasal naloxone to 385 participants who reported 74 successful overdose reversals. They found problems with intranasal naloxone to be uncommon and concluded that its distribution with relevant training is a feasible public health intervention to address opioid overdose. Unfortunately, we are unable to provide free access to this article at this stage.

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Galea S, Worthington N, Markham Piper T, Nandi VV, Curtis M & Rosenthal DM (2006) Provision of Naloxone to Injection Drug Users as an Overdose Prevention Strategy: Early evidence from a pilot study in New York City. Addictive Behaviors, 31, pages 907 – 912.

This paper is an early evaluation of a pilot naloxone distribution scheme in New York. The initiative was launched in 2004 through the city’s needle and syringe programmes. This study outlines the assessed demographics, drug use, and overdose history, experience, and behavior of participants at intake into the scheme, when they returned for prescription refills, and three months after the baseline assessment. There were 17 witnessed overdoses during the study period, and naloxone was administered in ten of them with no fatalities. Unfortunately, we are unable to provide free access to this article at this stage.

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Green TC, Heimer R & Grau LE (2008) Distinguishing signs of opioid overdose and indication for naloxone: an evaluation of six overdose training and naloxone distribution programs in the United States. Addiction, 103, pages 979 – 989.

This paper assesses the effectiveness of six overdose prevention programmes in increasing awareness of potential overdose bystanders to when an overdose was occurring and whether or not the administration of naloxone was required. The study concluded that training did significantly increase awareness and understanding of overdose and overdose prevention. Trained respondents were as skilled as medical experts in recognising opioid overdose situations and when naloxone was required. Unfortunately, we are unable to provide free access to this article at this stage.

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Maxwell S, Bigg, D, Stanczykiewicz K & Carlberg-Racich S (2006) Prescribing Naloxone to Actively Injecting Heroin Users: A Program to Reduce Heroin Overdose Deaths. Journal of Addictive Diseases, 25(3), pages 89 – 96.

This paper describes an overdose prevention programme in Chicago which combines education and the administration of intramuscular naloxone through a large harm reduction programme network. Since the programme began in January 2001, more than 3,500 vials of naloxone have been prescribed and 319 reports of ‘peer reversals’ (incidents of overdose where peers have successfully intervened) have been received.

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Piper TM, Rudenstine S, Stancliff S, Sherman S, Nandi V, Clear A & Galea S (2007) Overdose Prevention for Injection Drug Users: Lessons learned from naloxone training and distribution programs in New York City. Harm Reduction Journal, 4:3.

This paper evaluates the SKOOP (Skills and Knowledge on Opiate Prevention) programme in the USA. During a one year period, over 1,000 participants were trained and received a prescription for naloxone. The authors describe six primary challenges and lessons learned in developing, implementing and evaluating the programme. These include the political climate surrounding naloxone distribution, existing prescription drug laws, initial low levels of recruitment into the programme, the development of appropriate training methods, challenges in evaluation designs, and the evolution of programme response to naloxone.

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Sherman SG, Gann DS, Tobin KE, Latkin CA, Welsh C & Bielenson P (2009) “The Life They Save May Be Mine”: Diffusion of overdose prevention information from a city sponsored programme. International Journal of Drug Policy, 20 (2), pages 137 – 142.

This is the second of two papers in Harm Reduction International’s official journal evaluating the ‘Staying Alive’ overdose prevention and naloxone distribution programme which was established in Baltimore (USA). This qualitative study examines the diffusion of information through this programme, and demonstrates the participant’s interest in – and ability to diffuse – overdose prevention information and response skills. The study shows the importance of promoting the diffusion of information and skills within overdose prevention programmes. Unfortunately, we are unable to provide free access to this article.

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Sporer KA & Kral AH (2007) Prescription Naloxone: A Novel Approach to Heroin Overdose Prevention. Annals of Emergency Medicine Volume 49, No. 2: February 2007, 172 – 177.

This paper provides a contemporary overview of naloxone distribution programmes across the USA and beyond. There are many examples of these projects, and programme implementation considerations, legal ramifications, and current research needs for prescription naloxone are also outlined.

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Tobin KE, Sherman SG, Beilenson P, Welsh C & Latkin CA (2008) Evaluation of the Staying Alive Programme: Training injection drug users to properly administer naloxone and save lives. International Journal of Drug Policy, 20 (2), pages 131 – 136.

This is the first of two papers in Harm Reduction International’s official journal evaluating the ‘Staying Alive’ overdose prevention and naloxone distribution programme which was established in Baltimore (USA). This study examines the impact of the programme on a sample of 85 participants. During the study period, naloxone was administered by 19 participants with no reported adverse effects. After the training, a greater proportion of participants also reported using resuscitation skills that had been taught in the programme, along with increased knowledge about naloxone.

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Worthington N, Markham Piper T, Galea S & Rosenthal D (2006) Opiate Users' Knowledge about Overdose Prevention and Naloxone in New York City: A focus group study. Harm Reduction Journal, 3:19.

This paper reports on the results of a focus group study in the USA in which participants received a prescription for two doses of naloxone (with refills as needed) and comprehensive training to reduce overdose risks, administer naloxone, perform rescue breathing, and call emergency services. By September 2005, 204 participants had received the training and been issued with naloxone. Forty of these reported having used the naloxone to revive and help a peer or family member.

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