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#243 Widespread Distribution of Naloxone to Decrease Opioid-Related Deaths


CLINICAL QUESTION
QUESTION CLINIQUE
 Does population-based or programmatic provision of naloxone kits decrease the risk of opioid- related deaths in people who use opioids?

BOTTOM LINE
RÉSULTAT FINAL
 Offering naloxone kits and overdose related education for people who use opioids and their community may decrease opioid related deaths by ~7 per 100,000 population over one year. Effectiveness is likely influenced by magnitude of opioid problem in a given community and other confounders (like co-ingestions, co-morbidities, type and dose of opioid used).


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EVIDENCE
DONNÉES PROBANTES
 Randomized controlled trial:  
  • 1676 inmates being released from prison were randomized to kit with single dose naloxone versus no naloxone.1,2 After 3 months: 
    • Opioid-related deaths: 0.7% naloxone versus 0.4% no naloxone arm, not statistically different. 
    • Limitations: Trial stopped early as ~66% of naloxone used on others, thus limiting individual patient analysis. 
Observational studies: pre/post naloxone program initiation: 
  • Naloxone kits and overdose education provided to people who use opioids, friends/family, and social agency staff, in Massachesettes.3 After one year: 
    • Opioid-related deaths in community (per 100,000): 11.6 with program, 19.0 without program. 
    • Opioid-related hospital visits: unchanged. 
  • Other studies found naloxone kits provided to Scottish prisoners (pre-release) or to patients attending Catalonia harm reduction centers decreased opioid-related deaths.4,5 Evidence limited by:  
    • Improper or unknown “denominators” (number of prisoners released or Catalonian program participants). 
  • Limitations: observational studies results may be influenced by other interventions (example: opioid agonist therapy prescribing). 
Context: 
  • Every day, 2 Albertans and 11 Canadians die of an opioid-related death.6,7 
  • Those at higher risk of opioid-related death include:  
    • Previous opioid overdose.8 
    • Discharge themselves from drug treatment programs.8,9 
    • Recently released from prison.8,10  
    • Use higher doses of prescribed opioids.8,11 
    • Co-ingest benzodiazepines and/or anti-psychotics.8,11,12,13 
  • Patient level data supports the use of naloxone by non-medical personnel, emergency medical services, or in the emergency department.14,15 

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Author(s)
Auteur(s)
  • Dan (Lucy) Ni BMSc
  • Michael R Kolber MD CCFP MSc
  • Joey Ton PharmD

1. Parmar MB, Strang J, Choo L, et al. Addiction. 2017;112(3):502-515.

2. Meade AM, Bird SM, Strang J, et al. Drug Alcohol Rev. 2018; 37(4):487-498.

3. Walley AY, Xuan Z, Hackman HH, et al. BMJ. 2013; 346:f174.

4. Bird SM, McAuley A, Perry S, et al. Addiction. 2016; 111(5):883-91.

5. Espelt A, Bosque-Prous M, Folch C, et al. PLoS One. 2017; 12(10):e0186833.

6. Alberta Health. Quarterly report on: Opioids and Substances of Misuse Alberta Report, 2017 Q4. Retrieved from the Government of Alberta website: https://www.alberta.ca/opioid-reports.aspx. Accessed May 10, 2019. 

7. Statistic Canada. “Accidental apparent opioid-related deaths”. National Report: Apparent Opioid-related Deaths in Canada. Last updated April 2019. Available from: https://infobase.phac-aspc.gc.ca/datalab/national-surveillance-opioid-mortality.html#accidentalAORD Accessed May 10, 2019.

8. Albert S, Brason II FW, Sanford CK, et al. Pain Medicine. 2011; 12:S77-S85.

9. Cousins G, Boland F, Courtney B, et al. Addiction. 2016; 111(1):73-82.

10. Ranapurwala SI, Shanahan ME, Alexandridis AA, et al. Am J Public Health. 2018; 108(9):1207-1213.

11. Dasgupta N, Funk MJ, Proescholdbell S, et al. Pain Med. 2016; 17(1):85-98.

12. Gomes T, Mamdani MM, Dhalla IA, et al. Arch Intern Med. 2011 Apr 11;171(7):686-91.

13. Leece P, M.D., Cavacuiti C, Macdonald EM, et al. J Subst Abuse Treat. 2015; 57:30-5.

14. Lynn RR, Galinkin JL. Ther Adv Drug Saf. 2018, Vol.9(1)63-88.

15. Willman MW, Liss DB, Schwarz ES, et al. Toxicology. 2017; 55(2):81-87.

Authors do not have any conflicts of interest to declare.

Les auteurs n’ont aucun conflit d’intérêts à déclarer.