Take-Home Naloxone for the Emergency Interim Management of Opioid Overdose: The Public Health Application of an Emergency Medicine

John Strang; Rebecca McDonald; Gabrielle Campbell; Louisa Degenhardt; Suzanne Nielsen; Alison Ritter; Ola Dale

doi:10.1007/s40265-019-01154-5

Back

Take-Home Naloxone for the Emergency Interim Management of Opioid Overdose: The Public Health Application of an Emergency Medicine

Journal article

Open access

Peer reviewed

Take-Home Naloxone for the Emergency Interim Management of Opioid Overdose: The Public Health Application of an Emergency Medicine

John Strang, Rebecca McDonald, Gabrielle Campbell, Louisa Degenhardt, Suzanne Nielsen, Alison Ritter and Ola Dale

Drugs, Vol.79(13), pp.1395-1418

2019

DOI: https://doi.org/10.1007/s40265-019-01154-5

PMID: 31352603

Files and links (2)

pdf

Take-Home Naloxone for the Emergency Interim Management of Opioid Overdose - The Public Health Application of an Emergency Medicine1.20 MBDownload View

Published VersionCC BY-NC V4.0, Open Access

url

https://doi.org/10.1007/s40265-019-01154-5View

Published Version Open

Abstract

Opioid-Related Disorders - drug therapy

Analgesics, Opioid - adverse effects

Animals

Drug Overdose - drug therapy

Humans

Naloxone - therapeutic use

Public Health - methods

Emergency Medicine - methods

Naloxone is a well-established essential medicine for the treatment of life-threatening heroin/opioid overdose in emergency medicine. Over two decades, the concept of 'take-home naloxone' has evolved, comprising pre-provision of an emergency supply to laypersons likely to witness an opioid overdose (e.g. peers and family members of people who use opioids as well as non-medical personnel), with the recommendation to administer the naloxone to the overdose victim as interim care while awaiting an ambulance. There is an urgent need for more widespread naloxone access considering the growing problem of opioid overdose deaths, accounting for more than 100,000 deaths worldwide annually. Rises in mortality are particularly sharp in North America, where the ongoing prescription opioid problem is now overlaid with a rapid growth in overdose deaths from heroin and illicit fentanyl. Using opioids alone is dangerous, and the mortality risk is clustered at certain times and contexts, including on prison release and discharge from hospital and residential care. The provision of take-home naloxone has required the introduction of new legislation and new naloxone products. These include pre-filled syringes and auto-injectors and, crucially, new concentrated nasal sprays (four formulations recently approved in different countries) with speed of onset comparable to intramuscular naloxone and relative bioavailability of approximately 40-50%. Choosing the right naloxone dose in the fentanyl era is a matter of ongoing debate, but the safety margin of the approved nasal sprays is superior to improvised nasal kits. New legislation in different countries permits over-the-counter sales or other prescription-free methods of provision. However, access remains uneven with take-home naloxone still not provided in many countries and communities, and with ongoing barriers contributing to implementation inertia. Take-home naloxone is an important component of the response to the global overdose problem, but greater commitment to implementation will be essential, alongside improved affordable products, if a greater impact is to be achieved.

Details

Title: Take-Home Naloxone for the Emergency Interim Management of Opioid Overdose: The Public Health Application of an Emergency Medicine
Authors: John Strang (Corresponding Author) - King's College London
Rebecca McDonald (Author) - King's College London
Gabrielle Campbell (Author) - UNSW Australia
Louisa Degenhardt (Author) - UNSW Australia
Suzanne Nielsen (Author) - UNSW Australia
Alison Ritter (Author) - UNSW Australia
Ola Dale (Author) - Norwegian University of Science and Technology
Publication details: Drugs, Vol.79(13), pp.1395-1418
Publisher: Adis International Ltd.
Date published: 2019
DOI: 10.1007/s40265-019-01154-5
ISSN: 1179-1950; 0012-6667
PMID: 31352603
Copyright note: Open Access: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Organisation Unit: University of the Sunshine Coast, Queensland; School of Health and Sport Sciences - Legacy; School of Health and Behavioural Sciences - Legacy
Language: English
Record Identifier: 99473407702621
Output Type: Journal article

Metrics

19 File views/ downloads

32 Record Views

89 Times Cited - Web of Science

See more details

InCites Highlights

These are selected metrics from InCites Benchmarking & Analytics tool, related to this output

Collaboration types: Domestic collaboration; International collaboration
Web Of Science research areas: Pharmacology & Pharmacy; Toxicology

UN Sustainable Development Goals (SDGs)

This output has contributed to the advancement of the following goals:

Source: InCites