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. 2021 Sep:95:103253.
doi: 10.1016/j.drugpo.2021.103253. Epub 2021 Apr 11.

Rethinking 'carriage' of take-home naloxone

Rebecca McDonald  1 , Stephen Parkin  1 , Desiree Eide  2 , Joanne Neale  1 , Thomas Clausen  3 , Nicola Metrebian  1 , Ben Carter  4 , John Strang  5
Affiliations

Rethinking 'carriage' of take-home naloxone

Rebecca McDonald et al. Int J Drug Policy. 2021 Sep.

Abstract

Take-home naloxone (THN) provision to people who use drugs, their family/friends, and non-medical personnel is considered a public health strategy to improve community-based naloxone access and reduce the time to antidote treatment for opioid overdose in order to prevent fatal outcome. THN programs typically report up to three performance indicators: the volume of THN kits distributed, the rate of requests for re-supply of THN kits (e.g., following naloxone use for overdose reversal), and - increasingly - THN "carriage". In this Research Methods piece, we discuss the current shortcomings in the latter measurement of THN carriage from a mixed-methods perspective and describe possible implications for public health related research and improved data analyses. We present an argument for the need to improve research methods in the case of THN "carriage" and propose a multidimensional measurement structure that takes into account: 1) the location of the THN kit relative to its owner, 2) the owner's immediate access to the kit in an emergency, 3) the type of THN device, and 4) the purpose of THN ownership (i.e., for use in self or known/unknown other/s).

Keywords: Harm reduction; Measurement; Naloxone; Opioid; Overdose; Research methods.

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Conflict of interest statement

Declarations of Interest Declaration of Competing Interest in the last 3 years (authors listed in alphabetical order) Ben Carter: B.C. has no competing interests. Thomas Clausen: T.C. has no competing interests. Desiree Eide: D.E. has no competing interests. Rebecca McDonald: RMcD received conference-related travel funding and an honorarium from IOTOD (Improving Opioid Outcomes in the Treatment of Opioid Dependence) in 2018. RMcD's employer (King's College London) has received a research grant from Mundipharma Research Ltd for an observational cohort study of take-home naloxone provision in Europe. Separately, King's College London registered intellectual property on a novel buccal naloxone formulation, naming RMcD as co-inventor. RMcD worked as a consultant on community-based naloxone access in Central Asia and Eastern Europe for the United Nations Office on Drugs and Crime (UNODC; 2016–17). Nicola Metrebian: NM has (through her employer King's College London) received a grant from MundiPharma Research Ltd (a pharmaceutical company that produces one of the naloxone products). Joanne Neale: JN has received, through her university, research funding from Mundipharma Research Ltd and Camurus AB. Stephen Parkin: S.P. has indirectly received, through his university, funding from Mundipharma Research Ltd and Camurus AB that supports his position of employment. John Strang: JS, through his university, is working with the pharmaceutical industry to identify new or improved treatments and his employer (King's College London) has received grants, travel costs and/or consultancy payments; this includes investigation of new naloxone formulations and has included work within the past 3 years with Mundipharma Research Ltd (that produces one of the naloxone products). His employer (King's College London) has also registered intellectual property on a novel buccal naloxone formulation, naming JS as co-inventor, and he was earlier named in a patent registration by a pharmaceutical company regarding a concentrated nasal naloxone spray. JS worked as a consultant on community-based naloxone access in Central Asia and Eastern Europe for the United Nations Office on Drugs and Crime (UNODC; 2016–17). For a fuller account, see JS’ webpage at www.kcl.ac.uk/ioppn/depts/addictions/people/hod.aspx.

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