A rapid assessment of take-home naloxone provision during COVID-19 in Europe

Rebecca McDonald¹, Desiree Eide², Katri Abel-Ollo³, Lee Barnsdale⁴, Ben Carter⁵, Thomas Clausen⁶, Ed Day⁷, Francina Fonseca⁸, Elin Holmén⁹, Kirsten Horsburgh¹⁰, Mike Kelleher¹¹, Martin Kåberg¹², Martin Ladenhauf¹³, Andrew McAuley¹⁴, Nicola Metrebian¹⁵, Joanne Neale¹⁵, Stephen Parkin¹⁵, Kevin Ratcliffe¹⁶, Chris Rintoul¹⁷, Josie Smith¹⁸, Viktorija Stifanoviciute¹⁹, Marta Torrens⁸, Henrik Thiesen²⁰, John Strang²¹

Affiliations

¹ National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Norway. Electronic address: Rebecca.mcdonald@medisin.uio.no.
² National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Norway.
³ Drug Abuse and Infectious Diseases Prevention Centre, National Institute for Health Development, Tallinn, Estonia.
⁴ Public Health Scotland, UK.
⁵ Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
⁶ Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Norway.
⁷ Institute for Mental Health, School of Psychology, University of Birmingham, UK.
⁸ Addiction Research Group, Neuroscience Research Program, Hospital del Mar Medical Research Institute, Barcelona, Spain.
⁹ Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden.
¹⁰ Scottish Drugs Forum, Glasgow, UK.
¹¹ South London and Maudsley NHS Foundation Trust, London, UK.
¹² Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Department of Medicine, Division of Infectious Diseases, Karolinska Institute, Stockholm, Sweden.
¹³ Caritas Kontaktladen und Streetwork im Drogenbereich, Graz, Austria.
¹⁴ Public Health Scotland, UK; School of Health and Life Sciences, Glasgow Caledonian University, UK.
¹⁵ National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
¹⁶ Change Grow Live, Birmingham, UK.
¹⁷ Cranstoun, Esher, UK.
¹⁸ Substance Misuse Programme, Public Health Wales, Cardiff, UK.
¹⁹ Drug, Tobacco and Alcohol Control Department, Lithuania.
²⁰ Health Team for the Homeless, Center for Marginalized Adults and Families, Copenhagen City Social Services, Denmark.
²¹ National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK.

PMID: 35849935
PMCID: PMC9247228
DOI: 10.1016/j.drugpo.2022.103787

A rapid assessment of take-home naloxone provision during COVID-19 in Europe

Rebecca McDonald et al. Int J Drug Policy. 2022 Sep.

. 2022 Sep:107:103787.

doi: 10.1016/j.drugpo.2022.103787. Epub 2022 Jul 1.

Authors

Affiliations

¹ National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Norway. Electronic address: Rebecca.mcdonald@medisin.uio.no.
² National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Norway.
³ Drug Abuse and Infectious Diseases Prevention Centre, National Institute for Health Development, Tallinn, Estonia.
⁴ Public Health Scotland, UK.
⁵ Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
⁶ Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Norway.
⁷ Institute for Mental Health, School of Psychology, University of Birmingham, UK.
⁸ Addiction Research Group, Neuroscience Research Program, Hospital del Mar Medical Research Institute, Barcelona, Spain.
⁹ Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden.
¹⁰ Scottish Drugs Forum, Glasgow, UK.
¹¹ South London and Maudsley NHS Foundation Trust, London, UK.
¹² Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Department of Medicine, Division of Infectious Diseases, Karolinska Institute, Stockholm, Sweden.
¹³ Caritas Kontaktladen und Streetwork im Drogenbereich, Graz, Austria.
¹⁴ Public Health Scotland, UK; School of Health and Life Sciences, Glasgow Caledonian University, UK.
¹⁵ National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
¹⁶ Change Grow Live, Birmingham, UK.
¹⁷ Cranstoun, Esher, UK.
¹⁸ Substance Misuse Programme, Public Health Wales, Cardiff, UK.
¹⁹ Drug, Tobacco and Alcohol Control Department, Lithuania.
²⁰ Health Team for the Homeless, Center for Marginalized Adults and Families, Copenhagen City Social Services, Denmark.
²¹ National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK.

PMID: 35849935
PMCID: PMC9247228
DOI: 10.1016/j.drugpo.2022.103787

Abstract

Background: In March 2020, the World Health Organization declared COVID-19 a global pandemic. In the following weeks, most European countries implemented national lockdowns to mitigate viral spread. Services for people who use drugs had to quickly revise their operating procedures to rearrange service provision while adhering to lockdown requirements. Given the scarcity of literature published on overdose prevention during COVID-19 in Europe, we aimed to examine how these changes to service provision affected take-home naloxone (THN) programmes and naloxone availability across Europe.

Methods: Between November 2020 and January 2021, we conducted a rapid assessment with country experts from European countries that provide THN. We sent country experts a template to report monthly THN distribution data (January 1, 2019-October 31, 2020) and a structured 6-item survey for completion.

Results: Responses were received from 14 of the 15 European countries with THN provision of which 11 participated in the rapid assessment: Austria, Denmark, England, Estonia, Lithuania, Northern Ireland, Norway, Scotland, Spain (Catalonia only), Sweden, and Wales. All reported reduced organisational capacity during COVID-19, and some put into place a range of novel approaches to manage the restrictions on face-to-face service provision. In six countries, the introduction of programme innovation occurred alongside the publication of government guidelines recommending increased THN provision during COVID-19. Eight of the eleven participating countries managed to maintain 2019-level monthly THN distribution rates or even increase provision during the pandemic.

Conclusion: Through programme innovation supported by public guidelines, many European THN programmes managed to ensure stable or even increased THN provision during the pandemic, despite social distancing and stay-at-home orders affecting client mobility.

Keywords: Coronavirus; Harm reduction; Heroin; Opiate; Opioid; Overdose.

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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): Katri Abel-Ollo: KAO has no competing interests. Lee Barnsdale: LB has no competing interests. Ben Carter: BC has received, through his university research funding from Mundipharma Research Ltd. Thomas Clausen: TC has no competing interests. Ed Day: ED has no competing interests. Desiree Eide: DE has no competing interests. Francina Fonseca: FF has no competing interests. Elin Holmén: EH has no competing interests. Kirsten Horsburgh: KH has no competing interests. Mike Kelleher: MK, in the past 3 years, has taken part in research funded by Indivior, Camurus and Mundipharma. He has received honoraria from Indivior, Gilead, and Abbvie. Martin Kåberg: MKå has received honoraria for lectures/consultancy from Abbvie, Gilead, MSD, Mundipharma, DnE Pharma, and Nordic Drugs and has received research grants from Gilead and Nordic Drugs. Martin Ladenhauf: ML has no competing interests. Andrew McAuley: AMcA has no competing interests. Rebecca McDonald: RMcD indirectly received, through her former employer King's College London, funding from Mundipharma Research Ltd that supported her position of employment (2019-21). RM was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King's College London. Nicola Metrebian: NM has received, through her university, King's College London, research funding from Mundipharma Research Ltd (a pharmaceutical company that produces a naloxone nasal spray). She has also received, through her university, consultancy payment from an agency for Mayne Pharma International, on another area of research not relevant to the article under consideration. Joanne Neale: JN has received, through her university, research funding from Mundipharma Research Ltd and Camurus AB for unrelated research and an honorarium from Indivior for an unrelated conference presentation. JN was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King's College London. Stephen Parkin: SP has received funding, as part of his employment within King's College London, funding from Mundipharma Research Ltd, and Camurus AB pharmaceutical company and The Pilgrim Trust. SP was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King's College London. Kevin Ratcliffe: KR has no competing interests. Chris Rintoul: CR has no competing interests. Josie Smith: JS has no competing interests. Viktorija Stifanoviciute: VS has no competing interests. John Strang: JS has been a longstanding advocate for, and research enquirer into, take-home naloxone. Through his university, JS has worked/is working with pharma and tech industries to identify new or improved interventions (including overdose crisis management) and his employer (King's College London) has received grants, travel costs and/or consultancy payments; this includes discussion and investigation of new naloxone formulations with, past 3 years, Mundipharma, Accord, dne pharma (all of whom have naloxone products). JS is currently leading a cohort study of individuals to whom a supply of take-home naloxone has been provided and who are being followed up prospectively over time, supported by an investigator-initiated grant from Mundipharma. His employer (King's College London) also earlier registered intellectual property on a buccal naloxone formulation, naming JS and colleagues, and he was previously named in a patent registration by a pharmaceutical company regarding concentrated nasal naloxone spray. JS does not receive any personal payment from these arrangements. JS was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King's College London. For a fuller account, see JS's web-page at http://www.kcl.ac.uk/ioppn/depts/addictions/people/hod.aspx Marta Torrens: MT has been a consultant/advisor and/or speaker for Gilead Sciences, Merck Sharp & Dohme Corp, Indivior, Mundipharma Pharmaceutics, Servier Adamed, Lundbeck, Camurus, and Rovi. Henrik Thiesen: HT has no competing interests.

References

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A rapid assessment of take-home naloxone provision during COVID-19 in Europe

Affiliations

A rapid assessment of take-home naloxone provision during COVID-19 in Europe

Authors

Affiliations

Abstract

Conflict of interest statement

References

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical