Guidance on take-home naloxone distribution and use by community overdose responders in Canada

Affiliations

¹ BC Centre for Disease Control (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, BC; Department of Psychiatry (Rittenbach), University of Calgary, Calgary, Alta.; Department of Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Public Health Ontario (PHO) (Leece); Dalla Lana School of Public Health (Leece, Elton-Marshall, Strike) and Department of Family and Community Medicine (Leece), University of Toronto; Institute for Mental Health Policy Research (Ali, Elton-Marshall), Centre for Addiction and Mental Health, Toronto, Ont.; School of Epidemiology and Public Health (Elton-Marshall), University of Ottawa, Ottawa, Ont.; Department of Medicine (Brothers), Dalhousie University, Halifax, NS; UCL Collaborative Centre for Inclusion Health (Brothers), University College London, London, UK; Center for Indigenous Health (Medley), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; Overdose Emergency Response and Addictions Program (Medley), Vancouver Coastal Health, Vancouver, BC; Health Sciences Library (Lorenzetti), University of Calgary; Department of Community Health Sciences (Lorenzetti), Cumming School of Medicine, University of Calgary; O'Brien Institute for Public Health (Lorenzetti), University of Calgary, Calgary, Alta.; BC Centre on Substance Use (Gallant); School of Population and Public Health (Buxton), University of British Columbia, Vancouver, BC.
² BC Centre for Disease Control (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, BC; Department of Psychiatry (Rittenbach), University of Calgary, Calgary, Alta.; Department of Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Public Health Ontario (PHO) (Leece); Dalla Lana School of Public Health (Leece, Elton-Marshall, Strike) and Department of Family and Community Medicine (Leece), University of Toronto; Institute for Mental Health Policy Research (Ali, Elton-Marshall), Centre for Addiction and Mental Health, Toronto, Ont.; School of Epidemiology and Public Health (Elton-Marshall), University of Ottawa, Ottawa, Ont.; Department of Medicine (Brothers), Dalhousie University, Halifax, NS; UCL Collaborative Centre for Inclusion Health (Brothers), University College London, London, UK; Center for Indigenous Health (Medley), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; Overdose Emergency Response and Addictions Program (Medley), Vancouver Coastal Health, Vancouver, BC; Health Sciences Library (Lorenzetti), University of Calgary; Department of Community Health Sciences (Lorenzetti), Cumming School of Medicine, University of Calgary; O'Brien Institute for Public Health (Lorenzetti), University of Calgary, Calgary, Alta.; BC Centre on Substance Use (Gallant); School of Population and Public Health (Buxton), University of British Columbia, Vancouver, BC jane.buxton@bccdc.ca.

PMID: 37640401
PMCID: PMC10462409
DOI: 10.1503/cmaj.230128

Guidance on take-home naloxone distribution and use by community overdose responders in Canada

Max Ferguson et al. CMAJ. 2023.

. 2023 Aug 28;195(33):E1112-E1123.

doi: 10.1503/cmaj.230128.

Authors

Affiliations

¹ BC Centre for Disease Control (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, BC; Department of Psychiatry (Rittenbach), University of Calgary, Calgary, Alta.; Department of Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Public Health Ontario (PHO) (Leece); Dalla Lana School of Public Health (Leece, Elton-Marshall, Strike) and Department of Family and Community Medicine (Leece), University of Toronto; Institute for Mental Health Policy Research (Ali, Elton-Marshall), Centre for Addiction and Mental Health, Toronto, Ont.; School of Epidemiology and Public Health (Elton-Marshall), University of Ottawa, Ottawa, Ont.; Department of Medicine (Brothers), Dalhousie University, Halifax, NS; UCL Collaborative Centre for Inclusion Health (Brothers), University College London, London, UK; Center for Indigenous Health (Medley), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; Overdose Emergency Response and Addictions Program (Medley), Vancouver Coastal Health, Vancouver, BC; Health Sciences Library (Lorenzetti), University of Calgary; Department of Community Health Sciences (Lorenzetti), Cumming School of Medicine, University of Calgary; O'Brien Institute for Public Health (Lorenzetti), University of Calgary, Calgary, Alta.; BC Centre on Substance Use (Gallant); School of Population and Public Health (Buxton), University of British Columbia, Vancouver, BC.
² BC Centre for Disease Control (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, BC; Department of Psychiatry (Rittenbach), University of Calgary, Calgary, Alta.; Department of Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Public Health Ontario (PHO) (Leece); Dalla Lana School of Public Health (Leece, Elton-Marshall, Strike) and Department of Family and Community Medicine (Leece), University of Toronto; Institute for Mental Health Policy Research (Ali, Elton-Marshall), Centre for Addiction and Mental Health, Toronto, Ont.; School of Epidemiology and Public Health (Elton-Marshall), University of Ottawa, Ottawa, Ont.; Department of Medicine (Brothers), Dalhousie University, Halifax, NS; UCL Collaborative Centre for Inclusion Health (Brothers), University College London, London, UK; Center for Indigenous Health (Medley), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; Overdose Emergency Response and Addictions Program (Medley), Vancouver Coastal Health, Vancouver, BC; Health Sciences Library (Lorenzetti), University of Calgary; Department of Community Health Sciences (Lorenzetti), Cumming School of Medicine, University of Calgary; O'Brien Institute for Public Health (Lorenzetti), University of Calgary, Calgary, Alta.; BC Centre on Substance Use (Gallant); School of Population and Public Health (Buxton), University of British Columbia, Vancouver, BC jane.buxton@bccdc.ca.

PMID: 37640401
PMCID: PMC10462409
DOI: 10.1503/cmaj.230128

Abstract

Background: The increasing toxicity of opioids in the unregulated drug market has led to escalating numbers of overdoses in Canada and worldwide; takehome naloxone (THN) is an evidence-based intervention that distributes kits containing naloxone to people in the community who may witness an overdose. The purpose of this guidance is to provide policy recommendations for territorial, provincial and federal THN programs, using evidence from scientific and grey literature and community evidence that reflects 11 years of THN distribution in Canada.

Methods: The Naloxone Guidance Development Group - a multidisciplinary team including people with lived and living experience and expertise of drug use - used the Appraisal of Guidelines for Research & Evaluation (AGREE II) instrument to inform development of this guidance. We considered published evidence identified through systematic reviews of all literature types, along with community evidence and expertise, to generate recommendations between December 2021 and September 2022. We solicited feedback on preliminary recommendations through an External Review Committee and a public input process. The project was funded by the Canadian Institutes of Health Research through the Canadian Research Initiative in Substance Misuse. We used the Guideline International Network principles for managing competing interests.

Recommendations: Existing evidence from the literature on THN was of low quality. We incorporated evidence from scientific and grey literature, and community expertise to develop our recommendations. These were in 3 areas: routes of naloxone administration, THN kit contents and overdose response. Take-home naloxone programs should offer the choice of both intramuscular and intranasal formulations of naloxone in THN kits. Recommended kit contents include naloxone, a naloxone delivery device, personal protective equipment, instructions and a carrying case. Trained community overdose responders should prioritize rescue breathing in the case of respiratory depression, and conventional cardiopulmonary resuscitation in the case of cardiac arrest, among other interventions.

Interpretation: This guidance development project provides direction for THN programs in Canada in the context of limited published evidence, with recommendations developed in collaboration with diverse stakeholders.

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Conflict of interest statement

Competing interests: Thomas Brothers reports receiving a research fellowship from the Canadian Institutes of Health Research (CIHR), Dalhousie University Internal Medicine Research Foundation, in support of the present manuscript. Jane Buxton reports receiving a CIHR grant to the Canadian Research Initiative in Substance Misuse (CRISM) for the work overseen and managed by the Centre for Addictions and Mental Health, in support of the present manuscript. Dr. Buxton has also received fees from the Canadian Centre on Substance Use and Addiction to write a foreword for a report, from the British Columbia Centre for Disease Control, and Glasgow Caledonian University; and received honoraria from the Canadian Association of Nurses and the Canadian Association of Hepatitis Nurses for invited presentations, all outside the present work. Katherine Rittenbach was an employee of Alberta Health Services, during the conduct of the study. During the conduct of the study, Pamela Leece reports receiving grants from the following public institutions, administered at Public Health Ontario (Ontario Agency for Health Protection and Promotion): CIHR, Health Canada, Public Health Agency of Canada. Tara Elton-Marshall reports receiving a grant from CIHR, outside the submitted work. Charlene Burmeister is executive director of the Coalition of Substance Users of the North. No other competing interests were declared.

References

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Guidance on take-home naloxone distribution and use by community overdose responders in Canada

Affiliations

Guidance on take-home naloxone distribution and use by community overdose responders in Canada

Authors

Affiliations

Abstract

Conflict of interest statement

References

MeSH terms

Substances

LinkOut - more resources

Full Text Sources