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Saari TI, Strang J, Dale O. Clinical Pharmacokinetics and Pharmacodynamics of Naloxone. Clin Pharmacokinet 2024; 63:397-422. [PMID: 38485851 PMCID: PMC11052794 DOI: 10.1007/s40262-024-01355-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 04/29/2024]
Abstract
Naloxone is a World Health Organization (WHO)-listed essential medicine and is the first choice for treating the respiratory depression of opioids, also by lay-people witnessing an opioid overdose. Naloxone acts by competitive displacement of opioid agonists at the μ-opioid receptor (MOR). Its effect depends on pharmacological characteristics of the opioid agonist, such as dissociation rate from the MOR receptor and constitution of the victim. Aim of treatment is a balancing act between restoration of respiration (not consciousness) and avoidance of withdrawal, achieved by titration to response after initial doses of 0.4-2 mg. Naloxone is rapidly eliminated [half-life (t1/2) 60-120 min] due to high clearance. Metabolites are inactive. Major routes for administration are intravenous, intramuscular, and intranasal, the latter primarily for take-home naloxone. Nasal bioavailability is about 50%. Nasal uptake [mean time to maximum concentration (Tmax) 15-30 min] is likely slower than intramuscular, as reversal of respiration lag behind intramuscular naloxone in overdose victims. The intraindividual, interindividual and between-study variability in pharmacokinetics in volunteers are large. Variability in the target population is unknown. The duration of action of 1 mg intravenous (IV) is 2 h, possibly longer by intramuscular and intranasal administration. Initial parenteral doses of 0.4-0.8 mg are usually sufficient to restore breathing after heroin overdose. Fentanyl overdoses likely require higher doses of naloxone. Controlled clinical trials are feasible in opioid overdose but are absent in cohorts with synthetic opioids. Modeling studies provide valuable insight in pharmacotherapy but cannot replace clinical trials. Laypeople should always have access to at least two dose kits for their interim intervention.
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Affiliation(s)
- Teijo I Saari
- Department of Anaesthesiology and Intensive Care, University of Turku, Turku, Finland
- Division of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
| | - John Strang
- National Addiction Centre, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, SE5 8BB, UK
| | - Ola Dale
- Department of Circulation and Medical Imaging, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.
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Du Pont D, Fenderson R, Hunter K, Kuc A, Carroll G. Adverse Effects After Prehospital Administration of Naloxone by Bystanders: A Preliminary Study. Prehosp Disaster Med 2024; 39:212-217. [PMID: 38449098 PMCID: PMC11035918 DOI: 10.1017/s1049023x24000128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/05/2024] [Accepted: 01/24/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE Opioid use disorder is a cause of significant morbidity and mortality. In order to reverse opioid overdose as quickly as possible, many institutions and municipalities have encouraged people with no professional medical training to carry and administer naloxone. This study sought to provide preliminary data for research into the rates of adverse effects of naloxone when administered by bystanders compared to Emergency Medical Services (EMS) personnel, since this question has not been studied previously. METHODS This was a retrospective cohort study performed at an urban, tertiary, academic medical center that operates its own EMS service. A consecutive sample of patients presenting to EMS with opioid overdose requiring naloxone was separated into two groups based on whether naloxone was administered by bystanders or by EMS personnel. Each group was analyzed to determine the incidence of four pre-specified adverse events. RESULTS There was no significant difference in the rate of adverse events between the bystander (19%) and EMS (16%) groups (OR = 1.23; 95% CI, 0.63 - 2.32; P = .499) in this small sample. Based on these initial results, a study would need a sample size of 6,188 in order to reach this conclusion with 80% power. Similarly, there were no significant differences in the rates of any of the individual adverse events. Secondary analysis of patients' demographics showed differences between the two groups which generate hypotheses for further investigation of disparities in naloxone administration. CONCLUSIONS This preliminary study provides foundational data for further investigation of naloxone administration by bystanders. Adverse events after the prehospital administration of naloxone are rare, and future studies will require large sample sizes. These preliminary data did not demonstrate a statistically significant difference in adverse event rates when comparing naloxone administration by bystanders and EMS clinicians. This study provides data that will be useful for conducting further research on multiple facets of this topic.
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Affiliation(s)
- Daniel Du Pont
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PennsylvaniaUSA
| | - Rebecca Fenderson
- Department of Emergency Medicine, Cooper University Hospital, Camden, New JerseyUSA
| | - Krystal Hunter
- Cooper Research Institute, Cooper Medical School of Rowan University, Camden, New JerseyUSA
| | - Alexander Kuc
- Division of EMS and Disaster Medicine, Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, New JerseyUSA
| | - Gerard Carroll
- Division of EMS and Disaster Medicine, Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, New JerseyUSA
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Lavonas EJ, Akpunonu PD, Arens AM, Babu KM, Cao D, Hoffman RS, Hoyte CO, Mazer-Amirshahi ME, Stolbach A, St-Onge M, Thompson TM, Wang GS, Hoover AV, Drennan IR. 2023 American Heart Association Focused Update on the Management of Patients With Cardiac Arrest or Life-Threatening Toxicity Due to Poisoning: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2023; 148:e149-e184. [PMID: 37721023 DOI: 10.1161/cir.0000000000001161] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
In this focused update, the American Heart Association provides updated guidance for resuscitation of patients with cardiac arrest, respiratory arrest, and refractory shock due to poisoning. Based on structured evidence reviews, guidelines are provided for the treatment of critical poisoning from benzodiazepines, β-adrenergic receptor antagonists (also known as β-blockers), L-type calcium channel antagonists (commonly called calcium channel blockers), cocaine, cyanide, digoxin and related cardiac glycosides, local anesthetics, methemoglobinemia, opioids, organophosphates and carbamates, sodium channel antagonists (also called sodium channel blockers), and sympathomimetics. Recommendations are also provided for the use of venoarterial extracorporeal membrane oxygenation. These guidelines discuss the role of atropine, benzodiazepines, calcium, digoxin-specific immune antibody fragments, electrical pacing, flumazenil, glucagon, hemodialysis, hydroxocobalamin, hyperbaric oxygen, insulin, intravenous lipid emulsion, lidocaine, methylene blue, naloxone, pralidoxime, sodium bicarbonate, sodium nitrite, sodium thiosulfate, vasodilators, and vasopressors for the management of specific critical poisonings.
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Ferguson M, Rittenbach K, Leece P, Adams A, Ali F, Elton-Marshall T, Burmeister C, Brothers TD, Medley A, Choisil P, Strike C, Ng J, Lorenzetti DL, Gallant K, Buxton JA. Document d’orientation sur la distribution et l’utilisation de trousses de naloxone à emporter par les intervenants et intervenantes communautaires en cas de surdose au Canada. CMAJ 2023; 195:E1312-E1325. [PMID: 37788838 PMCID: PMC10637331 DOI: 10.1503/cmaj.230128-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Affiliation(s)
- Max Ferguson
- Centre de contrôle des maladies de la Colombie-Britannique (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, C.-B.; Département de psychiatrie (Rittenbach), Université de Calgary, Calgary, Alb.; Département de psychiatrie (Rittenbach), Université de l'Alberta, Edmonton, Alb.; Santé publique Ontario (Leece); École Dalla Lana de santé publique (Leece, Elton-Marshall, Strike) et Département de médecine familiale et communautaire (Leece), Université de Toronto; Institut de recherche sur les politiques de santé mentale (Ali, Elton-Marshall), Centre de toxicomanie et de santé mentale, Toronto, Ont.; École d'épidémiologie et de santé publique (Elton-Marshall), Université d'Ottawa, Ottawa, Ont.; Département de médecine (Brothers), Université Dalhousie, Halifax, N.-É.; Centre collaboratif pour la santé inclusive UCL (Brothers), Collège universitaire de Londres, Londres, Royaume-Uni; Centre de santé des Autochtones (Medley), École de santé publique Johns Hopkins Bloomberg, Baltimore, Md.; Programme d'interventions d'urgence en cas de surdose et de toxicomanie (Medley), Régie de la santé du littoral de Vancouver, Vancouver, C.-B.; Bibliothèque des sciences de la santé (Lorenzetti), Université de Calgary; Département des sciences de la santé communautaire (Lorenzetti), École de médecine Cumming, Université de Calgary; Institut O'Brien de santé publique (Lorenzetti), Université de Calgary, Calgary, Alb.; Centre de traitement de la toxicomanie de la Colombie-Britannique (Gallant); École de santé des populations et de santé publique (Buxton), Université de Colombie-Britannique, Vancouver, C.-B
| | - Katherine Rittenbach
- Centre de contrôle des maladies de la Colombie-Britannique (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, C.-B.; Département de psychiatrie (Rittenbach), Université de Calgary, Calgary, Alb.; Département de psychiatrie (Rittenbach), Université de l'Alberta, Edmonton, Alb.; Santé publique Ontario (Leece); École Dalla Lana de santé publique (Leece, Elton-Marshall, Strike) et Département de médecine familiale et communautaire (Leece), Université de Toronto; Institut de recherche sur les politiques de santé mentale (Ali, Elton-Marshall), Centre de toxicomanie et de santé mentale, Toronto, Ont.; École d'épidémiologie et de santé publique (Elton-Marshall), Université d'Ottawa, Ottawa, Ont.; Département de médecine (Brothers), Université Dalhousie, Halifax, N.-É.; Centre collaboratif pour la santé inclusive UCL (Brothers), Collège universitaire de Londres, Londres, Royaume-Uni; Centre de santé des Autochtones (Medley), École de santé publique Johns Hopkins Bloomberg, Baltimore, Md.; Programme d'interventions d'urgence en cas de surdose et de toxicomanie (Medley), Régie de la santé du littoral de Vancouver, Vancouver, C.-B.; Bibliothèque des sciences de la santé (Lorenzetti), Université de Calgary; Département des sciences de la santé communautaire (Lorenzetti), École de médecine Cumming, Université de Calgary; Institut O'Brien de santé publique (Lorenzetti), Université de Calgary, Calgary, Alb.; Centre de traitement de la toxicomanie de la Colombie-Britannique (Gallant); École de santé des populations et de santé publique (Buxton), Université de Colombie-Britannique, Vancouver, C.-B
| | - Pamela Leece
- Centre de contrôle des maladies de la Colombie-Britannique (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, C.-B.; Département de psychiatrie (Rittenbach), Université de Calgary, Calgary, Alb.; Département de psychiatrie (Rittenbach), Université de l'Alberta, Edmonton, Alb.; Santé publique Ontario (Leece); École Dalla Lana de santé publique (Leece, Elton-Marshall, Strike) et Département de médecine familiale et communautaire (Leece), Université de Toronto; Institut de recherche sur les politiques de santé mentale (Ali, Elton-Marshall), Centre de toxicomanie et de santé mentale, Toronto, Ont.; École d'épidémiologie et de santé publique (Elton-Marshall), Université d'Ottawa, Ottawa, Ont.; Département de médecine (Brothers), Université Dalhousie, Halifax, N.-É.; Centre collaboratif pour la santé inclusive UCL (Brothers), Collège universitaire de Londres, Londres, Royaume-Uni; Centre de santé des Autochtones (Medley), École de santé publique Johns Hopkins Bloomberg, Baltimore, Md.; Programme d'interventions d'urgence en cas de surdose et de toxicomanie (Medley), Régie de la santé du littoral de Vancouver, Vancouver, C.-B.; Bibliothèque des sciences de la santé (Lorenzetti), Université de Calgary; Département des sciences de la santé communautaire (Lorenzetti), École de médecine Cumming, Université de Calgary; Institut O'Brien de santé publique (Lorenzetti), Université de Calgary, Calgary, Alb.; Centre de traitement de la toxicomanie de la Colombie-Britannique (Gallant); École de santé des populations et de santé publique (Buxton), Université de Colombie-Britannique, Vancouver, C.-B
| | - Alison Adams
- Centre de contrôle des maladies de la Colombie-Britannique (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, C.-B.; Département de psychiatrie (Rittenbach), Université de Calgary, Calgary, Alb.; Département de psychiatrie (Rittenbach), Université de l'Alberta, Edmonton, Alb.; Santé publique Ontario (Leece); École Dalla Lana de santé publique (Leece, Elton-Marshall, Strike) et Département de médecine familiale et communautaire (Leece), Université de Toronto; Institut de recherche sur les politiques de santé mentale (Ali, Elton-Marshall), Centre de toxicomanie et de santé mentale, Toronto, Ont.; École d'épidémiologie et de santé publique (Elton-Marshall), Université d'Ottawa, Ottawa, Ont.; Département de médecine (Brothers), Université Dalhousie, Halifax, N.-É.; Centre collaboratif pour la santé inclusive UCL (Brothers), Collège universitaire de Londres, Londres, Royaume-Uni; Centre de santé des Autochtones (Medley), École de santé publique Johns Hopkins Bloomberg, Baltimore, Md.; Programme d'interventions d'urgence en cas de surdose et de toxicomanie (Medley), Régie de la santé du littoral de Vancouver, Vancouver, C.-B.; Bibliothèque des sciences de la santé (Lorenzetti), Université de Calgary; Département des sciences de la santé communautaire (Lorenzetti), École de médecine Cumming, Université de Calgary; Institut O'Brien de santé publique (Lorenzetti), Université de Calgary, Calgary, Alb.; Centre de traitement de la toxicomanie de la Colombie-Britannique (Gallant); École de santé des populations et de santé publique (Buxton), Université de Colombie-Britannique, Vancouver, C.-B
| | - Farihah Ali
- Centre de contrôle des maladies de la Colombie-Britannique (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, C.-B.; Département de psychiatrie (Rittenbach), Université de Calgary, Calgary, Alb.; Département de psychiatrie (Rittenbach), Université de l'Alberta, Edmonton, Alb.; Santé publique Ontario (Leece); École Dalla Lana de santé publique (Leece, Elton-Marshall, Strike) et Département de médecine familiale et communautaire (Leece), Université de Toronto; Institut de recherche sur les politiques de santé mentale (Ali, Elton-Marshall), Centre de toxicomanie et de santé mentale, Toronto, Ont.; École d'épidémiologie et de santé publique (Elton-Marshall), Université d'Ottawa, Ottawa, Ont.; Département de médecine (Brothers), Université Dalhousie, Halifax, N.-É.; Centre collaboratif pour la santé inclusive UCL (Brothers), Collège universitaire de Londres, Londres, Royaume-Uni; Centre de santé des Autochtones (Medley), École de santé publique Johns Hopkins Bloomberg, Baltimore, Md.; Programme d'interventions d'urgence en cas de surdose et de toxicomanie (Medley), Régie de la santé du littoral de Vancouver, Vancouver, C.-B.; Bibliothèque des sciences de la santé (Lorenzetti), Université de Calgary; Département des sciences de la santé communautaire (Lorenzetti), École de médecine Cumming, Université de Calgary; Institut O'Brien de santé publique (Lorenzetti), Université de Calgary, Calgary, Alb.; Centre de traitement de la toxicomanie de la Colombie-Britannique (Gallant); École de santé des populations et de santé publique (Buxton), Université de Colombie-Britannique, Vancouver, C.-B
| | - Tara Elton-Marshall
- Centre de contrôle des maladies de la Colombie-Britannique (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, C.-B.; Département de psychiatrie (Rittenbach), Université de Calgary, Calgary, Alb.; Département de psychiatrie (Rittenbach), Université de l'Alberta, Edmonton, Alb.; Santé publique Ontario (Leece); École Dalla Lana de santé publique (Leece, Elton-Marshall, Strike) et Département de médecine familiale et communautaire (Leece), Université de Toronto; Institut de recherche sur les politiques de santé mentale (Ali, Elton-Marshall), Centre de toxicomanie et de santé mentale, Toronto, Ont.; École d'épidémiologie et de santé publique (Elton-Marshall), Université d'Ottawa, Ottawa, Ont.; Département de médecine (Brothers), Université Dalhousie, Halifax, N.-É.; Centre collaboratif pour la santé inclusive UCL (Brothers), Collège universitaire de Londres, Londres, Royaume-Uni; Centre de santé des Autochtones (Medley), École de santé publique Johns Hopkins Bloomberg, Baltimore, Md.; Programme d'interventions d'urgence en cas de surdose et de toxicomanie (Medley), Régie de la santé du littoral de Vancouver, Vancouver, C.-B.; Bibliothèque des sciences de la santé (Lorenzetti), Université de Calgary; Département des sciences de la santé communautaire (Lorenzetti), École de médecine Cumming, Université de Calgary; Institut O'Brien de santé publique (Lorenzetti), Université de Calgary, Calgary, Alb.; Centre de traitement de la toxicomanie de la Colombie-Britannique (Gallant); École de santé des populations et de santé publique (Buxton), Université de Colombie-Britannique, Vancouver, C.-B
| | - Charlene Burmeister
- Centre de contrôle des maladies de la Colombie-Britannique (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, C.-B.; Département de psychiatrie (Rittenbach), Université de Calgary, Calgary, Alb.; Département de psychiatrie (Rittenbach), Université de l'Alberta, Edmonton, Alb.; Santé publique Ontario (Leece); École Dalla Lana de santé publique (Leece, Elton-Marshall, Strike) et Département de médecine familiale et communautaire (Leece), Université de Toronto; Institut de recherche sur les politiques de santé mentale (Ali, Elton-Marshall), Centre de toxicomanie et de santé mentale, Toronto, Ont.; École d'épidémiologie et de santé publique (Elton-Marshall), Université d'Ottawa, Ottawa, Ont.; Département de médecine (Brothers), Université Dalhousie, Halifax, N.-É.; Centre collaboratif pour la santé inclusive UCL (Brothers), Collège universitaire de Londres, Londres, Royaume-Uni; Centre de santé des Autochtones (Medley), École de santé publique Johns Hopkins Bloomberg, Baltimore, Md.; Programme d'interventions d'urgence en cas de surdose et de toxicomanie (Medley), Régie de la santé du littoral de Vancouver, Vancouver, C.-B.; Bibliothèque des sciences de la santé (Lorenzetti), Université de Calgary; Département des sciences de la santé communautaire (Lorenzetti), École de médecine Cumming, Université de Calgary; Institut O'Brien de santé publique (Lorenzetti), Université de Calgary, Calgary, Alb.; Centre de traitement de la toxicomanie de la Colombie-Britannique (Gallant); École de santé des populations et de santé publique (Buxton), Université de Colombie-Britannique, Vancouver, C.-B
| | - Thomas D Brothers
- Centre de contrôle des maladies de la Colombie-Britannique (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, C.-B.; Département de psychiatrie (Rittenbach), Université de Calgary, Calgary, Alb.; Département de psychiatrie (Rittenbach), Université de l'Alberta, Edmonton, Alb.; Santé publique Ontario (Leece); École Dalla Lana de santé publique (Leece, Elton-Marshall, Strike) et Département de médecine familiale et communautaire (Leece), Université de Toronto; Institut de recherche sur les politiques de santé mentale (Ali, Elton-Marshall), Centre de toxicomanie et de santé mentale, Toronto, Ont.; École d'épidémiologie et de santé publique (Elton-Marshall), Université d'Ottawa, Ottawa, Ont.; Département de médecine (Brothers), Université Dalhousie, Halifax, N.-É.; Centre collaboratif pour la santé inclusive UCL (Brothers), Collège universitaire de Londres, Londres, Royaume-Uni; Centre de santé des Autochtones (Medley), École de santé publique Johns Hopkins Bloomberg, Baltimore, Md.; Programme d'interventions d'urgence en cas de surdose et de toxicomanie (Medley), Régie de la santé du littoral de Vancouver, Vancouver, C.-B.; Bibliothèque des sciences de la santé (Lorenzetti), Université de Calgary; Département des sciences de la santé communautaire (Lorenzetti), École de médecine Cumming, Université de Calgary; Institut O'Brien de santé publique (Lorenzetti), Université de Calgary, Calgary, Alb.; Centre de traitement de la toxicomanie de la Colombie-Britannique (Gallant); École de santé des populations et de santé publique (Buxton), Université de Colombie-Britannique, Vancouver, C.-B
| | - Andrea Medley
- Centre de contrôle des maladies de la Colombie-Britannique (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, C.-B.; Département de psychiatrie (Rittenbach), Université de Calgary, Calgary, Alb.; Département de psychiatrie (Rittenbach), Université de l'Alberta, Edmonton, Alb.; Santé publique Ontario (Leece); École Dalla Lana de santé publique (Leece, Elton-Marshall, Strike) et Département de médecine familiale et communautaire (Leece), Université de Toronto; Institut de recherche sur les politiques de santé mentale (Ali, Elton-Marshall), Centre de toxicomanie et de santé mentale, Toronto, Ont.; École d'épidémiologie et de santé publique (Elton-Marshall), Université d'Ottawa, Ottawa, Ont.; Département de médecine (Brothers), Université Dalhousie, Halifax, N.-É.; Centre collaboratif pour la santé inclusive UCL (Brothers), Collège universitaire de Londres, Londres, Royaume-Uni; Centre de santé des Autochtones (Medley), École de santé publique Johns Hopkins Bloomberg, Baltimore, Md.; Programme d'interventions d'urgence en cas de surdose et de toxicomanie (Medley), Régie de la santé du littoral de Vancouver, Vancouver, C.-B.; Bibliothèque des sciences de la santé (Lorenzetti), Université de Calgary; Département des sciences de la santé communautaire (Lorenzetti), École de médecine Cumming, Université de Calgary; Institut O'Brien de santé publique (Lorenzetti), Université de Calgary, Calgary, Alb.; Centre de traitement de la toxicomanie de la Colombie-Britannique (Gallant); École de santé des populations et de santé publique (Buxton), Université de Colombie-Britannique, Vancouver, C.-B
| | - Paul Choisil
- Centre de contrôle des maladies de la Colombie-Britannique (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, C.-B.; Département de psychiatrie (Rittenbach), Université de Calgary, Calgary, Alb.; Département de psychiatrie (Rittenbach), Université de l'Alberta, Edmonton, Alb.; Santé publique Ontario (Leece); École Dalla Lana de santé publique (Leece, Elton-Marshall, Strike) et Département de médecine familiale et communautaire (Leece), Université de Toronto; Institut de recherche sur les politiques de santé mentale (Ali, Elton-Marshall), Centre de toxicomanie et de santé mentale, Toronto, Ont.; École d'épidémiologie et de santé publique (Elton-Marshall), Université d'Ottawa, Ottawa, Ont.; Département de médecine (Brothers), Université Dalhousie, Halifax, N.-É.; Centre collaboratif pour la santé inclusive UCL (Brothers), Collège universitaire de Londres, Londres, Royaume-Uni; Centre de santé des Autochtones (Medley), École de santé publique Johns Hopkins Bloomberg, Baltimore, Md.; Programme d'interventions d'urgence en cas de surdose et de toxicomanie (Medley), Régie de la santé du littoral de Vancouver, Vancouver, C.-B.; Bibliothèque des sciences de la santé (Lorenzetti), Université de Calgary; Département des sciences de la santé communautaire (Lorenzetti), École de médecine Cumming, Université de Calgary; Institut O'Brien de santé publique (Lorenzetti), Université de Calgary, Calgary, Alb.; Centre de traitement de la toxicomanie de la Colombie-Britannique (Gallant); École de santé des populations et de santé publique (Buxton), Université de Colombie-Britannique, Vancouver, C.-B
| | - Carol Strike
- Centre de contrôle des maladies de la Colombie-Britannique (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, C.-B.; Département de psychiatrie (Rittenbach), Université de Calgary, Calgary, Alb.; Département de psychiatrie (Rittenbach), Université de l'Alberta, Edmonton, Alb.; Santé publique Ontario (Leece); École Dalla Lana de santé publique (Leece, Elton-Marshall, Strike) et Département de médecine familiale et communautaire (Leece), Université de Toronto; Institut de recherche sur les politiques de santé mentale (Ali, Elton-Marshall), Centre de toxicomanie et de santé mentale, Toronto, Ont.; École d'épidémiologie et de santé publique (Elton-Marshall), Université d'Ottawa, Ottawa, Ont.; Département de médecine (Brothers), Université Dalhousie, Halifax, N.-É.; Centre collaboratif pour la santé inclusive UCL (Brothers), Collège universitaire de Londres, Londres, Royaume-Uni; Centre de santé des Autochtones (Medley), École de santé publique Johns Hopkins Bloomberg, Baltimore, Md.; Programme d'interventions d'urgence en cas de surdose et de toxicomanie (Medley), Régie de la santé du littoral de Vancouver, Vancouver, C.-B.; Bibliothèque des sciences de la santé (Lorenzetti), Université de Calgary; Département des sciences de la santé communautaire (Lorenzetti), École de médecine Cumming, Université de Calgary; Institut O'Brien de santé publique (Lorenzetti), Université de Calgary, Calgary, Alb.; Centre de traitement de la toxicomanie de la Colombie-Britannique (Gallant); École de santé des populations et de santé publique (Buxton), Université de Colombie-Britannique, Vancouver, C.-B
| | - Justin Ng
- Centre de contrôle des maladies de la Colombie-Britannique (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, C.-B.; Département de psychiatrie (Rittenbach), Université de Calgary, Calgary, Alb.; Département de psychiatrie (Rittenbach), Université de l'Alberta, Edmonton, Alb.; Santé publique Ontario (Leece); École Dalla Lana de santé publique (Leece, Elton-Marshall, Strike) et Département de médecine familiale et communautaire (Leece), Université de Toronto; Institut de recherche sur les politiques de santé mentale (Ali, Elton-Marshall), Centre de toxicomanie et de santé mentale, Toronto, Ont.; École d'épidémiologie et de santé publique (Elton-Marshall), Université d'Ottawa, Ottawa, Ont.; Département de médecine (Brothers), Université Dalhousie, Halifax, N.-É.; Centre collaboratif pour la santé inclusive UCL (Brothers), Collège universitaire de Londres, Londres, Royaume-Uni; Centre de santé des Autochtones (Medley), École de santé publique Johns Hopkins Bloomberg, Baltimore, Md.; Programme d'interventions d'urgence en cas de surdose et de toxicomanie (Medley), Régie de la santé du littoral de Vancouver, Vancouver, C.-B.; Bibliothèque des sciences de la santé (Lorenzetti), Université de Calgary; Département des sciences de la santé communautaire (Lorenzetti), École de médecine Cumming, Université de Calgary; Institut O'Brien de santé publique (Lorenzetti), Université de Calgary, Calgary, Alb.; Centre de traitement de la toxicomanie de la Colombie-Britannique (Gallant); École de santé des populations et de santé publique (Buxton), Université de Colombie-Britannique, Vancouver, C.-B
| | - Diane L Lorenzetti
- Centre de contrôle des maladies de la Colombie-Britannique (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, C.-B.; Département de psychiatrie (Rittenbach), Université de Calgary, Calgary, Alb.; Département de psychiatrie (Rittenbach), Université de l'Alberta, Edmonton, Alb.; Santé publique Ontario (Leece); École Dalla Lana de santé publique (Leece, Elton-Marshall, Strike) et Département de médecine familiale et communautaire (Leece), Université de Toronto; Institut de recherche sur les politiques de santé mentale (Ali, Elton-Marshall), Centre de toxicomanie et de santé mentale, Toronto, Ont.; École d'épidémiologie et de santé publique (Elton-Marshall), Université d'Ottawa, Ottawa, Ont.; Département de médecine (Brothers), Université Dalhousie, Halifax, N.-É.; Centre collaboratif pour la santé inclusive UCL (Brothers), Collège universitaire de Londres, Londres, Royaume-Uni; Centre de santé des Autochtones (Medley), École de santé publique Johns Hopkins Bloomberg, Baltimore, Md.; Programme d'interventions d'urgence en cas de surdose et de toxicomanie (Medley), Régie de la santé du littoral de Vancouver, Vancouver, C.-B.; Bibliothèque des sciences de la santé (Lorenzetti), Université de Calgary; Département des sciences de la santé communautaire (Lorenzetti), École de médecine Cumming, Université de Calgary; Institut O'Brien de santé publique (Lorenzetti), Université de Calgary, Calgary, Alb.; Centre de traitement de la toxicomanie de la Colombie-Britannique (Gallant); École de santé des populations et de santé publique (Buxton), Université de Colombie-Britannique, Vancouver, C.-B
| | - Kat Gallant
- Centre de contrôle des maladies de la Colombie-Britannique (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, C.-B.; Département de psychiatrie (Rittenbach), Université de Calgary, Calgary, Alb.; Département de psychiatrie (Rittenbach), Université de l'Alberta, Edmonton, Alb.; Santé publique Ontario (Leece); École Dalla Lana de santé publique (Leece, Elton-Marshall, Strike) et Département de médecine familiale et communautaire (Leece), Université de Toronto; Institut de recherche sur les politiques de santé mentale (Ali, Elton-Marshall), Centre de toxicomanie et de santé mentale, Toronto, Ont.; École d'épidémiologie et de santé publique (Elton-Marshall), Université d'Ottawa, Ottawa, Ont.; Département de médecine (Brothers), Université Dalhousie, Halifax, N.-É.; Centre collaboratif pour la santé inclusive UCL (Brothers), Collège universitaire de Londres, Londres, Royaume-Uni; Centre de santé des Autochtones (Medley), École de santé publique Johns Hopkins Bloomberg, Baltimore, Md.; Programme d'interventions d'urgence en cas de surdose et de toxicomanie (Medley), Régie de la santé du littoral de Vancouver, Vancouver, C.-B.; Bibliothèque des sciences de la santé (Lorenzetti), Université de Calgary; Département des sciences de la santé communautaire (Lorenzetti), École de médecine Cumming, Université de Calgary; Institut O'Brien de santé publique (Lorenzetti), Université de Calgary, Calgary, Alb.; Centre de traitement de la toxicomanie de la Colombie-Britannique (Gallant); École de santé des populations et de santé publique (Buxton), Université de Colombie-Britannique, Vancouver, C.-B
| | - Jane A Buxton
- Centre de contrôle des maladies de la Colombie-Britannique (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, C.-B.; Département de psychiatrie (Rittenbach), Université de Calgary, Calgary, Alb.; Département de psychiatrie (Rittenbach), Université de l'Alberta, Edmonton, Alb.; Santé publique Ontario (Leece); École Dalla Lana de santé publique (Leece, Elton-Marshall, Strike) et Département de médecine familiale et communautaire (Leece), Université de Toronto; Institut de recherche sur les politiques de santé mentale (Ali, Elton-Marshall), Centre de toxicomanie et de santé mentale, Toronto, Ont.; École d'épidémiologie et de santé publique (Elton-Marshall), Université d'Ottawa, Ottawa, Ont.; Département de médecine (Brothers), Université Dalhousie, Halifax, N.-É.; Centre collaboratif pour la santé inclusive UCL (Brothers), Collège universitaire de Londres, Londres, Royaume-Uni; Centre de santé des Autochtones (Medley), École de santé publique Johns Hopkins Bloomberg, Baltimore, Md.; Programme d'interventions d'urgence en cas de surdose et de toxicomanie (Medley), Régie de la santé du littoral de Vancouver, Vancouver, C.-B.; Bibliothèque des sciences de la santé (Lorenzetti), Université de Calgary; Département des sciences de la santé communautaire (Lorenzetti), École de médecine Cumming, Université de Calgary; Institut O'Brien de santé publique (Lorenzetti), Université de Calgary, Calgary, Alb.; Centre de traitement de la toxicomanie de la Colombie-Britannique (Gallant); École de santé des populations et de santé publique (Buxton), Université de Colombie-Britannique, Vancouver, C.-B.
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Ferguson M, Rittenbach K, Leece P, Adams A, Ali F, Elton-Marshall T, Burmeister C, Brothers TD, Medley A, Choisil P, Strike C, Ng J, Lorenzetti DL, Gallant K, Buxton JA. Guidance on take-home naloxone distribution and use by community overdose responders in Canada. CMAJ 2023; 195:E1112-E1123. [PMID: 37640401 PMCID: PMC10462409 DOI: 10.1503/cmaj.230128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
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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Affiliation(s)
- Max Ferguson
- 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
| | - Katherine Rittenbach
- 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
| | - Pamela Leece
- 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
| | - Alison Adams
- 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
| | - Farihah Ali
- 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
| | - Tara Elton-Marshall
- 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
| | - Charlene Burmeister
- 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
| | - Thomas D Brothers
- 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
| | - Andrea Medley
- 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
| | - Paul Choisil
- 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
| | - Carol Strike
- 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
| | - Justin Ng
- 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
| | - Diane L Lorenzetti
- 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
| | - Kat Gallant
- 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 A Buxton
- 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
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6
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Foster T, Mooranian A, Al-Salami H. Industry news update, May 2023. Ther Deliv 2023; 14:331-336. [PMID: 37401362 DOI: 10.4155/tde-2023-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Affiliation(s)
- Thomas Foster
- The Biotechnology & Drug Development Research Laboratory, Curtin Medical School & Curtin Health Innovation Research Institute, Curtin University, Bentley, 6102, Perth, Western Australia, Australia
- Department of Clinical Biochemistry, Pathwest Laboratory Medicine, Royal Perth Hospital, Perth, 6000, Western Australia, Australia
| | - Armin Mooranian
- The Biotechnology & Drug Development Research Laboratory, Curtin Medical School & Curtin Health Innovation Research Institute, Curtin University, Bentley, 6102, Perth, Western Australia, Australia
- School of Pharmacy, University of Otago, Dunedin, 9016, Otago, New Zealand
| | - Hani Al-Salami
- The Biotechnology & Drug Development Research Laboratory, Curtin Medical School & Curtin Health Innovation Research Institute, Curtin University, Bentley, 6102, Perth, Western Australia, Australia
- Medical School, University of Western Australia, Perth, 6000, Western Australia, Australia
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7
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Bodnar RJ. Endogenous opiates and behavior: 2021. Peptides 2023; 164:171004. [PMID: 36990387 DOI: 10.1016/j.peptides.2023.171004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023]
Abstract
This paper is the forty-fourth consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2021 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonizts and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, CUNY, 65-30 Kissena Blvd., Flushing, NY 11367, USA.
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8
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Dodson C, Gentges J. Transverse Myelitis in Naloxone Reversible Acute Respiratory Failure-A Case Report. JOURNAL OF EDUCATION & TEACHING IN EMERGENCY MEDICINE 2022; 7:V15-V18. [PMID: 37465136 PMCID: PMC10332668 DOI: 10.21980/j8b659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/18/2022] [Indexed: 07/20/2023]
Abstract
Transverse myelitis (TM) is a rare inflammatory myelopathy presenting as bilateral neurologic deficit localized to the spinal cord. A critical management step in the emergency department (ED) is evaluating for and treating acute reversible causes such as mass lesion or reversible ischemia when present. Described in this case report is TM presenting after a respiratory arrest in suspected opioid overdose. Magnetic resonance imaging (MRI), ideally with contrast, and lumbar puncture are essential diagnostic studies to confirm inflammation. Finally, further diagnostic efforts are aimed at evaluation and treatment for other concurrent illnesses. Topics Transverse myelitis, transverse myelopathy, hypoxia, opioid overdose, hypoxic spinal cord injury.
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Affiliation(s)
- Chance Dodson
- University of Oklahoma, Department of Emergency Medicine, Tulsa, OK
| | - Joshua Gentges
- University of Oklahoma, Department of Emergency Medicine, Tulsa, OK
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9
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Skulberg AK, Tylleskär I, Dale O. Naloxone administration-no balance without titration. Addiction 2022; 117:2750-2751. [PMID: 35589622 DOI: 10.1111/add.15947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Arne Kristian Skulberg
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Divison of Pre-hospital Services, Oslo Universitetssykehus, Oslo, Norway
| | - Ida Tylleskär
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Emergency Medicine and Pre-Hospital Services, St Olavs Hospital University Hospital in Trondheim, Trondheim, Norway
| | - Ola Dale
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
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10
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Core competencies of peer workers who use pulse oximeters to supplement their overdose response in British Columbia. PLoS One 2022; 17:e0273744. [PMID: 36054132 PMCID: PMC9439192 DOI: 10.1371/journal.pone.0273744] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/15/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction
Peer workers (those with lived/living experience of substance use) are at the forefront of overdose response initiatives in British Columbia, Canada. The onset of the coronavirus disease pandemic has significantly compounded the impact of the overdose crisis. Peer workers are integral in supporting people who use substances. However, despite the important work they do, peer workers often lack formalized credibility and do not have the same resources available to them as service providers without lived experience. The peer-led project titled the Peer2Peer Project implemented several support programs for peer workers, including providing pulse oximeters to peer workers to supplement their overdose response procedures.
Materials and methods
This study was a component of a larger evaluation of the pulse oximeter program at two organizations in BC. The study aims to highlight the competencies of peer workers who use pulse oximeters. Telephone interviews were conducted with seven peer workers who were given pulse oximeters. The transcripts were thematically coded using Covert et al.’s framework of core competencies of community health workers to compare our sample with other widely recognized professions.
Findings
We found that peer workers who used pulse oximeters described several core competencies in their work and these were aligned with Covert et al.’s core competencies for community health workers, including assessment, community health practice, communication, diversity and inclusion, professional practice, and disease prevention and management.
Conclusion
By aligning peer workers’ skills to those of community health workers, we create awareness on the competencies of peer workers in using oximeters to supplement overdose response and advocate for them to receive more recognition and respect within the workplace. Further, our findings act as groundwork for future research in identifying the professional proficiencies of peer workers.
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11
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Rowe A, Chang A, Lostchuck E, Lin K, Scheuermeyer F, McCann V, Buxton J, Moe J, Cho R, Clerc P, McSweeney C, Jiang A, Purssell R. Out-of-hospital management of unresponsive, apneic, witnessed opioid overdoses: a case series from a supervised consumption site. CAN J EMERG MED 2022; 24:650-658. [PMID: 35670914 DOI: 10.1007/s43678-022-00326-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 05/04/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES There are conflicting recommendations for lay rescuer management of patients who are unresponsive and apneic due to opioid overdose. We evaluated the management of such patients at an urban supervised consumption site. METHODS At a single urban supervised consumption site in Vancouver, BC, we conducted a retrospective chart review and administrative database linkage of consecutive patients who were unresponsive and apneic following witnessed opioid overdose between January 1, 2012 and December 31, 2017. We linked these visits with regional hospital records to define the entire care episode, which concluded when the patient was discharged from the supervised consumption site, ED, or hospital, or died. The primary outcome was successful resuscitation, defined as alive and neurologically intact (ambulatory and speaking coherently, or alert and oriented, or Glasgow Coma Scale 15) at the conclusion of the care episode. Secondary outcomes included mortality and predefined complications of resuscitation. RESULTS We collected 767 patients, with a median age of 43 and 81.6% male, with complete follow-up on 763 patients (99.5%). All patients were managed with oxygen and ventilation (100%, 95% CI 0.995-1.0); 715 (93.2%, 95% CI 0.911-0.949) received naloxone; no patients underwent chest compressions (0%, 95% CI 0-0.005). All patients with complete follow-up were alive and neurologically intact at the end of their care episode (100%, 95% CI 0.994-1.0). Overall, 191 (24.9%) patients were transported to hospital, and 15 (2.0%) patients required additional naloxone after leaving the supervised consumption site; 16 (2.1%) developed complications, and 1 patient was admitted to hospital. CONCLUSIONS At an urban supervised consumption site, all unresponsive, apneic patients with witnessed opioid overdose were successfully resuscitated with oxygen and/or naloxone. No patients required chest compressions.
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Affiliation(s)
- Adrianna Rowe
- Department of Emergency Medicine, University Health Network, ON, Toronto, Canada. .,Division of Clinical Pharmacology and Toxicology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Andrew Chang
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Emily Lostchuck
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kathleen Lin
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Frank Scheuermeyer
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Emergency Medicine, St. Paul's Hospital, Vancouver, BC, Canada
| | - Victoria McCann
- Faculty of Medicine, Queen's University, Kingston, ON, Canada
| | - Jane Buxton
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jessica Moe
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.,British Columbia Centre for Disease Control, Vancouver, BC, Canada.,Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC, Canada
| | - Raymond Cho
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Paul Clerc
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Connor McSweeney
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Andy Jiang
- Department of Internal Medicine, University of Western Ontario, London, ON, Canada
| | - Roy Purssell
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC, Canada.,British Columbia Drug and Poison Information Centre, Vancouver, BC, Canada
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12
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Xavier J, Greer A, Crabtree A, Buxton JA. Police officers’ perceptions of their role at overdose events: a qualitative study. DRUGS: EDUCATION, PREVENTION AND POLICY 2022. [DOI: 10.1080/09687637.2022.2070057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jessica Xavier
- British Columbia Center for Disease Control, Vancouver, BC, Canada
| | - Alissa Greer
- School of Criminology, Simon Fraser University, Burnaby, BC, Canada
| | - Alexis Crabtree
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jane A. Buxton
- British Columbia Center for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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13
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Lei V, Ferguson M, Geiger R, Williams S, Liu L, Buxton JA. Factors associated with take-home naloxone kit usage in British Columbia: an analysis of administrative data. Subst Abuse Treat Prev Policy 2022; 17:25. [PMID: 35361228 PMCID: PMC8968772 DOI: 10.1186/s13011-022-00452-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The British Columbia (BC) Take-Home Naloxone (THN) program provides naloxone to people at risk of experiencing or witnessing an opioid overdose for use in reversing suspected overdose events. This study seeks to examine trends and correlates of individuals obtaining a THN kit in BC between 2017 and 2020. METHODS Records of THN kits distributed between 2017 and 2020 were the primary source of data for this analysis. Frequency tables were used to describe characteristics of people obtaining kits from THN sites. Correlates of individuals obtaining a THN kit to replace a previous kit reported as used to reverse an overdose were assessed with multivariate logistic regression. RESULTS Between January 1, 2017, and December 31, 2020, 240,606 THN kits were reported distributed by registered sites to members of the public, with 90,011 records indicating that a kit was obtained to replace a previous kit that had been used to reverse an overdose. There was a significant trend in increasing kits reported used by year (p < 0.01). The kit recipient's risk of overdose was a significant predictor of having reported using a THN kit, and the strength of the association was dependent on gender (Male: Adjusted odds ratio (AOR) 5.37 [95% confidence interval (CI) 5.08 - 5.67]; Female: AOR 8.35 [95% CI 7.90 - 8.82]; Trans and gender expansive: AOR 3.68 [95% CI 2.82 - 4.79]). CONCLUSIONS Between 2017 and 2020, THN kits were used to reverse tens of thousands of overdose events in BC, with people at risk of overdose (i.e. people who use drugs [PWUD]) having greater odds of using a kit to reverse an overdose than those not at risk. Thus, PWUD are responsible for reversing the vast majority of overdoses. THN kits are being distributed to the people who use them most. However, additional strategies in conjunction with community-based naloxone distribution programs are needed to address the rising number of illicit drug toxicity deaths.
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Affiliation(s)
- Victor Lei
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Max Ferguson
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Rachael Geiger
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | | | - Lisa Liu
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada. .,BC Centre for Disease Control, Vancouver, BC, Canada.
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14
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Dale O. Pharmacokinetic considerations for community-based dosing of nasal naloxone in opioid overdose in adults. Expert Opin Drug Metab Toxicol 2022; 18:203-217. [PMID: 35500297 DOI: 10.1080/17425255.2022.2072728] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The administration of the opioid antagonist naloxone in the community is a measure to prevent death from opioid overdose. Approved nasal naloxone sprays deliver initial doses of 0.9 to 8 mg. The level of the initial community dose is controversial, as the scientific base is weak.In this review knowledge of the pharmacokinetics of nasal, both approved and improvised nasal sprays, and intramuscular naloxone will be utilized to evaluate dose-effect relationships in previous studies of opioid overdose outcomes. AREAS COVERED The aim was to present scientifically based considerations on the initial nasal naloxone doses currently available, which reasonably balances the effect and adverse outcomes, given that at least two doses are at hand. Also included in these considerations is the challenge by illicitly manufactured fentanyl and analogs.This paper is based on both peer-reviewed and grey literature identified by several searches, of such as naloxone pharmacokinetics/formulations/outcomes/emergency medical services, in PubMed and Embase. EXPERT OPINION There is little scientific evidence that supports the use of initial systemic dosing that exceeds 0.8 mg in the community. Higher doses increase the risk of withdrawal symptoms feared in people who use opioids. Many obstacles may reduce the potential of community-administered naloxone.
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Affiliation(s)
- Ola Dale
- Department of Circulation and Medical Imaging, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
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15
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Goodman-Meza D, Slim S, Angulo L, Gonzalez-Nieto P, Cambou MC, Loera A, Shoptaw S, Arredondo J. Impact of an overdose reversal program in the context of a safe consumption site in Northern Mexico. DRUG AND ALCOHOL DEPENDENCE REPORTS 2021; 2:100021. [PMID: 36845896 PMCID: PMC9948854 DOI: 10.1016/j.dadr.2021.100021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/14/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
Background Drug overdoses are prevalent in low- and middle-income countries but are scarcely reported in the literature. We report on an opioid overdose reversal and naloxone distribution program that was instituted at the first safe consumption site in Latin America. Methods A cross-sectional analysis of witnessed drug overdoses and naloxone distribution between 1 June 2019 and 31 May 2021 in Mexicali, Mexico. Case report forms were entered in an electronic database. Trends in overdose and naloxone distribution were described. Comparisons were made before and after the COVID-19 pandemic was declared in the city. Maps were created to represent the geographic distribution of overdose in the city. Results During the study period 1,534 doses of naloxone were distributed throughout the community. In addition, there were 464 overdoses reported during this period, of which 4 were fatal. There was a 30% increase in reported overdoses from the period before the COVID-19 pandemic to the period after the pandemic was declared (p = 0.03). Most common substance reported included heroin (93%), sedatives (21%), methamphetamine (16%) and fentanyl (14%). Naloxone was given in 96% of cases (median 1 dose, IQR 1-2 doses) and emergency services were called in 20% of cases. Conclusions An opioid overdose reversal program in Mexicali, Mexico was able to distribute naloxone and register drug overdoses between 2019 and 2021 as a harm reduction strategy. This adds to the growing body of literature on the impact of community-based programs on preventing fatal overdoses and the potential for implementation in low-resource settings.
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Affiliation(s)
- David Goodman-Meza
- Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095,Corresponding author at: David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, CHS 52-215, Los Angeles, CA 90095
| | - Said Slim
- Integración Social Verter, A.C., Calle José Azueta 230, Primera, 21100 Mexicali, B.C., México
| | - Lourdes Angulo
- Integración Social Verter, A.C., Calle José Azueta 230, Primera, 21100 Mexicali, B.C., México
| | - Pablo Gonzalez-Nieto
- Integración Social Verter, A.C., Calle José Azueta 230, Primera, 21100 Mexicali, B.C., México
| | - Mary C. Cambou
- Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095
| | - Alejandra Loera
- Centro de Investigación y Docencia Económicas (CIDE), Circuito Tecnopolo Norte #117, Col. Tecnopolo Pocitos II, 20313 Aguascalientes, Ags., México
| | - Steve Shoptaw
- Department of Family Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095
| | - Jaime Arredondo
- Integración Social Verter, A.C., Calle José Azueta 230, Primera, 21100 Mexicali, B.C., México,Centro de Investigación y Docencia Económicas (CIDE), Circuito Tecnopolo Norte #117, Col. Tecnopolo Pocitos II, 20313 Aguascalientes, Ags., México
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