A Review of Opioid Overdose Prevention and Naloxone Prescribing: Implications for Translating Community Programming into Clinical Practice

Abstract

Background As physicians have increased opioid prescribing, overdose deaths from pharmaceutical opioids have substantially increased in the United States. Naloxone hydrochloride (naloxone), an opioid antagonist, is the standard of care for treatment of opioid induced respiratory depression. Since 1996, community-based programs have offered overdose prevention education and distributed naloxone for bystander administration to people who use opioids, particularly heroin. There is growing interest in translating overdose education and naloxone distribution (OEND) into conventional medical settings for patients who are prescribed pharmaceutical opioids. For this review, we summarized and classified existing publications on overdose education and naloxone distribution to identify evidence of effectiveness and opportunities for translation into conventional medical settings. Methods For this review, we searched English language PubMed for articles on naloxone based on primary data collection from humans, including feasibility studies, program evaluations, surveys, qualitative studies and studies comparing the effectiveness of different routes of naloxone administration. We also included cost-effectiveness studies. Results We identified 41 articles that represented 5 categories: evaluations of OEND programs, effects of OEND programs on experiences and attitudes of participants, willingness of medical providers to prescribe naloxone, comparisons of different routes of naloxone administration, and the cost-effectiveness of naloxone. Conclusions Existing research suggests that people who are at risk for overdose and other bystanders are willing and able to be trained to prevent overdoses and administer naloxone. Counseling patients about the risks of opioid overdose and prescribing naloxone is an emerging clinical practice which may reduce fatalities from overdose while enhancing the safe prescribing of opioids.

Process evaluation of the Prevent Overdose in Toronto (POINT) program

“…The program continues to expand, and had distributed 1,975 naloxone kits and received reports of 335 naloxone administrations as of November 2015. Similar to other reports, 10,12 we found that people at risk of opioid overdose were willing to be trained and to use naloxone to respond …”

“…[6][7][8][9] The current evidence on the effectiveness of naloxone programs remains limited. [10][11][12][13][14] Naloxone programs are promising for reducing mortality 15 and being cost-effective, 16 and there are several descriptive reports of program data in the literature. 10 To date, no rigorous prospective studies have been completed to assess impact on rates of overdose death.…”

Availability of naloxone in Canadian pharmacies:a population-based survey

“…These programs have been effective in the United States and the United Kingdom. [27][28][29][30][31][32] Similar programs exist in Canada and aim to provide education about prevention, recognition and treatment of opioid overdose. Providing take-home naloxone through emergency departments or supervised consumption sites to high-risk individuals is another cost-effective strategy with high acceptance rates.…”

“…[27][28][29][30][31][32][33] Moreover, take-home naloxone is acceptable to patients receiving opioids for chronic pain, 34,35 with recipients stating that receiving education about the risks of opioids and having naloxone available in the event of overdose would be beneficial and that they would not be offended if offered the product.…”

Acceptability of Naloxone Co-Prescription Among Primary Care Providers Treating Patients on Long-Term Opioid Therapy for Pain

“…This intervention has been associated with both a reduction in the likelihood of death when an overdose occurs and a substantial relative reduction in opioid overdose mortality in communities that distribute the medication. [4][5][6] Prescribing naloxone through primary care to patients receiving opioid analgesics, in contrast, has not been well studied. Implementation of a naloxone Bco-prescription^program for patients on long-term opioids at the Fort Bragg U.S. Army base was associated with a decline in opioid overdoses from eight to zero per month.…”