Impact of a publicly funded pharmacy-dispensed naloxone program on fatal opioid overdose rates: A population-based study

Antoniou, Tony; Men, Siyu; Tadrous, Mina; Leece, Pamela; Munro, Charlotte; Gomes, Tara

doi:10.1016/j.drugalcdep.2022.109473

Cited by 5 publications

(3 citation statements)

References 42 publications

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“…Lowder et al argue that naloxone needs to be complemented by buy-in from criminal justice stakeholders and community treatment providers to enable diversion from acute setting (jail and hospital). This compares with recent research by Antoniou et al which found that THN on its own is not enough to reduce DRD rates, and that a multi-faceted approach with access to additional harm reduction, treatment and other interventions is required [ 42 ].…”

Section: Discussionmentioning

confidence: 70%

‘I’m not going to leave someone to die’: carriage of naloxone by police in Scotland within a public health framework: a qualitative study of acceptability and experiences

et al. 2023

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Background Scotland has one of the highest rates of drug-related deaths (DRDs) per capita in Europe, the majority of which involve opioids. Naloxone is a medication used to reverse opioid-related overdoses. In efforts to tackle escalating DRDs in many countries, naloxone is increasingly being provided to people who are likely first responders in overdose situations. This includes non-healthcare professionals, such as police officers. A pilot exercise to test the carriage and administration of naloxone by police officers was conducted in selected areas of Scotland between March and October 2021. The aim of the study was to explore the acceptability and experiences of naloxone carriage and administration by police in Scotland. Methods The study comprised of two stages. Stage 1 involved in-depth one-to-one qualitative interviews with 19 community stakeholders (people with lived experience, family members, support workers). Stage 2 involved a mixture of in-depth one-to-one interviews and focus groups with 41 police officers. Data were analysed thematically, and the findings from the two stages were triangulated to develop overarching themes and subthemes. Results By the end of the pilot, 808 police officers had been trained in the use of intranasal naloxone. Voluntary uptake of naloxone kits among police officers who completed training was 81%. There were 51 naloxone administration incidents recorded by police officers at suspected opioid-related overdose incidents during the pilot. Most officers shared positive experiences of naloxone administration. Naloxone as a first aid tool suited their role as first responders and their duty and desire to preserve life. Perceived barriers included concerns about police undertaking health-related work, potential legal liabilities and stigmatising attitudes. The majority of participants (and all community stakeholders) were supportive of the pilot and for it to be expanded across Scotland. Conclusions Police carriage of naloxone is an acceptable and potentially valuable harm reduction tool to help tackle the DRDs crisis in Scotland. However, it requires appropriate integration with existing health and social care systems. The intervention lies at the intersection between public health and policing and implies a more explicit public health approach to policing.

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Section: Discussionmentioning

confidence: 70%

‘I’m not going to leave someone to die’: carriage of naloxone by police in Scotland within a public health framework: a qualitative study of acceptability and experiences

et al. 2023

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“…Of note, dispensing naloxone is not the only solution to curb the opioid crisis; a recent population-based study mentioned that the naloxone program alone is insufficient to curb opioid overdose deaths, but a combination of multiple harm reduction methods is needed. 47 …”

Section: Discussionmentioning

confidence: 99%

An economic evaluation of community pharmacy–dispensed naloxone in Canada

Cid,

Mahajan,

Wong

et al. 2024

Can Pharm J

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Aims: To determine the cost-effectiveness of pharmacy-based intranasal (IN) and intramuscular (IM) naloxone distribution in Canada. Methods: We developed a state-transition model for pharmacy-based naloxone distribution, every 3 years, to illicit, prescription, opioid-agonist therapy and nonopioid use populations compared to no naloxone distribution. We used a monthly cycle length, lifetime horizon and a Canadian provincial Ministry of Health perspective. Transition probabilities, cost and utility data were retrieved from the literature. Costs (2020) and quality-adjusted life years (QALY) were discounted 1.5% annually. Microsimulation, 1-way and probabilistic sensitivity analyses were conducted. Results: Distribution of naloxone to all Canadians compared to no distribution prevented 151 additional overdose deaths per 10,000 persons, with an incremental cost-effectiveness ratio (ICER) of $50,984 per QALY for IM naloxone and an ICER of $126,060 per QALY for IN naloxone. Distribution of any naloxone to only illicit opioid users was the most cost-effective. One-way sensitivity analysis showed that survival rates for illicit opioid users were most influenced by the availability of either emergency medical services or naloxone. Conclusion: Distribution of IM and IN naloxone to all Canadians every 3 years is likely cost-effective at a willingness-to-pay threshold of $140,000 Canadian dollars/QALY (~3 × gross domestic product from the World Health Organization). Distribution to people who use illicit opioids was most cost-effective and prevented the most deaths. This is important, as more overdose deaths could be prevented through nationwide public funding of IN naloxone kits through pharmacies, since individuals report a preference for IN naloxone and these formulations are easier to use, save lives and are cost-effective. Can Pharm J (Ott) 2024;157:xx-xx.

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“…In the province of Ontario as of June 2016, pharmacists were granted the authority to distribute free naloxone kits to any Ontario resident upon request [47]. While uptake of naloxone kits in the province was initially slow [48,49], there has been substantive increase in numbers of individuals dispensed a naloxone kit from March 2018, when distribution of intranasal naloxone was incorporated into the pharmacy programme and requirements to provide identification when being dispensed naloxone were removed [50]. The observed high level of resuscitation attempts and naloxone administration may indicate deeper awareness and response to opioid-related overdose events by both members of this priority population and the larger community.…”

Section: Circumstances Surrounding Deathmentioning

confidence: 99%

Opioid‐related overdose deaths among people experiencing homelessness, 2017 to 2021: A population‐based analysis using coroner and health administrative data from Ontario, Canada

Booth,

Shariff,

Carter

et al. 2023

Addiction

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AimsTo measure the change in proportion of opioid‐related overdose deaths attributed to people experiencing homelessness and to compare the opioid‐related fatalities between individuals experiencing homelessness and not experiencing homelessness at time of death.Design, setting and participantsPopulation‐based, time‐trend analysis using coroner and health administrative databases from Ontario, Canada from 1 July 2017 and 30 June 2021.MeasurementsQuarterly proportion of opioid‐related overdose deaths attributed to people experiencing homelessness. We also obtained socio‐demographic and health characteristics of decedents, health‐care encounters preceding death, substances directly contributing to death and circumstances surrounding deaths.FindingsA total of 6644 individuals (median age = 40 years, interquartile range = 31–51; 74.1% male) experienced an accidental opioid‐related overdose death, among whom 884 (13.3%) were identified as experiencing homelessness at the time of death. The quarterly proportion of opioid‐related overdose deaths attributed to people experiencing homelessness increased from 7.2% (26/359) in July–September 2017 to 16.8% (97/578) by April–June 2021 (trend test P < 0.01). Compared with housed decedents, those experiencing homelessness were younger (61.3 versus 53.1% aged 25–44), had higher prevalence of mental health or substance use disorders (77.1 versus 67.1%) and more often visited hospitals (32.1 versus 24.5%) and emergency departments (82.6 versus 68.5%) in the year prior to death. Fentanyl and its analogues more often directly contributed to death among people experiencing homelessness (94.0 versus 81.4%), as did stimulants (67.4 versus 51.6%); in contrast, methadone was less often present (7.8 versus 12.4%). Individuals experiencing homelessness were more often in the presence of a bystander during the acute toxicity event that led to death (55.8 versus 49.7%); and where another individual was present, more often had a resuscitation attempted (61.7 versus 55.1%) or naloxone administered (41.2 versus 28.9%).ConclusionsPeople experiencing homelessness account for an increasing proportion of fatal opioid‐related overdoses in Ontario, Canada, reaching nearly one in six such deaths in 2021.

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Impact of a publicly funded pharmacy-dispensed naloxone program on fatal opioid overdose rates: A population-based study

Cited by 5 publications

References 42 publications

‘I’m not going to leave someone to die’: carriage of naloxone by police in Scotland within a public health framework: a qualitative study of acceptability and experiences

‘I’m not going to leave someone to die’: carriage of naloxone by police in Scotland within a public health framework: a qualitative study of acceptability and experiences

An economic evaluation of community pharmacy–dispensed naloxone in Canada

Opioid‐related overdose deaths among people experiencing homelessness, 2017 to 2021: A population‐based analysis using coroner and health administrative data from Ontario, Canada

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