A take-home naloxone program is a governmental program that provides naloxone drug kits to those that are at risk of an opioid overdose. Naloxone is a medication that was created to reverse opioid overdoses. As an opioid antagonist, it binds to the μ-opioid receptors blocking the opioid's effects. Naloxone quickly restores normal respiration. The ongoing opioid epidemic has caused many public health authorities to expand access to naloxone.
History Naloxone was created in a laboratory, patented in 1961, and approved by the FDA a decade later. It was first proposed in the 1990s for community-based provisions of take-home naloxone rescue kits (THN) to opioid users, which involved training opioid users, along with their family or friends, in awareness, emergency management, and administration of naloxone. Police have been carrying naloxone in their squad cars since the mid-2000s. Paramedics have been carrying it since the release, however EMT's have started carrying it since the earlier 2000s. In 2010, there were 30 states with programs for take-home naloxone. In 2016, almost every state enacted legislation addressing this epidemic, and reinstated it in 2017.
Administration There are three ways to administer naloxone. The first method is intravenous, working within two minutes. The second is through the nose (intranasal), or it could be injected into the muscles (intramuscular) which works within 5 minutes. Most likely, more than one dose will be needed. The effects only last about half an hour. Naloxone is administered from home kits either by nasal spray or injection into the thigh.
Effectiveness A systematic review of previous nine studies found that naloxone successfully reversed overdose used by participants in all but one study. The curriculum for training participants included recognizing an overdose, how to prevent one, how to appropriately respond to an overdose, and administer naloxone correctly and safely. The researchers found that the amount of time to train participants varied in the studies, some taking 10 minutes to hours. Eleven studies reported 100% survival rate, and the remaining articles reported 83% to 93% survival rates. Multiple articles' results suggest that programs trained laypersons to respond to and treat opioid overdoses correctly, which resulted in thousands of lives being saved. Another systematic review utilized the Bradford Hill criteria, They found that twenty-one of the twenty-two studies they used to meet the Bradford-Hill criterion were cost-effective, and ongoing projects were able to access and train high-risk populations, which resulted in a low amount of adverse withdrawal effects. The programs reduced the number of deaths-by-overdose among the participants and their acquaintances. The review also found no evidence of increased heroin usage among the compiled studies. In fact, they found that a few studies had participants that reduced their drug usage, or in other studies that it had not changed. A limitation of their study was noted that the majority (90%) of reversed overdoses were heroin-induced when a study recruited methadone users specifically. Take-home naloxone programs have also been implemented overseas in Europe, Asia, and Australia, but studies of these programs used uncontrolled study designs.
CDC Reports
Prevention program report According to the CDC, deaths from drug overdoses have more than doubled since 1999 in the U.S. 43, 982 deaths-by-overdose, whether unintentional, intentional, or undetermined intent were reported during 2013. Of these, 37% were from opioid prescriptions, and 19% were from heroin. The number of programs providing laypersons with training and take-home naloxone kits has been increasing since 1996. 136 of 140 organizations completed a survey for the Harm Reduction Coalition (HRC) in July 2014 that were known to provide naloxone take-home kits to laypersons in the United States. Between 1996 and June 2014, 152,283 people have received naloxone kits, and 26,463 reversals have been reported. People who received the kits were characterized as follows: about 82% as drug-users, 11.7% family/friends, 3.3% service providers, or 3.4% unknown. The HRC created a database of organizations, such as public health departments, pharmacies, substance use treatment facilities and more, who provide naloxone kits. Sixty-eight organizations reported that approximately 83% of laypersons who said they administered naloxone were users, approximately 10% were family and friends, under 1% were service providers, and 7% were unknown. According to forty-two organizations, 81.6% of the reversed overdoses involved heroin, and 14.1% were prescribed opioids. 90 organizations reported having distributed 140,053 vials, including refills, the year prior. Three operational organizations did not respond, and the remaining forty-three reported not yet distributing naloxone take-home kits. Sixty-nine organizations reported providing injectable naloxone only. Fifty-one organizations reported providing intranasal naloxone only. While sixteen organizations reported providing both. There were 111,602 injectable naloxone vials distributed in total, and 28,446 intranasal vials of naloxone. Of the responding organizations, approximately 30% reported trouble sustaining competent supply, while 54% reported deficient resources to sustain supplies to disperse kits. These numbers have increased substantially from a survey conducted in 2010. There used to be only 43 organizations, now there are 644 local sites providing naloxone instead of only 188. This is a 243% increase. In conclusion, the CDC has determined that these programs are safe and cost-effective. In fact, international health organizations recommend providing take-home naloxone kits.
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