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Administration of Naloxone in a Home or Community Setting: A Review of the Clinical Effectiveness, Cost-effectiveness, and Guidelines

Last updated: June 20, 2014
Project Number: RC0560-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Report in Brief

Context
Opioids are commonly used to manage pain but are also used recreationally, and sometimes children accidentally gain access to and ingest them. When opioids are misused or unintentionally ingested — even if they have been prescribed — there is a risk of overdose. Respiratory depression, a main hazard of severe opioid overdose, is potentially fatal.

Technology
Naloxone is a non-selective, short-acting opioid receptor antagonist. Opioid receptor antagonists are medications typically used to reverse respiratory depression caused by opioid overdose.

Dispensing naloxone to opioid users so they can self-treat in the event of an opioid overdose, rather than rely on a health professional to administer treatment, may be an effective way to reduce overdose-related deaths. In Canada, there are at least four cities with local overdose prevention and response programs involving naloxone dispensing, and British Columbia has recently launched a provincial program.

Issue
A review of the clinical and cost-effectiveness of the administration of naloxone by non-health care professionals in a home or community setting compared with its administration by health professionals, as well as of the evidence-based guidelines for administering naloxone, will help inform decisions on how to prevent opioid overdose-related deaths.

Methods
A limited literature search was conducted of key resources, and titles and abstracts of the retrieved publications were reviewed. Full-text publications were evaluated for final article selection according to predetermined selection criteria (population, intervention, comparator, outcomes, and study designs).

Results
The literature search identified 227 citations, with 2 additional articles identified from other sources. Of these, 13 were deemed potentially relevant; however, none met the criteria for inclusion in this review.

Key Messages

  • When comparing naloxone administration by non-health professionals in a home or community setting with naloxone administration by health professionals:
    • no clinical effectiveness information was found
    • no cost-effectiveness information was found.
  • No guidelines on the administration of naloxone were found.
  • Evidence on take-home naloxone programs suggests that they are associated with a low mortality rate, but it is not known how this rate compares with the mortality rate when naloxone is administered by health care professionals.

Question

  1. What is the comparative clinical effectiveness of naloxone administered in a community or home setting versus administered by a health professional?
  2. What is the cost-effectiveness of naloxone administered in a home or community setting compared with administration by a health professional?
  3. What are the evidence-based guidelines for the administration of naloxone?

Key Message

No relevant literature was identified regarding the comparative clinical and cost-effectiveness of naloxone administered in a home or community setting compared with administration by a health professional. No evidence-based clinical practice guidelines were retrieved in the literature search.