TY - JOUR
T1 - Guidance on take-home naloxone distribution and use by community overdose responders in Canada
AU - Ferguson, Max
AU - Rittenbach, Katherine
AU - Leece, Pamela
AU - Adams, Alison
AU - Ali, Farihah
AU - Elton-Marshall, Tara
AU - Burmeister, Charlene
AU - Brothers, Thomas D.
AU - Medley, Andrea
AU - Choisil, Paul
AU - Strike, Carol
AU - Ng, Justin
AU - Lorenzetti, Diane L.
AU - Gallant, Kat
AU - Buxton, Jane A.
N1 - Funding Information:
Competing interests: Thomas Brothers reports receiving a research fellowship from the Canadian Institutes of Health Research (CIHR), Dalhousie University Internal Medicine Research Foundation, in support of the present manuscript. Jane Buxton reports receiving a CIHR grant to the Canadian Research Initiative in Substance Misuse (CRISM) for the work overseen and managed by the Centre for Addictions and Mental Health, in support of the present manuscript. Dr. Buxton has also received fees from the Canadian Centre on Substance Use and Addiction to write a foreword for a report, from the British Columbia Centre for Disease Control, and Glasgow Caledonian University; and received honoraria from the Canadian Association of Nurses and the Canadian Association of Hepatitis Nurses for invited presentations, all outside the present work. Katherine Rittenbach was an employee of Alberta Health Services, during the conduct of the study. During the conduct of the study, Pamela Leece reports receiving grants from the following public institutions, administered at Public Health Ontario (Ontario Agency for Health Protection and Promotion): CIHR, Health Canada, Public Health Agency of Canada. Tara Elton-Marshall reports receiving a grant from CIHR, outside the submitted work. Charlene Burmeister is executive director of the Coalition of Substance Users of the North. No other competing interests were declared.
Funding Information:
Development of Canadian THN guidance for policy started in December 2018 and was finalized in October 2022. We used the Appraisal of Guidelines for Research & Evaluation (AGREE II) instrument to inform the development of our guidance42 (Appendix 4, available at www.cmaj.ca/lookup/doi/10.1503/ cmaj.230128/tab-related-content). The THN guidance development project was funded by the Canadian Institutes of Health Research for the Canadian Research Initiative in Substance Misuse (CRISM) Implementation Science Program on Opioid Interventions and Services (OCC-154821). The funder had no role in the execution of the guidance development. (The authors acknowledge the stigmatizing nature of the term “Substance Misuse” in the CRISM name, respect the autonomy of people who use drugs and support person-centred language.)
Publisher Copyright:
© 2023 Canadian Medical Association. All rights reserved.
PY - 2023/8/28
Y1 - 2023/8/28
N2 - 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 evidencebased 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.
AB - 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 evidencebased 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.
UR - http://www.scopus.com/inward/record.url?scp=85168928134&partnerID=8YFLogxK
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U2 - 10.1503/cmaj.230128
DO - 10.1503/cmaj.230128
M3 - Article
C2 - 37640401
AN - SCOPUS:85168928134
SN - 0820-3946
VL - 195
SP - E1112-E1123
JO - CMAJ. Canadian Medical Association Journal
JF - CMAJ. Canadian Medical Association Journal
IS - 33
ER -