Opioid overdose is a major cause of mortality, but fatal outcome can be prevented by timely administration of the opioid antagonist naloxone. Pre-provision of naloxone to opioid users and family members for emergency use (take-home naloxone, THN) was first proposed in 1996. While THN is now widespread in some countries, its availability is minimal or absent elsewhere, and reasons for inertia and poor implementation are not well understood. Through literature review, we aim to chart the development of THN over twenty years, identifying critical steps from speculative harm reduction proposal to public health strategy.
Medline and PsycINFO were searched for peer-reviewed literature (1990-2016) using Boolean queries: 1) ‘naloxone OR Narcan’; 2) ‘(opioid OR opiate) AND overdose AND prevention’. Grey literature and specialist websites were also searched. THN-related data were extracted and synthesized as narrative review, with key events presented as chronological timeline.
Relevant data are presented in four 5-year intervals which discuss the following themes.
1996-2001: original articulation of THN proposal, testing of acceptability, and first implementation; 2001-2006: early THN schemes amid safety and legal concerns; 2006-2011: response to legal concerns and THN program expansions to state/national level; 2011-2016: high-impact research and efforts to widen THN availability via new settings, workforces, and non-injectable products.
THN has overcome legal barriers in many jurisdictions, and naloxone products developed specifically for layperson are now available. Nonetheless, the rising death toll of opioid overdose illustrates that current THN coverage is insufficient, and public investment in overdose prevention is required.
PROFESSOR NANCY CAMPBELL Department of Science and Technology Studies Sage Labs 5202 Rensselaer Polytechnic Institute 110 Eighth Street Troy, NY 12180 United States PROFESSOR SIR JOHN STRANG National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience (IoPPN) King’s College London Addictions Sciences Building 4 Windsor Walk Denmark Hill, London SE5 8BB United Kingdom
Conflicts of interest:
JS declares that he is a researcher and clinician who has worked with a range of types of treatment and rehabilitation service-providers. JS is supported by the National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King’s College London. He has also worked with a range of governmental and non-governmental organizations, and with pharmaceutical companies to seek to identify new or improved treatments (including naloxone products) from whom he and his employer (King’s College London) have received honoraria, travel costs and/or consultancy payments. This includes work with, during past 3 years, Martindale, Indivior, Mundipharma, Braeburn and trial medication supply from iGen and Braeburn. JS has been named as an inventor in a patent application for concentrated naloxone nasal spray. JS is an NIHR Senior Investigator (2017-2022). For fuller account, see https://www.kcl.ac.uk/ioppn/depts/addictions/people/hod.aspx
RM has undertaken an unpaid student industry placement with Mundipharma Research Ltd., with focus on the analysis of naloxone nasal spray formulations.
King’s College London (employer for both JS and RM) has separately applied to register intellectual property on a novel buccal naloxone formulation with which JS and RM are involved.
RM and JS are working as consultants for the United Nations Office on Drugs and Crime (UNODC), supporting a feasibility study of community-based opioid overdose prevention strategies in the framework of the UNODC-WHO Programme on Drug Dependence Treatment and Care (GLOK32). The views expressed in this article are NDC is supported by the Rensselaer Polytechnic Institute School of Humanities, Arts, and Social Sciences FLASH Grant and by a University of Freiburg Institute for Advanced Study (FRIAS) Fellowship.