RT Journal Article
SR Electronic
T1 Guidance on take-home naloxone distribution and use by community overdose responders in Canada
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP E1112
OP E1123
DO 10.1503/cmaj.230128
VO 195
IS 33
A1 Ferguson, Max
A1 Rittenbach, Katherine
A1 Leece, Pamela
A1 Adams, Alison
A1 Ali, Farihah
A1 Elton-Marshall, Tara
A1 Burmeister, Charlene
A1 Brothers, Thomas D.
A1 Medley, Andrea
A1 Choisil, Paul
A1 Strike, Carol
A1 Ng, Justin
A1 Lorenzetti, Diane L.
A1 Gallant, Kat
A1 Buxton, Jane A.
A1 
YR 2023
UL http://www.cmaj.ca/content/195/33/E1112.abstract
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 evidence-based 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.Interpretation: This guidance development project provides direction for THN programs in Canada in the context of limited published evidence, with recommendations developed in collaboration with diverse stakeholders.