Literature Collection

: In September 2016, the American Academic of Pediatrics released a policy statement that adolescents with opioid use disorder should be offered pharmacotherapy with buprenorphine/naloxone, methadone, or naltrexone. In our clinical practice, however, we have encountered the perception among patients, families, and clinicians alike that medications should be used as a last resort. That we should wait until things get worse is a discarded approach. As addiction specialists, it is imperative that we prevent and identify risky use and use disorders, then intervene early and offer timely, evidence-based treatment. We suggest that adolescents deserve special attention and that specific efforts should be made to reduce the stigma associated with treating adolescents with opioid use disorder with medications to optimize those efforts.

This purpose of this report was to explore the experience of administering naloxone in the home and community setting and to explore whether this experience differs between those who may typically administer naloxone, including paramedics and peers or people who use drugs (PWUD). Understanding the administration of naloxone from the perspective of the person administering it is useful for a number of different reasons. It can highlight the challenges and advantages of using naloxone from the perspective of the user, and can shed light on the emotional consequences of dealing with the opioid crisis. This review presents a thematic analysis of the results of 11 included studies and reveals both the promise and the challenges of administering naloxone in the home and community setting. Experiences emerged as different across groups who typically administer naloxone, including Emergency Medical Service (EMS) workers, police, and peer responders.

Opioid overdose can induce acute respiratory and central nervous system depression that may lead to death. Recently the numbers of opioid-related deaths or hospitalizations have increased in Canada and there is an ongoing opioid crisis. Naloxone, a medication that temporarily blocks the effects of opioids, has been advocated for a wider use in the communities. Naloxone works by competing for opioid receptors with opioids and remains active in the body for 20 to 90 minutes, shorter than most opioids. Without opioids, naloxone has little pharmacologic activity. Data from noncomparative studies suggest that naloxone use in a home or community setting for opioid overdose is associated with a low mortality rate. In Canada, take-home naloxone kits are available at most pharmacies without a prescription and are free in some provinces. This report aims to update a previous CADTH review on the clinical effectiveness and cost effectiveness of the administration of naloxone in a home or community setting, as well as to identify evidence-based guidelines for its use.