Literature Collection

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.

Adolescent substance use remains a major public health concern, and the emergency department (ED) represents a critical point of contact for identification and early intervention. Many adolescents rely on the ED as their primary or sole source of health care, making missed opportunities for screening particularly consequential. Although overall substance use rates among youth have stabilized or declined in recent years, drug-related mortality, especially from illicitly manufactured fentanyl, has risen sharply, highlighting the need for proactive detection and intervention. Professional organizations recommend universal, validated screening for substance use in adolescents, yet implementation in ED settings remains inconsistent due to workflow constraints, confidentiality concerns, and limited provider training. Validated tools, such as the Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) questionnaire, the screening to brief intervention (S2BI) tool, and the brief screener for tobacco, alcohol, and other drugs (BSTAD) tool, allow rapid, developmentally appropriate screening. They can be integrated into electronic health records (EHRs) or self-administered digital formats. Evidence suggests that electronic or kiosk-based screening increases disclosure and detection without adversely affecting throughput. Screening alone is insufficient; pairing detection with brief motivational interventions and facilitated referral to treatment improves short-term outcomes and linkage to care. However, follow-up rates remain suboptimal, underscoring the need for structured referral pathways, behavioral health integration, and technology-enabled supports such as text-based reminders or telehealth. Universal, developmentally tailored screening in the ED, combined with brief intervention and active linkage to outpatient care, offers a practical strategy to reduce substance-related morbidity and improve long-term outcomes for adolescents.