Take-Home Naloxone and the Prevention of Deaths from Heroin Overdose: Pursuing Strong Science, Fuller Understanding, Greater Impact

European Addiction Research ◽

10.1159/000519939 ◽

2021 ◽

pp. 1-15

Author(s):

John Strang

Keyword(s):

Drug Users ◽

Opioid Overdose ◽

Policy And Practice ◽

The Public ◽

Global Impact ◽

Training Aids ◽

Life Saving ◽

Societal Level ◽

Funding Support ◽

Overdose Deaths

Background and Context: Realization of the life-saving potential of “take-home naloxone” has been a personal journey, but it has also been a collective journey. It has been a story of individual exploration and growth, and also a story of changes at a societal level. “Take-home naloxone” has matured since its first conceptualization a quarter of a century ago. It required recognition of the enormous burden of deaths from drug overdose (particularly heroin and other opioids), and also realization of critical clusterings (such as post-release from prison). It also required realization that, since many overdose deaths are witnessed, we can potentially prevent many deaths by mobilizing drug users themselves, their families, and the wider caring community to act as intervention workforce to give life-saving interim emergency care. Summary of Scope: This article explores 5 areas (many illustrations UK-based where the author works): firstly, the need for strong science; secondly, our improved understanding of opioid overdose and deaths; thirdly, the search for greater impact from our policies and interventions; fourthly, developing better forms of naloxone; and fifthly, examining the challenges still to be addressed. Key Messages: “Take-home naloxone” is an exemplar of harm reduction with potential global impact – drug policy and practice for the public good. However, “having the potential” is not good enough – there needs to be actual implementation. This will be easier once the component parts of “take-home naloxone” are improved (better naloxone products, better training aids, revised legislation, and explicit funding support). Many improvements are already possible, but we hesitate about implementation. It is our responsibility to drive progress faster. With “take-home naloxone,” we can be proud of what we have achieved, but we must also be humble about how much more we still need to do.

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Direct-to-Docs Opioid Marketing

Pained ◽

10.1093/oso/9780197510384.003.0041 ◽

2020 ◽

pp. 141-144

Author(s):

Michael D. Stein ◽

Sandro Galea

Keyword(s):

Health Care Providers ◽

Direct Marketing ◽

Pharmaceutical Companies ◽

Opioid Overdose ◽

Care Providers ◽

The Public ◽

Opioid Prescribing ◽

Overdose Mortality ◽

The Relationship ◽

Overdose Deaths

This chapter addresses the pharmaceutical industry’s direct-to-physician marketing of opioids, a factor that has fueled the current addiction epidemic. A 2019 study sought to understand the relationship between mortality from opioid overdose and the pharmaceutical industry’s direct marketing of opioids to physicians. The study analyzed the association between three factors in every US county: the amount of marketing payments pharmaceutical companies made to physicians, opioid prescribing rates, and the number of overdose deaths. Researchers found that direct marketing of opioids to physicians was associated with increased opioid prescribing rates and increased overdose mortality 1 year after marketing engagements. As such, the national response to the opioid epidemic has focused in part on reducing the number of opioids prescribed by physicians. Additionally, the Physician Payments Sunshine Act promotes financial transparency between pharmaceutical companies and health care providers. By increasing regulation around pharmaceutical direct-to-physician marketing, and by making reports of pharmaceutical company payments to physicians available to the public, states have the potential to reduce overdose mortality.

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Increasing Naloxone Access and Use to Prevent Opioid Overdose Death and Disability

American Journal of Lifestyle Medicine ◽

10.1177/1559827618803874 ◽

2018 ◽

Vol 13 (1) ◽

pp. 33-35 ◽

Cited By ~ 2

Author(s):

Nicole D. White

Keyword(s):

Health Care ◽

Health Care Providers ◽

Opioid Overdose ◽

Care Providers ◽

Overdose Death ◽

Surgeon General ◽

Life Saving ◽

Legislative Changes ◽

Overdose Deaths

In 2018, the Surgeon General released a public health advisory emphasizing the importance of naloxone in preventing opioid overdose deaths. Legislation is rapidly changing to simplify the process of obtaining naloxone by expanding who can receive and distribute the life-saving drug. Even with legislation in place expanding access to naloxone, the drug is underutilized and health care providers are responsible for ensuring these efforts are put to use within their practice. Legislative changes will be summarized and the role of the health care provider will be discussed.

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Summary and conclusions

10.1093/oso/9780198818014.003.0016 ◽

2018 ◽

Author(s):

Thomas F. Babor ◽

Jonathan Caulkins ◽

Benedikt Fischer ◽

David Foxcroft ◽

Keith Humphreys ◽

...

Keyword(s):

International Organizations ◽

Drug Policy ◽

Drug Users ◽

Illicit Drug ◽

Supply And Demand ◽

Unintended Consequences ◽

Public Health Approach ◽

Drug Supply ◽

The Public ◽

Balanced Approach

Among the 47 options reviewed in this book, most show some evidence of effectiveness in at least one country, but the evidence is less than definitive for many others, either because the interventions are ineffective, or the research is inadequate. Unfortunately, policies that have shown little or no evidence of effectiveness continue to be the preferred options of many countries and international organizations. The evidence reviewed in this book supports two overarching conclusions. First, an integrated and balanced approach to evidence-informed drug policy is more likely to benefit the public good than uncoordinated efforts to reduce drug supply and demand. Second, by shifting the emphasis toward a public health approach, it may be possible to reduce the extent of illicit drug use, prevent the escalation of new epidemics, and avoid the unintended consequences arising from the marginalization of drug users through severe criminal penalties.

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Opioid overdose deaths can occur in patients with naltrexone implants

The Medical Journal of Australia ◽

10.5694/j.1326-5377.2007.tb01124.x ◽

2007 ◽

Vol 187 (1) ◽

pp. 56-56 ◽

Cited By ~ 2

Author(s):

Nikolaj Kunøe ◽

Helge Waal

Keyword(s):

Opioid Overdose ◽

Overdose Deaths

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A Thematic Analysis of Overdose Prevention and Response Efforts in States Experiencing Declines in Rates of Opioid-Involved Overdose Deaths

Public Health Reports ◽

10.1177/00333549211026816 ◽

2021 ◽

pp. 003335492110268

Author(s):

Amber B. Robinson ◽

Nida Ali ◽

Olga Costa ◽

Cherie Rooks-Peck ◽

Amy Sorensen-Alawad ◽

...

Keyword(s):

Thematic Analysis ◽

Prevention Program ◽

Data Access ◽

Mortality Rates ◽

Opioid Overdose ◽

Overdose Prevention ◽

Core Elements ◽

Specific Activities ◽

Context Specific ◽

Overdose Deaths

Objective To address the opioid overdose epidemic, it is important to understand the broad scope of efforts under way in states, particularly states in which the rate of opioid-involved overdose deaths is declining. The primary objective of this study was to examine core elements of overdose prevention activities in 4 states with a high rate of opioid-involved overdose deaths that experienced a decrease in opioid-involved overdose deaths from 2016 to 2017. Methods We identified 5 states experiencing decreases in age-adjusted mortality rates for opioid-involved overdoses from 2016 to 2017 and examined their overdose prevention programs via program narratives developed with collaborators from each state’s overdose prevention program. These program narratives used 10 predetermined categories to organize activities: legislative policies; strategic planning; data access, capacity, and dissemination; capacity building; public-facing resources (eg, web-based dashboards); training resources; enhancements and improvements to prescription drug monitoring programs; linkage to care; treatment; and community-focused initiatives. Using qualitative thematic analysis techniques, core elements and context-specific activities emerged. Results In the predetermined categories of programmatic activities, we identified the following core elements of overdose prevention and response: comprehensive state policies; strategic planning; local engagement; data access, capacity, and dissemination; training of professional audiences (eg, prescribers); treatment infrastructure; and harm reduction. Conclusions The identification of core elements and context-specific activities underscores the importance of implementation and adaptation of evidence-based prevention strategies, interdisciplinary partnerships, and collaborations to address opioid overdose. Further evaluation of these state programs and other overdose prevention efforts in states where mortality rates for opioid-involved overdoses declined should focus on impact, optimal timing, and combinations of program activities during the life span of an overdose prevention program.

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