Administration of Naloxone in a Home or Community Setting: A Review of the Clinical Effectiveness, Cost-effectiveness, and Guidelines


( Last Updated : December 18, 2019)
Project Line:
Health Technology Review
Project Sub Line:
Summary with Critical Appraisal
Project Number:
RC1221-000

Details


Question


  1. What is the clinical effectiveness of naloxone administered in a community or home setting?

  2. What is the cost-effectiveness of naloxone administered in a home or community setting?

  3. What are the evidence-based guidelines for the administration of naloxone?


Key Message

There was one systematic reviews (SR), two non-randomized studies, one cost-effectiveness study, and two guidelines identified. In the SR, there was evidence that take-home naloxone was associated with a reduction in overdose mortality. One review in the SR showed take-home naloxone was also associated with more successful reversals and minimal adverse events than usual care. One non-randomized study indicated that patients using opioids for long-term pain who received naloxone co-prescriptions had significantly fewer subsequent emergency department visits than those who did not receive naloxone. However, in a population study that did not describe the intervention and populations clearly, the implementation of a national take-home naloxone program was not significantly associated with ambulance call-outs to opioid-related overdoses in Scotland.In a cost-effectiveness analysis in which 30% of the heroin users were prescribed naloxone, the base case scenario demonstrated that there might be a decrease in overdose deaths by 6.6% and 2,500 fewer premature deaths with community naloxone distribution at an incremental cost per quality-adjusted life year gained of £899 in a population of 200,000 heroin users.Guidelines produced by the World Health Organization (WHO) and the American Society of Addiction Medicine (ASAM) recommend that naloxone should be given in case of opioid overdose and should be accessible to people with opioid use disorder and people likely to witness an opioid overdose. It was recommended that the patients and those likely to witness an opioid overdose should be trained for naloxone administration. In the WHO guideline, regardless of the administration routes, naloxone is recommended due to its effectiveness for opioid overdose. Individuals should choose a route of naloxone administration depending on the formulation available, administration skills, and settings. In the ASAM guideline, in which the supporting evidence was not linked to the recommendations, naloxone is not recommended for use in pregnant women with opioid use disorder, except for life-threatening situations.The limitations to this report included a lack of RCTs, a lack of studies in Canadian contexts, a lack of studies specifically focusing on the safety of naloxone, and a lack of direct comparison between non-health professionals and professional first responders.Further research on the clinical effectiveness and cost-effectiveness of the currently available naloxone kits for use in home and community settings in Canada may help to reduce uncertainties.