From evidence to policy: The Scottish national naloxone programme

Drug-related death (DRD) is a major public health problem globally, with rates in Scotland higher than any other UK region and among the highest in Europe. One of the most important public health interventions to emerge aimed at tackling rising DRD rates is the distribution of naloxone, the opioid antagonist, for peer administration. The Scottish Government established a national naloxone programme in 2010 aimed at reducing the increasing levels of DRD. The national coverage of the programme is unique by comparison and is an important development in substance misuse public health. This review aims to describe the journey to this landmark public health programme, detailing the research, advocacy and policy contributions that facilitated its creation. The use of naloxone in other countries will also be described, discussing the barriers in place to adopting similar national programmes elsewhere.

[1]  Matt Anderson,et al.  European Monitoring Centre for Drugs and Drug Addiction , 2014 .

[2]  J. McVeigh,et al.  United Kingdom drug situation: annual report to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) 2012. , 2013 .

[3]  S. Bird,et al.  A record-linkage study of drug-related death and suicide after hospital discharge among drug-treatment clients in Scotland, 1996-2006. , 2013, Addiction.

[4]  D. Best,et al.  A quantitative exploration of risk factors associated with drug-related deaths involving heroin, alcohol or methadone in the West of Scotland , 2012 .

[5]  S. Bird,et al.  Toxicology of Scotland's drugs-related deaths in 2000–2007: Presence of heroin, methadone, diazepam and alcohol by sex, age-group and era , 2011 .

[6]  I. Sanderson.  Evidence-Based Policy or Policy-Based Evidence? Reflections on Scottish Experience. , 2011 .

[7]  MORTALITY RELATED TO DRUG USE IN EUROPE: PUBLIC HEALTH IMPLICATIONS , 2011 .

[8]  J. Strang,et al.  Impact of training for healthcare professionals on how to manage an opioid overdose with naloxone: effective, but dissemination is challenging. , 2011, The International journal on drug policy.

[9]  J. K. Dunbar,et al.  The National Drug Related Deaths Database (Scotland) Report 2009. , 2011 .

[10]  W. Hall,et al.  Impact of supervision of methadone consumption on deaths related to methadone overdose (1993-2008): analyses using OD4 index in England and Scotland , 2010, BMJ : British Medical Journal.

[11]  M. Farrell,et al.  Meta-analysis of drug-related deaths soon after release from prison , 2010, Addiction.

[12]  T. Valente,et al.  Evaluation of an overdose prevention and response training programme for injection drug users in the Skid Row area of Los Angeles, CA. , 2010, The International journal on drug policy.

[13]  S. Lenton,et al.  Naloxone for administration by peers in cases of heroin overdose , 2009, The Medical journal of Australia.

[14]  A. McAuley,et al.  Responsible management and use of a personal take-home naloxone supply: A pilot project , 2009 .

[15]  Andrew Tannahill,et al.  Beyond evidence--to ethics: a decision-making framework for health promotion, public health and health improvement. , 2008, Health promotion international.

[16]  C. Semmler,et al.  Overdose training and take-home naloxone for opiate users: prospective cohort study of impact on knowledge and attitudes and subsequent management of overdoses. , 2008, Addiction.

[17]  Sarz Maxwell,et al.  Prescribing Naloxone to Actively Injecting Heroin Users , 2006, Journal of addictive diseases.

[18]  K. Seal,et al.  Naloxone distribution and cardiopulmonary resuscitation training for injection drug users to prevent heroin overdose death: A pilot intervention study , 2005, Journal of Urban Health.

[19]  D. Wight,et al.  Evidence, policy and practice: developing collaborative approaches in Scotland , 2005 .

[20]  N. Mckeganey,et al.  Estimating the National and Local Prevalence of Problem Drug Misuse in Scotland , 2005 .

[21]  A. Busuttil,et al.  Working Group on drug-related deaths: Report and recommendations , 2005 .

[22]  T. Fahey,et al.  National Investigation into Drug Related Deaths in Scotland, 2003 , 2005 .

[23]  J. Oliver,et al.  The role of methadone in drug-related deaths in the west of Scotland. , 2003, Addiction.

[24]  K. Sporer.  Strategies for preventing heroin overdose , 2003, BMJ : British Medical Journal.

[25]  N. Wright,et al.  A UK Policy on 'Take Home Naloxone' for Opiate Users--Strategy or Stalemate? , 2003 .

[26]  D. Bigg.  Data on take home naloxone are unclear but not condemnatory , 2002, BMJ : British Medical Journal.

[27]  A. Spyropoulos.  Patient group directions. , 2002, Nursing times.

[28]  A. Ashworth,et al.  Take home naloxone for opiate addicts. Apparent advantages may be balanced by hidden harms. , 2001, BMJ.

[29]  M. White,et al.  Doctors should be trained in advanced life support before students are , 2001, BMJ : British Medical Journal.

[30]  D. Mountain.  Take home naloxone for opiate addicts , 2001, BMJ : British Medical Journal.

[31]  G. Blackwood.  Take home naloxone for opiate addicts. Figures in Jersey give no support to scheme's effectiveness. , 2001, BMJ.

[32]  S. Burris,et al.  Legal aspects of providing naloxone to heroin users in the United States , 2001 .

[33]  A. Ashworth,et al.  Management of prisoners with HIV infection , 2001, BMJ : British Medical Journal.

[34]  J. Strang,et al.  Take home naloxone and the prevention of deaths from opiate overdose: two pilot schemes , 2001, BMJ : British Medical Journal.

[35]  S. Lenton,et al.  Should we conduct a trial of distributing naloxone to heroin users for peer administration to prevent fatal overdose? , 2000, The Medical journal of Australia.

[36]  C. Taylor,et al.  Preventing opiate overdose fatalities with take-home naloxone: pre-launch study of possible impact and acceptability. , 1999, Addiction.

[37]  B. Simini.  bologna Naloxone supplied to Italian heroin addicts , 1998, The Lancet.

[38]  W. Hall,et al.  The distribution of naloxone to heroin users. , 1997, Addiction.

[39]  W. Hall,et al.  Heroin overdose: the case for take-home naloxone , 1996, BMJ.

[40]  J. Strang,et al.  Harm minimisation for drug misusers. , 1992, BMJ.

[41]  A. Wilson.  The British National Formulary. , 1963, The Practitioner.