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Are take‐home naloxone programmes effective? Systematic review utilizing application of the Bradford Hill criteria

BACKGROUND AND AIMS: Fatal outcome of opioid overdose, once detected, is preventable through timely administration of the antidote naloxone. Take‐home naloxone provision directly to opioid users for emergency use has been implemented recently in more than 15 countries worldwide, albeit mainly as pil...

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Detalles Bibliográficos
Autores principales: McDonald, Rebecca, Strang, John
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5071734/
https://www.ncbi.nlm.nih.gov/pubmed/27028542
http://dx.doi.org/10.1111/add.13326
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author McDonald, Rebecca
Strang, John
author_facet McDonald, Rebecca
Strang, John
author_sort McDonald, Rebecca
collection PubMed
description BACKGROUND AND AIMS: Fatal outcome of opioid overdose, once detected, is preventable through timely administration of the antidote naloxone. Take‐home naloxone provision directly to opioid users for emergency use has been implemented recently in more than 15 countries worldwide, albeit mainly as pilot schemes and without formal evaluation. This systematic review assesses the effectiveness of take‐home naloxone, with two specific aims: (1) to study the impact of take‐home naloxone distribution on overdose‐related mortality; and (2) to assess the safety of take‐home naloxone in terms of adverse events. METHODS: PubMed, MEDLINE and PsychINFO were searched for English‐language peer‐reviewed publications (randomized or observational trials) using the Boolean search query: (opioid OR opiate) AND overdose AND prevention. Evidence was evaluated using the nine Bradford Hill criteria for causation, devised to assess a potential causal relationship between public health interventions and clinical outcomes when only observational data are available. RESULTS: A total of 1397 records (1164 after removal of duplicates) were retrieved, with 22 observational studies meeting eligibility criteria. Due to variability in size and quality of the included studies, meta‐analysis was dismissed in favour of narrative synthesis. From eligible studies, we found take‐home naloxone met all nine Bradford Hill criteria. The additional five World Health Organization criteria were all either met partially (two) or fully (three). Even with take‐home naloxone administration, fatal outcome was reported in one in 123 overdose cases (0.8%; 95% confidence interval = 0.4, 1.2). CONCLUSIONS: Take‐home naloxone programmes are found to reduce overdose mortality among programme participants and in the community and have a low rate of adverse events.
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spelling pubmed-50717342016-11-02 Are take‐home naloxone programmes effective? Systematic review utilizing application of the Bradford Hill criteria McDonald, Rebecca Strang, John Addiction Reviews BACKGROUND AND AIMS: Fatal outcome of opioid overdose, once detected, is preventable through timely administration of the antidote naloxone. Take‐home naloxone provision directly to opioid users for emergency use has been implemented recently in more than 15 countries worldwide, albeit mainly as pilot schemes and without formal evaluation. This systematic review assesses the effectiveness of take‐home naloxone, with two specific aims: (1) to study the impact of take‐home naloxone distribution on overdose‐related mortality; and (2) to assess the safety of take‐home naloxone in terms of adverse events. METHODS: PubMed, MEDLINE and PsychINFO were searched for English‐language peer‐reviewed publications (randomized or observational trials) using the Boolean search query: (opioid OR opiate) AND overdose AND prevention. Evidence was evaluated using the nine Bradford Hill criteria for causation, devised to assess a potential causal relationship between public health interventions and clinical outcomes when only observational data are available. RESULTS: A total of 1397 records (1164 after removal of duplicates) were retrieved, with 22 observational studies meeting eligibility criteria. Due to variability in size and quality of the included studies, meta‐analysis was dismissed in favour of narrative synthesis. From eligible studies, we found take‐home naloxone met all nine Bradford Hill criteria. The additional five World Health Organization criteria were all either met partially (two) or fully (three). Even with take‐home naloxone administration, fatal outcome was reported in one in 123 overdose cases (0.8%; 95% confidence interval = 0.4, 1.2). CONCLUSIONS: Take‐home naloxone programmes are found to reduce overdose mortality among programme participants and in the community and have a low rate of adverse events. John Wiley and Sons Inc. 2016-03-30 2016-07 /pmc/articles/PMC5071734/ /pubmed/27028542 http://dx.doi.org/10.1111/add.13326 Text en © 2016 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs (http://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Reviews
McDonald, Rebecca
Strang, John
Are take‐home naloxone programmes effective? Systematic review utilizing application of the Bradford Hill criteria
title Are take‐home naloxone programmes effective? Systematic review utilizing application of the Bradford Hill criteria
title_full Are take‐home naloxone programmes effective? Systematic review utilizing application of the Bradford Hill criteria
title_fullStr Are take‐home naloxone programmes effective? Systematic review utilizing application of the Bradford Hill criteria
title_full_unstemmed Are take‐home naloxone programmes effective? Systematic review utilizing application of the Bradford Hill criteria
title_short Are take‐home naloxone programmes effective? Systematic review utilizing application of the Bradford Hill criteria
title_sort are take‐home naloxone programmes effective? systematic review utilizing application of the bradford hill criteria
topic Reviews
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5071734/
https://www.ncbi.nlm.nih.gov/pubmed/27028542
http://dx.doi.org/10.1111/add.13326
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