McDonald Rebecca, Campbell Nancy D, Strang John
National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, Addictions Sciences Building, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, United Kingdom.
Department of Science and Technology Studies, Sage Labs 5202, Rensselaer Polytechnic Institute, 110 Eighth Street Troy, NY, 12180, United States.
Drug Alcohol Depend. 2017 Sep 1;178:176-187. doi: 10.1016/j.drugalcdep.2017.05.001. Epub 2017 May 25.
Opioid overdose is a major cause of mortality, but injury and fatal outcomes can be prevented by timely administration of the opioid antagonist naloxone. Pre-provision of naloxone to opioid users and family members (take-home naloxone, THN) was first proposed in 1996, and WHO Guidelines were issued in 2014. While widespread in some countries, THN is minimally available or absent elsewhere. This review traces the development of THN over twenty years, from speculative harm reduction proposal to public health strategy.
Medline and PsycINFO were searched for peer-reviewed literature (1990-2016) using Boolean queries: 1) "naloxone OR Narcan"; 2) "(opioid OR opiate) AND overdose AND prevention". Grey literature and specialist websites were also searched. Data were extracted and synthesized as narrative review, with key events presented as chronological timeline.
Results are presented in 5-year intervals, starting with the original proposal and THN pilots from 1996 to 2001. Lack of familiarity with THN challenged early distribution schemes (2001-2006), leading to further testing, evaluation, and assessment of challenges and perceived medicolegal barriers. From 2006-2011, response to social and legal concerns led to the expansion of THN programs; followed by high-impact research and efforts to widen THN availability from 2011 to 2016.
Framed as a public health tool for harm reduction, THN has overcome social, clinical, and legal barriers in many jurisdictions. Nonetheless, the rising death toll of opioid overdose illustrates that current THN coverage is insufficient, and greater public investment in overdose prevention will be required if THN is to achieve its full potential impact.
阿片类药物过量是主要的死亡原因，但及时使用阿片类拮抗剂纳洛酮可预防伤害和致命后果。1996年首次提出向阿片类药物使用者及其家庭成员预先提供纳洛酮（居家使用纳洛酮，THN），世界卫生组织于2014年发布了相关指南。虽然在一些国家广泛使用，但在其他地方THN的供应极少或根本没有。本综述追溯了THN二十年来的发展历程，从减少伤害的推测性提议到公共卫生战略。
使用布尔查询在Medline和PsycINFO中检索同行评审文献（1990 - 2016年）：1）“纳洛酮或纳曲酮”；2）“（阿片类药物或阿片）与过量及预防”。还检索了灰色文献和专业网站。数据提取并综合为叙述性综述，关键事件按时间顺序排列。
结果按5年间隔呈现，始于1996年至2001年的最初提议和THN试点。对THN的不熟悉给早期分发计划带来挑战（2001年至2006年），导致进一步测试、评估以及对挑战和感知到的法医学障碍的评估。从2006年至2011年，对社会和法律问题的回应促使THN项目扩大；随后是2011年至2016年的高影响力研究以及扩大THN供应的努力。
作为减少伤害的公共卫生工具，THN在许多司法管辖区克服了社会、临床和法律障碍。尽管如此，阿片类药物过量死亡人数的上升表明当前THN的覆盖范围不足，如果THN要充分发挥其潜在影响，将需要在过量预防方面进行更多公共投资。
