BC Centre for Disease Control, Vancouver, British Columbia, Canada.
Faculty of Medicine, Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
PLoS One. 2021 Oct 29;16(10):e0259126. doi: 10.1371/journal.pone.0259126. eCollection 2021.
Take-Home Naloxone programs have been introduced across North America in response to rising opioid overdose deaths. There is currently limited real-world data on bystander naloxone administration, overdose outcomes, and evidence related to adverse events following bystander naloxone administration.
The research team used descriptive statistics from Take-Home Naloxone administration forms. We explored reported demographic variables and adverse events among people who received by-stander administered naloxone in a suspected opioid overdose event between August 31, 2012 and December 31, 2018 in British Columbia. We examined and contextualized differences across years given policy, program and drug toxicity changes. We used multivariate logistic regression to examine whether an association exists between number of ampoules of naloxone administered and the odds that the recipient will experience withdrawal symptoms.
A large majority (98.1%) of individuals who were administered naloxone survived their overdose and 69.2% had no or only mild withdrawal symptoms. Receiving three (Adjusted Odds Ratio (AOR) 1.64 (95% Confidence Interval (CI): 1.08-2.48)) or four or more (AOR 2.19 (95% CI: 1.32-3.62)) ampoules of naloxone was significantly associated with odds of moderate or severe withdrawal compared to receiving one ampoule of naloxone.
This study provides evidence from thousands of bystander reversed opioid overdoses using Take-Home Naloxone kits in British Columbia, and suggests bystander-administered naloxone is safe and effective for opioid overdose reversal. Data suggests an emphasis on titration during bystander naloxone training in situations where the person experiencing overdose can be adequately ventilated may help avoid severe withdrawal symptoms. We identified a decreasing trend in the likelihood of moderate or severe withdrawal over the study period.
为应对阿片类药物过量死亡人数的上升，北美各地都推出了随带纳洛酮计划。目前，有关旁观者纳洛酮给药、过量结局以及与旁观者纳洛酮给药后不良事件相关的证据方面的真实世界数据有限。
研究团队使用随带纳洛酮给药表中的描述性统计数据。我们在不列颠哥伦比亚省，于 2012 年 8 月 31 日至 2018 年 12 月 31 日期间，调查并分析了在疑似阿片类药物过量事件中接受旁观者给予纳洛酮的人群中报告的人口统计学变量和不良事件。我们根据政策、计划和药物毒性变化，对不同年份的差异进行了检查和背景分析。我们使用多变量逻辑回归检查给予的纳洛酮安瓿数与接受者出现戒断症状的几率之间是否存在关联。
绝大多数（98.1%）接受纳洛酮治疗的个体在过量后幸存下来，69.2%的个体没有或仅有轻度戒断症状。与接受 1 安瓿纳洛酮相比，接受 3 安瓿（调整后的优势比 (AOR) 1.64（95%置信区间 (CI)：1.08-2.48））或 4 或更多安瓿纳洛酮与中度或重度戒断的几率显著相关。
本研究提供了不列颠哥伦比亚省数千例使用随带纳洛酮试剂盒的旁观者逆转阿片类药物过量的证据，并表明旁观者给予纳洛酮对阿片类药物过量逆转是安全有效的。数据表明，在可以充分通气的情况下，在旁观者纳洛酮培训中强调滴定可能有助于避免严重的戒断症状。我们在研究期间发现中度或重度戒断的可能性呈下降趋势。
