Monash Addiction Research Centre and Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, VIC 3199, Australia; Monash University School of Medicine, Clayton Campus, Clayton, VIC 3800, Australia.
Burnet Institute Centre for Epidemiology and Population Health Research, Melbourne, VIC 3004, Australia.
Int J Drug Policy. 2022 Feb;100:103513. doi: 10.1016/j.drugpo.2021.103513. Epub 2021 Nov 16.
Take home naloxone (THN) programs have been rapidly upscaled in response to increasing opioid-related mortality. One often cited concern is that naloxone provision could be associated with increased opioid use, due to the availability of naloxone to reverse opioid overdose. We conducted a systematic review to determine whether THN provision is associated with changes in substance use by participants enrolled in THN programs.
We conducted a systematic review of the literature to assess changes in heroin or other substance use by people who use opioids following THN provision.
Seven studies with 2578 participants were included. Of the seven studies, there were two quasi-experimental studies and five cohort studies. Based on the Joanna Briggs Institute quality assessment, four studies were of moderate quality and three studies were of high quality. Of the five studies that reported on the primary outcome of heroin use, no study found evidence of increased heroin use across the study population. Five studies reported on other substance use (benzodiazepines, alcohol, cocaine, amphetamine, cannabis, prescription opioids), none of which found evidence of an increase in other substance use associated with THN provision. Four studies reported on changes in overdose frequency following THN provision: three studies reporting no change, and one study of people prescribed opioids finding a reduction in opioid-related emergency department attendances for participants who received naloxone.
We found no evidence that THN provision was associated with increased opioid use or overdose. Concerns that THN supply may lead to increased substance use were not supported by data from reviewed studies.
为应对阿片类药物相关死亡率的上升，带离纳洛酮（THN）项目已迅速扩大规模。人们经常提到的一个担忧是，由于纳洛酮可用于逆转阿片类药物过量，提供纳洛酮可能与阿片类药物使用增加有关。我们进行了系统评价，以确定 THN 供应是否与参加 THN 项目的参与者的物质使用变化有关。
我们对文献进行了系统评价，以评估在提供 THN 后，使用阿片类药物的人在海洛因或其他物质使用方面的变化。
纳入了 7 项研究，共 2578 名参与者。这 7 项研究中有 2 项准实验研究和 5 项队列研究。根据乔安娜布里格斯研究所的质量评估，有 4 项研究为中等质量，3 项研究为高质量。在报告海洛因使用主要结局的 5 项研究中，没有研究发现整个研究人群中海洛因使用增加的证据。5 项研究报告了其他物质使用（苯二氮䓬类、酒精、可卡因、安非他命、大麻、处方阿片类药物），没有一项研究发现与 THN 供应相关的其他物质使用增加的证据。有 4 项研究报告了 THN 供应后过量发生频率的变化：3 项研究报告无变化，一项为开处方阿片类药物的人进行的研究发现，接受纳洛酮的参与者因阿片类药物相关的急诊就诊次数减少。
我们没有发现 THN 供应与阿片类药物使用或过量增加有关的证据。THN 供应可能导致物质使用增加的担忧并没有得到审查研究数据的支持。
