BC Centre for Disease Control (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, BC; Department of Psychiatry (Rittenbach), University of Calgary, Calgary, Alta.; Department of Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Public Health Ontario (PHO) (Leece); Dalla Lana School of Public Health (Leece, Elton-Marshall, Strike) and Department of Family and Community Medicine (Leece), University of Toronto; Institute for Mental Health Policy Research (Ali, Elton-Marshall), Centre for Addiction and Mental Health, Toronto, Ont.; School of Epidemiology and Public Health (Elton-Marshall), University of Ottawa, Ottawa, Ont.; Department of Medicine (Brothers), Dalhousie University, Halifax, NS; UCL Collaborative Centre for Inclusion Health (Brothers), University College London, London, UK; Center for Indigenous Health (Medley), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; Overdose Emergency Response and Addictions Program (Medley), Vancouver Coastal Health, Vancouver, BC; Health Sciences Library (Lorenzetti), University of Calgary; Department of Community Health Sciences (Lorenzetti), Cumming School of Medicine, University of Calgary; O'Brien Institute for Public Health (Lorenzetti), University of Calgary, Calgary, Alta.; BC Centre on Substance Use (Gallant); School of Population and Public Health (Buxton), University of British Columbia, Vancouver, BC.
BC Centre for Disease Control (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, BC; Department of Psychiatry (Rittenbach), University of Calgary, Calgary, Alta.; Department of Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Public Health Ontario (PHO) (Leece); Dalla Lana School of Public Health (Leece, Elton-Marshall, Strike) and Department of Family and Community Medicine (Leece), University of Toronto; Institute for Mental Health Policy Research (Ali, Elton-Marshall), Centre for Addiction and Mental Health, Toronto, Ont.; School of Epidemiology and Public Health (Elton-Marshall), University of Ottawa, Ottawa, Ont.; Department of Medicine (Brothers), Dalhousie University, Halifax, NS; UCL Collaborative Centre for Inclusion Health (Brothers), University College London, London, UK; Center for Indigenous Health (Medley), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; Overdose Emergency Response and Addictions Program (Medley), Vancouver Coastal Health, Vancouver, BC; Health Sciences Library (Lorenzetti), University of Calgary; Department of Community Health Sciences (Lorenzetti), Cumming School of Medicine, University of Calgary; O'Brien Institute for Public Health (Lorenzetti), University of Calgary, Calgary, Alta.; BC Centre on Substance Use (Gallant); School of Population and Public Health (Buxton), University of British Columbia, Vancouver, BC
CMAJ. 2023 Aug 28;195(33):E1112-E1123. doi: 10.1503/cmaj.230128.
The increasing toxicity of opioids in the unregulated drug market has led to escalating numbers of overdoses in Canada and worldwide; takehome naloxone (THN) is an evidence-based intervention that distributes kits containing naloxone to people in the community who may witness an overdose. The purpose of this guidance is to provide policy recommendations for territorial, provincial and federal THN programs, using evidence from scientific and grey literature and community evidence that reflects 11 years of THN distribution in Canada.
The Naloxone Guidance Development Group - a multidisciplinary team including people with lived and living experience and expertise of drug use - used the Appraisal of Guidelines for Research & Evaluation (AGREE II) instrument to inform development of this guidance. We considered published evidence identified through systematic reviews of all literature types, along with community evidence and expertise, to generate recommendations between December 2021 and September 2022. We solicited feedback on preliminary recommendations through an External Review Committee and a public input process. The project was funded by the Canadian Institutes of Health Research through the Canadian Research Initiative in Substance Misuse. We used the Guideline International Network principles for managing competing interests.
Existing evidence from the literature on THN was of low quality. We incorporated evidence from scientific and grey literature, and community expertise to develop our recommendations. These were in 3 areas: routes of naloxone administration, THN kit contents and overdose response. Take-home naloxone programs should offer the choice of both intramuscular and intranasal formulations of naloxone in THN kits. Recommended kit contents include naloxone, a naloxone delivery device, personal protective equipment, instructions and a carrying case. Trained community overdose responders should prioritize rescue breathing in the case of respiratory depression, and conventional cardiopulmonary resuscitation in the case of cardiac arrest, among other interventions.
This guidance development project provides direction for THN programs in Canada in the context of limited published evidence, with recommendations developed in collaboration with diverse stakeholders.
不受监管的毒品市场中阿片类药物毒性的增加导致加拿大和全球范围内的过量用药事件不断增加；纳洛酮外出携带包（THN）是一种基于证据的干预措施，它向可能目睹过量用药的社区人员分发含有纳洛酮的套件。本指南的目的是为省级、地区和联邦 THN 计划提供政策建议，所使用的证据来自科学和灰色文献以及反映加拿大 11 年 THN 分发情况的社区证据。
纳洛酮指导开发小组 - 一个由具有吸毒生活和经验以及专业知识的多学科团队组成 - 使用评估健康研究与评估指南（AGREE II）工具为制定本指南提供信息。我们考虑了通过对所有类型文献进行系统评价确定的已发表证据，以及社区证据和专业知识，以在 2021 年 12 月至 2022 年 9 月之间生成建议。我们通过外部审查委员会和公众意见征集过程征求对初步建议的反馈。该项目由加拿大卫生研究院通过加拿大药物滥用研究倡议提供资金。我们使用了指南国际网络管理利益冲突的原则。
THN 文献中的现有证据质量较低。我们将来自科学和灰色文献以及社区专业知识的证据纳入我们的建议中。这些建议涉及三个领域：纳洛酮的给药途径、THN 套件的内容和过量反应。THN 计划应在套件中提供纳洛酮的肌肉内和鼻内制剂选择。推荐的套件内容包括纳洛酮、纳洛酮给药装置、个人防护设备、说明和携带箱。经过培训的社区过量反应人员应在出现呼吸抑制的情况下优先进行抢救性呼吸，在出现心脏骤停的情况下进行常规心肺复苏等干预措施。
本指南开发项目在有限的已发表证据背景下为加拿大的 THN 计划提供了方向，建议是与不同利益相关者合作制定的。
