Author:
Sajwani Hawraa Sameer,Williams Anna V
Abstract
AbstractBackgroundOpioid overdose epidemic is hitting record highs worldwide, accounting for 76% of mortality related to substance use. Take-home naloxone (THN) strategies are being implemented in many developed countries that suffer from high opioid overdose death rates. They aim to provide overdose identification and naloxone administration training, along with THN delivery to opioid users and others likely to witness an overdose incident such as family members and peers. However, little is known about such measures in low- and middle-income countries (LMIC), where opioid use and opioid-related deaths are reportedly high. This systematic literature review aims to examine the distribution of THN in LMIC, review studies identifying barriers to the implementation of THN programs worldwide, and assess their applicability to LMIC.MethodsThe literature was searched and analyzed for eligible studies with quality assessment.ResultsTwo studies were found from LMIC on THN programs with promising results, and 13 studies were found on the barriers identified in implementing THN programs worldwide. The main barriers to THN strategies were the lack of training of healthcare providers, lack of privileges, time constraints, cost, legislative/policy restrictions, stigma, fear of litigation, and some misperceptions around THN.ConclusionsThe barriers outlined in this paper are probably applicable to LMIC, but more difficult to overcome considering the differences in their response to opioid overdose, their cultural attitudes and norms, the high cost, the waivers required, the legislative differences and the severe penalties for drug-related offenses in some of these countries. The solutions suggested to counter-act these obstacles can also be more difficult to achieve in LMIC. Further research is required in this area with larger sample sizes to provide a better understanding of the obstacles to the implementation, feasibility, accessibility, and utilization of THN programs in LMIC.
Publisher
Springer Science and Business Media LLC
Subject
Psychiatry and Mental health,Public Health, Environmental and Occupational Health,Medicine (miscellaneous)
Reference67 articles.
1. United Nations Office on Drugs and Crime. UNODC. (2018, 2017). The World Drug Report. Retrieved on 5 May 2019, from: https://www.unodc.org/wdr2018/index.html, and https://www.unodc.org/wdr2018/prelaunch/WDR18_Booklet_2_GLOBAL.pdf
2. Wilby KJ, Wilbur K. Cross-national analysis of estimated narcotic utilization for twelve Arabic speaking countries in the Middle East. Saudi Pharm J SPJ Off Publ Saudi Pharm Soci. 2017;25(1):83–7.
3. Akhgari M, Amini-Shirazi N, Iravani FS. Forensic toxicology perspectives of methadone-associated deaths in Tehran, Iran, a 7-year overview. Basic Clin Pharmacol Toxicol. 2018;122(4):436–41.
4. Langham S, Wright A, Kenworthy J, Grieve R, Dunlop WCN. Cost-effectiveness of take-home naloxone for the prevention of overdose fatalities among heroin users in the United Kingdom. Value Health. 2018;21(4):407–15. https://doi.org/10.1016/j.jval.2017.07.014.
5. Coffin P, Sullivan SD. Cost effectiveness of distributing naloxone to heroin users for lay overdose reversal. Ann Intern Med. 2013;158:1–9.