Take-Home Naloxone in Opioid Dependency: An Intervention to Reduce Opioid-Related Deaths.

Abstract

Background: There were 2227 drug-related deaths in Germany in 2023, corresponding to a rise of 12% over the previous year and a doubling over the course of a decade. Approximately 60% of these deaths were related to opioid consumption. In this narrative review, we discuss whether take-home naloxone (THN) might lower the mortality of persons with opioid dependency.

Methods: This review is based on pertinent publications that were retrieved by a selective search in PubMed.

Results: Seven observational studies of the mortality of persons with opioid dependency were included in the analysis. The available evidence for the intervention is on a low level. The studies indicate an overall lowering of mortality even though a significant reduction in drug-related deaths was not always achieved. It was concluded in a meta-analysis of 9 observational studies that 9.2% (95% confidence interval, [5.2; 13.1]) of the THN kits provided were actually used in the first three months to prevent opioid overdose-related death. In a Canadian study, 43% [41; 45] of the naloxone kits that were handed out over a period of 8 years were used and successfully prevented opioid overdose-related death. The latter figures suggest that the use of THN may have been systematically underestimated to date.

Conclusion: Demonstrating the efficacy of THN is difficult because of the nature of the research topic. Current evidence implies that THN lowers the mortality of persons with opioid dependence. It is estimated that only about 1.3% of opioid dependent people have been provided with THN in Germany thus far. A major expansion of the provision and use of THN could contribute to a further reduction in opioid-related deaths.