The effect of take-home naloxone kits on opioid-related deaths in Alberta, Canada: An ecological analysis.

Objective: To estimate the association between publicly provided take-home naloxone kits and opioid-related deaths.

Methods: We analyzed 2732 opioid-related deaths and the distribution of 147,814 naloxone kits between January 2015 and June 2019 across five health zones in Alberta, Canada. We used a Poisson pseudo-maximum likelihood regression model with fixed effects to estimate the association between the number of kits in circulation and the number of monthly opioid-related deaths, controlling for population demographics, socio-economic indicators, other harm reduction strategies, police seizures of fentanyl and carfentanil, and an estimate of awareness.

Results: Every 10,000 kits in circulation was associated with a 23.9% (95% confidence interval (CI), 12.6-33.7) reduction in opioid-related deaths. Marginal analysis suggests that if no kits had been distributed, Alberta would have had 3548 deaths (95% CI, 2264-4831), 816 more deaths than were recorded during this 4.5-year period. If during this time 200,000 kits were consistently in circulation, Alberta would have had an estimated 1587 deaths (95% CI, 705-2468), 1145 fewer deaths than recorded.

Conclusion: This analysis provides evidence that the availability of naloxone kits is associated with a reduction in opioid-related deaths and suggests that a publicly funded program that allows the distribution of naloxone kits to all who request them reduces mortality.