Peers can save overdose victims: UK-Sweden study proves laypeople reverse opioid crises
A major study tracking 1,025 opioid users in the UK and Sweden shows that people with take-home naloxone kits successfully reverse overdoses in real-world settings. The finding could reshape addiction policy and emergency response budgets by shifting lifesaving intervention from hospitals to communities.
Originaltitel: Overdose reversal through peer intervention: Findings from the naloxone prospective outcome research study (NalPORS) on the effectiveness of overdose response by people who use opioids in the United Kingdom and Sweden.
**Lekmannadministrerad naloxon ökar överlevnad vid opioidöverdos** Ta-hem-naloxonprogram (THN) kan säkert distribueras till personer med opioidberoende för att reversera överdoser i verkliga miljöer. En prospektiv kohortanalys av 594 patienter från 22 behandlings- och skadereduceringsenheter i Storbritannien och Sverige följdes under sex månader. Av dessa vittnade 27 procent om minst en överlos; sannolikheten var 4,4 gånger högre bland deltagare som inte var i behandling. THN administrerades vid 82 procent av observerade överdoser, med framgångsrik reversering i nästan alla fall. Studien bekräftar att lekmannadministrering av naloxon fungerar effektivt utanför sjukvårdssystem. För regionvård och inköpsenheter innebär det ett underutnyttjat verktyg för att minska dödsfall bland högrisgrupper. Resultaten stödjer expansion av THN-program som kostnadseffektiv skadereduktion innan patienter når strukturerad behandling.
BACKGROUND/AIMS: Take-home naloxone (THN) programmes have been introduced in many European countries to provide non-medically trained people who are likely to witness an opioid overdose, including people who use opioids, with a naloxone kit and training. This study used data obtained from people supplied with THN and systematically followed up for 6 months to determine the proportion witnessing an overdose, administering naloxone and successfully reversing opioid overdose in real-world settings. The study aimed to compare reports of witnessed opioid overdose between participants in treatment and not in treatment at the time of recruitment. DESIGN: A multi-country, observational prospective cohort study. Participants supplied with THN were asked to report any witnessed overdose events and participate in a systematic follow-up over a 6-month period. SETTING: Participants were recruited from THN programmes at 22 drug treatment and harm reduction services in England, Wales, Scotland and Sweden. PARTICIPANTS: A total of 1025 people who used opioids and who were supplied with THN were recruited between June 2021 and November 2023, of whom 594 (58%) were successfully followed at 6 months. The participants were predominantly men (75%) and white (80%), with a mean age of 45.5 years (standard deviation 10). MEASUREMENT: Main outcomes: whether or not THN was administered at a witnessed overdose and overdose outcome where THN administered. Accurate recognition of opioid overdose, availability of naloxone and appropriate responses (including administering naloxone) to an opioid overdose were captured. Outcomes were compared between participants in treatment and not in treatment. FINDINGS: Of the 594 followed over 6 months, 160 (27%) witnessed at least one overdose. The likelihood of witnessing an overdose was higher among participants not in treatment than participants in treatment [56% vs. 23%; odds ratio = 4.4; 95% confidence interval (CI) = 2.69-7.21; P = 0.001]. THN was administered at most witnessed overdose events (83%; 95% CI = 74-85). Seven deaths were reported (4.4%; 95% CI = 0.02-8.8) by participants to be due to an overdose. For five deaths, naloxone was administered but was believed by participants to have been administered after death. Ninety-five percent (152) of participants were able to recognise one or more critical signs of overdose and respond appropriately. When naloxone was available, it was administered in almost all (90%; 142) emergency situations. CONCLUSIONS: In the United Kingdom and Sweden, people who use opioids appear to be likely to witness and recognise an opioid overdose, be the only person carrying naloxone at the overdose and be both willing and able to safely and effectively administer naloxone in a timely response. Clinical trial registration details (if applicable): ClinicalTrials.gov Identifier: NCT05072249. Date of Registration: 8.10.2021.