This study aimed to prospectively test the effectiveness of intranasal naloxone administration by paramedics in the USA. A total of 30 patients received naloxone during the study period – 11 of whom responded to naloxone. The authors conclude that intranasal naloxone may provide a safe, rapid, effective way to manage suspected opioid overdoses, and use of this route – rather than intravenous naloxone - may be preferential as associated risks are minimal. Unfortunately, we are unable to provide free access to this article at this stage.

This paper presents the findings from a summit on opioid overdose supported by the Drug Policy Alliance. The event brought together drug policy and public health experts to discuss strategies for preventing avoidable overdose by increasing access to naloxone and important basic overdose education. The authors explore the legal and policy obstacles to increasing implementation of naloxone prescription programmes in the United States and provide recommendations for increasing access to this life saving intervention. Unfortunately, we are unable to provide free access to this article at this stage.

This paper – in Harm Reduction International’s official journal – is a detailed legal analysis of naloxone provision in the United States. The authors found that the prescription of naloxone is fully compliant with state and federal laws regulating drug prescribing. They conclude that the risks of malpractice liability are consistent with those generally associated with providing healthcare, and offer simple guidelines to minimise these risks further.

This research paper from Australia aims to determine the effectiveness of intranasal naloxone compared with intramuscular naloxone in the treatment of opiate overdoses and the associated respiratory depression. The authors conclude that, in prehospital settings at least – the intranasal delivery of naxolone may be preferable as it could reduce the risk of needle-stick injuries and exposure to blood-borne infections. It is also relatively safe to make more widely available – for example, to increase access to this life-saving treatment in the community.

This study examines the attitudes and willingness of people who inject drugs in Australia to administer naloxone to their peers in the event of an opiate overdose. Of a sample of 99 participants recruited from needle and syringe programmes, the majority reported positive attitudes toward naloxone distribution and 92% said they were willing to participate in a related training programme. Some participants raised concerns about peer administration (such as competencies, victim responses afterwards, and legal implications), and almost three quarters said that they would prefer intranasal naloxone. Unfortunately, we are unable to provide free access to this article at this stage.

This paper explores the current evidence for scaling up access to naloxone in the United States and finds that extensive scale up is supported by findings from pilot programmes. The authors present a range of possible policy and programmatic responses to avoidable opioid overdose in the country and analyse the advantages and limitations associated with them. Unfortunately, we are unable to provide free access to this article at this stage.

This study aims to explore the distribution of naloxone among heroin users, and whether or not drug users are willing to administer the medication to others. 329 people were recruited to the study, most of whom had used heroin and nearly two thirds of whom reported that they had injected drugs. 64.6% reported having witnessed a drug overdose in the past, and over half of these had experienced an accidental drug overdose. The majority of individuals reported that they would be willing to administer a medication to a peer in the event of an overdose, regardless of their knowledge of first aid etc. Unfortunately, we are unable to provide free access to this article at this stage.

This paper evaluates the success of an opioid overdose prevention programme that included intranasal naloxone education and distribution to potential overdose bystanders in Boston, USA. The researchers describe how after 15 months, the programme had provided training and intranasal naloxone to 385 participants who reported 74 successful overdose reversals. They found problems with intranasal naloxone to be uncommon and concluded that its distribution with relevant training is a feasible public health intervention to address opioid overdose. Unfortunately, we are unable to provide free access to this article at this stage.

This paper is an early evaluation of a pilot naloxone distribution scheme in New York. The initiative was launched in 2004 through the city’s needle and syringe programmes. This study outlines the assessed demographics, drug use, and overdose history, experience, and behavior of participants at intake into the scheme, when they returned for prescription refills, and three months after the baseline assessment. There were 17 witnessed overdoses during the study period, and naloxone was administered in ten of them with no fatalities. Unfortunately, we are unable to provide free access to this article at this stage.

This paper assesses the effectiveness of six overdose prevention programmes in increasing awareness of potential overdose bystanders to when an overdose was occurring and whether or not the administration of naloxone was required. The study concluded that training did significantly increase awareness and understanding of overdose and overdose prevention. Trained respondents were as skilled as medical experts in recognising opioid overdose situations and when naloxone was required. Unfortunately, we are unable to provide free access to this article at this stage.

This paper describes an overdose prevention programme in Chicago which combines education and the administration of intramuscular naloxone through a large harm reduction programme network. Since the programme began in January 2001, more than 3,500 vials of naloxone have been prescribed and 319 reports of ‘peer reversals’ (incidents of overdose where peers have successfully intervened) have been received.

This paper evaluates the SKOOP (Skills and Knowledge on Opiate Prevention) programme in the USA. During a one year period, over 1,000 participants were trained and received a prescription for naloxone. The authors describe six primary challenges and lessons learned in developing, implementing and evaluating the programme. These include the political climate surrounding naloxone distribution, existing prescription drug laws, initial low levels of recruitment into the programme, the development of appropriate training methods, challenges in evaluation designs, and the evolution of programme response to naloxone.

This is the second of two papers in Harm Reduction International’s official journal evaluating the ‘Staying Alive’ overdose prevention and naloxone distribution programme which was established in Baltimore (USA). This qualitative study examines the diffusion of information through this programme, and demonstrates the participant’s interest in – and ability to diffuse – overdose prevention information and response skills. The study shows the importance of promoting the diffusion of information and skills within overdose prevention programmes. Unfortunately, we are unable to provide free access to this article.

This paper provides a contemporary overview of naloxone distribution programmes across the USA and beyond. There are many examples of these projects, and programme implementation considerations, legal ramifications, and current research needs for prescription naloxone are also outlined.

This is the first of two papers in Harm Reduction International’s official journal evaluating the ‘Staying Alive’ overdose prevention and naloxone distribution programme which was established in Baltimore (USA). This study examines the impact of the programme on a sample of 85 participants. During the study period, naloxone was administered by 19 participants with no reported adverse effects. After the training, a greater proportion of participants also reported using resuscitation skills that had been taught in the programme, along with increased knowledge about naloxone.

This paper reports on the results of a focus group study in the USA in which participants received a prescription for two doses of naloxone (with refills as needed) and comprehensive training to reduce overdose risks, administer naloxone, perform rescue breathing, and call emergency services. By September 2005, 204 participants had received the training and been issued with naloxone. Forty of these reported having used the naloxone to revive and help a peer or family member.