Research & Publications

This section offers information regarding research, evaluation and publications about naloxone.

Naloxone is a medication (an ‘opioid receptor antagonist’) which counters the effects of an opioid overdose, reversing the depression of the central nervous system and respiratory system. Naloxone has long been a ‘pre-hospital’ treatment used by emergency staff in many high-income countries, but is now becoming more widely distributed by harm reduction services to people who use drugs and their friends and families.

This section includes several research papers on naloxone – including the attitudes of drug users to the medication and to peer distribution, and the benefits of intranasal administration (spraying the drug up the nose rather than injecting it into the body), and legal aspects of naloxone distribution to heroin users.

Title Description  

Intranasal Administration of Naloxone by Paramedics. Pre-hospital Emergency Care, 6 (1), pages 54–58.
Barton ED, Ramos J, Colwell C, Benson J, Baily J & Dunn W (2002)

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.

Closing Death’s Door: Action Steps to Facilitate Emergency Opioid Drug Overdose Reversal in the United States
Beletsky L, Burris S & Kral AH (2009)

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.

Legal Aspects of Providing Naloxone to Heroin Users in the United States. International Journal of Drug Policy, 12, pages 237–248.
Burris S, Norland J & Edlin BR (2001)

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.

Randomised Trial of Intranasal versus Intramuscular Naloxone in Prehospital Treatment for Suspected Opioid Overdose. Medical Journal of Australia, 182 (1), pages 24–27
Kelly A-M, Kerr D, Dietze P, Patrick I, Walker T & Koutsogiannis Z (2005)

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.

Attitudes of Australian Heroin Users to Peer Distribution of Naloxone for Heroin Overdose: Perspectives on Intranasal Administration. Journal of Urban Health, 85 (3), pages 352–360.
Kerr D, Dietze P, Kelly A-M & Jolley D (2008)

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.

Expanded Access to Naloxone: Options for Critical Response to the Epidemic of Opioid Overdose Mortality. American Journal of Public Health, 99 (3), pages 402–407.
Kim D, Irwin KS & Khoshnood K

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.

Overdoses among Friends: Drug users are willing to administer naloxone to others. Journal of Substance Abuse Treatment, 30, pages 129-133.
Lagu T, Anderson BJ & Stein M (2006)

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.

Saved by the nose: bystander-administered intranasal naloxone hydrochloride for opioid overdose. American Journal of Public Health, 99(5), pages 788-791.
Doe-Simkins M, Walley AY, Epstein A, Moyer P. (2009)

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.

Provision of Naloxone to Injection Drug Users as an Overdose Prevention Strategy: Early evidence from a pilot study in New York City. Addictive Behaviors, 31, pages 907–912
Galea S, Worthington N, Markham Piper T, Nandi VV, Curtis M & Rosenthal DM (2006)

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.

Distinguishing signs of opioid overdose and indication for naloxone: an evaluation of six overdose training and naloxone distribution programs in the United States. Addiction, 103, pages 979–989
Green TC, Heimer R & Grau LE (2008)

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.

Prescribing Naloxone to Actively Injecting Heroin Users: A Program to Reduce Heroin Overdose Deaths. Journal of Addictive Diseases, 25(3), pages 89–96
Maxwell S, Bigg, D, Stanczykiewicz K & Carlberg-Racich S (2006)

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.

Overdose Prevention for Injection Drug Users: Lessons learned from naloxone training and distribution programs in New York City. Harm Reduction Journal, 4:3
Piper TM, Rudenstine S, Stancliff S, Sherman S, Nandi V, Clear A & Galea S (2007)

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.

“The Life They Save May Be Mine”: Diffusion of overdose prevention information from a city sponsored programme. International Journal of Drug Policy, 20 (2), pages 137–142
Sherman SG, Gann DS, Tobin KE, Latkin CA, Welsh C & Bielenson P (2009)

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.

Prescription Naloxone: A Novel Approach to Heroin Overdose Prevention. Annals of Emergency Medicine Volume 49, No. 2: February 2007, 172–177
Sporer KA & Kral AH (2007)

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.

Evaluation of the Staying Alive Programme: Training injection drug users to properly administer naloxone and save lives. International Journal of Drug Policy, 20 (2), pages 131–136
Tobin KE, Sherman SG, Beilenson P, Welsh C & Latkin CA (2008)

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.

Opiate Users' Knowledge about Overdose Prevention and Naloxone in New York City: A focus group study. Harm Reduction Journal, 3:19
Worthington N, Markham Piper T, Galea S & Rosenthal D (2006)

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.

Information kindly supplied by Harm Reduction International

Publication/Article Source Country

‘Opioid Overdose prevention’

New York State Department of Health website


NTA: ‘reducing drug related harm’

National Treatment Agency (NTA), UK


Health Statistics Quarterly. Number 39 Autumn 2008

Office for national statistics


Annual report 2008

European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)


Life saving kits to be given to families of injecting drug users in groundbreaking scheme

National Treatment Agency (NTA), UK


Annual Report 2009-2010

National Forum on Drug Related Deaths in Scotland Annual report


Information kindly supplied by