Recommendation for Practice
Naloxone Provision
• Professionals should mobilize themselves and be key-‐advocators for the naloxone
availability in each emergency response device (ambulances, fire-‐fighters).
Professionals managing overdoses: training and intervention
• Training on overdose prevention, recognition and response, including overdose
management with naloxone, should be provided to emergency staff, professionals working in the drugs field, and general healthcare professionals. The same is valid for pharmacists in regions were OST, NEP and naloxone provision exists on those facilities (e.g. Italy for naloxone provision).
• Provide training in overdose prevention, recognition and response, including training
in overdose management with naloxone to prison staff.
• Protocols for police attendance at overdose scenes should ensure that police action
does not dissuade overdose witnesses of calling emergency services. Outreach teams and PUD organizations should be in great position to offer consultancy according to the protocol’s design. By default, police forces should avoid attending overdose situations; especially in regions where law-‐enforcement approaches to drug use are more expressive.
• By routine, the ambulance should take the person who overdosed to medical facilities,
not only with the intent of monitoring him/her in the following hours, but also to provide opportunistic interventions. These include: deliver overdose information and promote approximation to health services. Emergency crews are vital to encourage people to accept this form of transportation.
protocols with outreach teams and other services within the community must be activated, to offer the necessary support and monitoring.
• Emergency devices should carry written information about overdose prevention and
response, ready to be delivered to overdose witnesses.
Overdose Prevention, Recognition and Response: training PUD, families/social network and other bystanders
• Overdose prevention programs aimed at PUD and their families must be implemented
and extended. Naloxone provision is an important resource, but its absence should not hinder the implementation of these programs.
• Network approaches that take into account the group dynamics and the ties between
PUD, should be increasingly considered, in order to optimize the training outputs. Instead of selecting “random” PUD to participate in training programs, a “snow-‐ball” selection based on the users’ relationships can be useful to promote motivation and increase the chances of trained users being with each-‐other.
• Harm reduction services should be perceived as suitable devices to host take-‐home
naloxone programs, since they have already established a proximal relationship with PUD and have frequent access to hard-‐to-‐reach PUD. Many times they also have updated information on consumption trends, overdose witnesses discourses, and emergency responses procedures.
• The dissemination of messages on overdose prevention and response should be a vital
part of the outreach teams’ routine work. This should include information about how to call emergency services, providing the right information.
• Implement overdose prevention training to inmates, as well as take-‐home naloxone
programs. They should be provided not only in the release moment, but also within the sentence period (i.e. distribution of naloxone kits among inmates).
Recommendation for Research
Naloxone Provision
• Investments on the assessment of intranasal naloxone efficacy and cost-‐effectiveness
should also be encouraged. Since this modality has some advantages -‐ namely in terms of making the administration easier to bystanders and in the decrease of minimal risks of unsafe administration – the tools to reduce manufacturing costs should be funded.
Professionals managing overdoses: training and intervention
• Investigate the knowledge on overdose prevention, recognition and response of
medical and non-‐medical personnel who frequently work alongside PUD, due to the scarce literature on this field.
• The impact of interventions on overdose prevention delivered to PUD in custody must
be assessed, since the empirical literature on the topic is incipient.
• Since few is known about the role of emergency lines operators in managing overdose
situations (instructions, security, quickness), studies on this topic must be promoted. This is particularly relevant, considering that those are frequently the first help platform.
• Close links with researchers and emergency services (e.g. ambulances) should be
established, in order to allow the collection and analysis of data concerning overdose episodes.
Overdose Prevention, Recognition and Response: training PUD, families/social network and other bystanders
• More research to differentiate risk and protective factors for both slow and
immediate onset of overdose should be encouraged. In this case, the contextual factors (like the witnesses role) are crucial, since not consuming alone is a limited strategy in cases of slow onset.
Recommendation for Policy
Naloxone Provision
• Governments should assume a more expressive role in the negotiation with naloxone
manufacturers, in order to promote the prices’ dropping and avoid the increasing demand.
Professionals managing overdoses: training and intervention
• The professionalization of technicians working in the drugs field must be presented as
a way to establish a learning curriculum and a way to standardize training, with mandatory contents on overdose prevention.
• The curriculum of academies’ training programs for law enforcement staff must
include modules on awareness, stigma on drug use and drug deaths, as well as the fundamentals of the harm reduction approach.
Overdose Prevention, Recognition and Response: training PUD, families/social network and other bystanders
• Activities concerning overdose prevention and response training should be included in
the contracts with services that work with drug users.
• Governments should find solutions to unlock the positive impact of naloxone
administration and provision by bystanders. Models of “standing order” prescription or prescription free (as in Italy) for naloxone provision should be considered.
• Naloxone provision should be implemented in pharmacies, in resemblance to what is
done in Italy, and to what is done in some countries regarding OST and NEP. These countries can capitalize on the already existing network, with pharmacies providing other harm reduction measures.