A rapid assessment of take-home naloxone provision during COVID-19 in Europe

Rebecca McDonald; Desiree Eide; Katri Abel-Ollo; Lee Barnsdale; Ben Carter; Thomas Clausen; Ed Day; Francina Fonseca; Elin Holmén; Kirsten Horsburgh; Mike Kelleher; Martin Kåberg; Martin Ladenhauf; Andrew McAuley; Nicola Metrebian; Joanne Neale; Stephen Parkin; Kevin Ratcliffe; Chris Rintoul; Josie Smith; Viktorija Stifanoviciute; Marta Torrens; Henrik Thiesen; John Strang

doi:10.1016/j.drugpo.2022.103787

A rapid assessment of take-home naloxone provision during COVID-19 in Europe

Int J Drug Policy. 2022 Sep:107:103787. doi: 10.1016/j.drugpo.2022.103787. Epub 2022 Jul 1.

Authors

Rebecca McDonald¹, Desiree Eide², Katri Abel-Ollo³, Lee Barnsdale⁴, Ben Carter⁵, Thomas Clausen⁶, Ed Day⁷, Francina Fonseca⁸, Elin Holmén⁹, Kirsten Horsburgh¹⁰, Mike Kelleher¹¹, Martin Kåberg¹², Martin Ladenhauf¹³, Andrew McAuley¹⁴, Nicola Metrebian¹⁵, Joanne Neale¹⁵, Stephen Parkin¹⁵, Kevin Ratcliffe¹⁶, Chris Rintoul¹⁷, Josie Smith¹⁸, Viktorija Stifanoviciute¹⁹, Marta Torrens⁸, Henrik Thiesen²⁰, John Strang²¹

Affiliations

¹ National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Norway. Electronic address: Rebecca.mcdonald@medisin.uio.no.
² National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Norway.
³ Drug Abuse and Infectious Diseases Prevention Centre, National Institute for Health Development, Tallinn, Estonia.
⁴ Public Health Scotland, UK.
⁵ Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
⁶ Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Norway.
⁷ Institute for Mental Health, School of Psychology, University of Birmingham, UK.
⁸ Addiction Research Group, Neuroscience Research Program, Hospital del Mar Medical Research Institute, Barcelona, Spain.
⁹ Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden.
¹⁰ Scottish Drugs Forum, Glasgow, UK.
¹¹ South London and Maudsley NHS Foundation Trust, London, UK.
¹² Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Department of Medicine, Division of Infectious Diseases, Karolinska Institute, Stockholm, Sweden.
¹³ Caritas Kontaktladen und Streetwork im Drogenbereich, Graz, Austria.
¹⁴ Public Health Scotland, UK; School of Health and Life Sciences, Glasgow Caledonian University, UK.
¹⁵ National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
¹⁶ Change Grow Live, Birmingham, UK.
¹⁷ Cranstoun, Esher, UK.
¹⁸ Substance Misuse Programme, Public Health Wales, Cardiff, UK.
¹⁹ Drug, Tobacco and Alcohol Control Department, Lithuania.
²⁰ Health Team for the Homeless, Center for Marginalized Adults and Families, Copenhagen City Social Services, Denmark.
²¹ National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK.

Abstract

Background: In March 2020, the World Health Organization declared COVID-19 a global pandemic. In the following weeks, most European countries implemented national lockdowns to mitigate viral spread. Services for people who use drugs had to quickly revise their operating procedures to rearrange service provision while adhering to lockdown requirements. Given the scarcity of literature published on overdose prevention during COVID-19 in Europe, we aimed to examine how these changes to service provision affected take-home naloxone (THN) programmes and naloxone availability across Europe.

Methods: Between November 2020 and January 2021, we conducted a rapid assessment with country experts from European countries that provide THN. We sent country experts a template to report monthly THN distribution data (January 1, 2019-October 31, 2020) and a structured 6-item survey for completion.

Results: Responses were received from 14 of the 15 European countries with THN provision of which 11 participated in the rapid assessment: Austria, Denmark, England, Estonia, Lithuania, Northern Ireland, Norway, Scotland, Spain (Catalonia only), Sweden, and Wales. All reported reduced organisational capacity during COVID-19, and some put into place a range of novel approaches to manage the restrictions on face-to-face service provision. In six countries, the introduction of programme innovation occurred alongside the publication of government guidelines recommending increased THN provision during COVID-19. Eight of the eleven participating countries managed to maintain 2019-level monthly THN distribution rates or even increase provision during the pandemic.

Conclusion: Through programme innovation supported by public guidelines, many European THN programmes managed to ensure stable or even increased THN provision during the pandemic, despite social distancing and stay-at-home orders affecting client mobility.

Keywords: Coronavirus; Harm reduction; Heroin; Opiate; Opioid; Overdose.

MeSH terms

COVID-19*
Communicable Disease Control
Drug Overdose* / drug therapy
Drug Overdose* / epidemiology
Drug Overdose* / prevention & control
Humans
Naloxone / therapeutic use
Narcotic Antagonists / therapeutic use
Opioid-Related Disorders* / drug therapy

Substances

Narcotic Antagonists
Naloxone