Intended for healthcare professionals


Take-home emergency naloxone to prevent deaths from heroin overdose

BMJ 2014; 349 doi: (Published 04 November 2014) Cite this as: BMJ 2014;349:g6580
  1. John Strang, professor1,
  2. Sheila M Bird, professor 2,
  3. Paul Dietze, professor3,
  4. Gilberto Gerra, chief4,
  5. A Thomas McLellan, chairman of the board5
  1. 1National Addiction Centre (Institute of Psychiatry and The Maudsley), King’s College London, London SE5 8AF, UK
  2. 2MRC Biostatistics Unit, Cambridge CB2 0SR, UK
  3. 3Burnet Institute, Melbourne, Australia
  4. 4Drug Prevention and Health Branch, United Nations Office on Drugs and Crime, Vienna, Austria
  5. 5Treatment Research Institute, Philadelphia, PA 19106, USA
  1. Correspondence to: J Strang john.strang{at}

Time to save lives

A paradigm shift is occurring in the treatment of heroin overdose. On 5 November the World Health Organization launched guidelines on the community management of heroin and opioid overdose and emergency administration of naloxone by people who are not medically trained.1 Historically, naloxone has been used only in hospitals and by ambulance workers to reverse the effects of an opioid overdose. Today, several countries are providing emergency naloxone to patients, their families, and other potential non-medical first responders.

This is important because these overdoses contribute substantially to drug related deaths worldwide, with an estimated 69 000 people dying from opioid overdose each year.1 Of nearly 3000 drug related deaths registered in England and Wales in 2013, more than half (56%) involved opioids.2 Last month Scotland (the first country to introduce a national programme to provide naloxone) released results from the first three years of its naloxone programme.3 The proportion of deaths from opioid overdose among people just released from prison (a particularly high risk group) was down substantially from 9.8% (193/1970) in 2006-10 to 6.3% (76/1212) during 2011-13.4

Providing emergency naloxone to take home was first seriously mooted in 1996.5 Since then policy and practice implications have been explored, with studies of acceptability and feasibility, reports of implementation, and observational studies on the training of staff (medical, nursing and drug workers), at risk populations, family members, and non-medical personnel such as hostel workers and police officers (see web appendix for references). Several countries …

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