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

In March 2020, COVID-19 was declared a global pandemic. In the following weeks, national lockdowns were implemented in European countries to mitigate viral spread. Addictions services had to quickly revise operating procedures for service provision while adhering to lockdown requirements. We thus aimed to examine:

• How these changes affected take-home naloxone (THN) availability in Europe
• What strategies THN programs implemented to maintain provision

We conducted a rapid assessment with stakeholders from European countries that provide THN. Rapid assessments are considered suitable for undertaking pragmatic research when only preliminary data exist. We sent national stakeholders a template to report monthly THN distribution data for the duration of the study period (January 1, 2019-October 31, 2020) and a structured 6-item questionnaire for completion.

Responses were received from 14 of the 15 European countries with THN provision of whom 11 participated in the rapid assessment. Eight of the eleven participating countries managed to maintain 2019-level monthly THN distribution rates or even increase provision during the pandemic. THN programs in six European countries increased the number of kits distributed per client encounter, with some countries also piloting novel approaches to THN provision (i.e., postal delivery, opt-out co-prescription, street outreach). In six countries, the introduction of such program innovations followed the publication of government guidelines recommending increased THN provision during COVID-19.

Through program innovation supported by national guidelines, most European THN programs managed to ensure stable or even increased THN provision during the pandemic, despite social distancing and stay-at-home orders affecting client mobility.