Seven years with take-home naloxone for overdose prevention in Norway: who are the first responders and how do they perform?

In 2014 the Norwegian government launched a large-scale take-home naloxone (THN) program to reduce overdose (OD) mortality. OD prevention training with THN was a cooperation between existing low threshold services, the Ministry of Health and the University. During the last 7 years, over 15000 naloxone kits were distributed to people who use drugs (PWUD) and their peers. The aim of this study is to describe characteristics among persons trained to receive THN and to explore factors associated with returning for refill. Further, we describe how they performed in an overdose situation and which actions were taken during the rescue.

This is a prospective cohort study of individuals who received THN and overdose prevention training in Norway from 2014-2021. Descriptive characteristics were collected at the first training. When returning for refill, participants reported on their previous naloxone use. In a multivariable logistic regression model, gender, age, opioid use history, benzodiazepine use, injecting, history of personal or witnessed overdose were included.

Between June 2014 and April 2021 3527 individuals voluntarily enrolled for this study. Most participants reported either current or previous opioid use (n= 2733, 77.5%), most were male (62.9%). Mean age was 39 years old. Those who returned for refill reported more frequently on common overdose risk factors such as injecting (OR= 1.54, 95% CI=1.25, 1.89, p< 0.001) and self-experienced overdoses (OR=1.33, 95% CI=1.05,1.69, p=0.02). There were reports of 1282 naloxone administrations. The rescuers reported successful reversals 96.5% (n=1202) of the time.

This study found that those who returned for THN refills reported personal risk factors for overdosing. The results show that PWUD are a suitable target group for THN-programs, as they seem to be positioned both to reverse the overdose, but also given their personal risk factors for overdosing, may benefit from the overdose prevention education given during THN training.