Overdose prevention with

naloxone nasal spray

Desiree Madah-Amiri, PhD

Norwegian Centre for Addiction Research

LAR conference, October 2018

Naloxone

• Antidote to an opioid overdose

• Take-home naloxone

– administered before ambulance arrives

• Training

– Prevention, recognition, response

Take-home naloxone in Norway

National overdose prevention strategy in 2014

– Pilot in Oslo & Bergen

– Funding provided

– Prescription-free

– Intranasal device

Expansion

15 new in 2018

Over 29 municipalities

75% coverage of OD locations

2018

Fredrikstad

Bodø

Tromsø

Skien

Porsgrund

Tønsberg

Arendal

2017

Drammen

Asker

Stavanger

Sandnes

Trondheim

2016

Oslo

Bergen

2014

Focus

• Anyone interested welcome to receive

naloxone

• Particular focus:

– People who inject drugs, especially those

outside of treatment

– People in treatment

– Upon release from prison

Staff training

Staff from existing low-threshold centers

• Train-the-trainer model

– Began with 3 central trainers

– >500 staff trained in first 18 months

– Currently over 1200

Madah-Amiri, Clausen, & Lobmaier. Drug alcohol depend. 2016

Distribution centers

100 different distribution sites throughout 29 municipalities

57

8 74

4 9

80

13

46

15

1

58

3 80

3

11

83

72

9

13

27

17

83

25

29

2014 2015 2016 2017

INITIAL AND REFILL NALOXONE DISTRIBUTED 2014-2017

Initial Refill Total

By first quarter 2018: 7000

Participant characteristics

• 85% were opioid users

• Most exhibited at least one known risk

factor for overdosing

• Nearly all (92%) had witnessed or

experienced an overdose

Madah-Amiri, Clausen, & Lobmaier, Drug Alcohol Depend, 2016

Coverage

• 497 substance users in 7 Norwegian cities

• Estimate proportion of those that had:

– Attended a naloxone training (58%)

– Currently possessed naloxone (43%)

– Had used naloxone (15%)

Madah-Amiri, Gjersing, & Clausen. Addiction, 2018

Goal: reach as many

people at risk as possible

Distribution goals (total and refills)

Reaching relevant groups

Coverage (possession

and use)

While successful, not sustainable…

…Naloxone had to modernize and adapt

E-learning

Online data collection

Instructional video

https://vimeo.com/276069515/78e83dd2bb

www.stoppoverdose.no

Acknowledgements Naloxone ninjas

Åse Merete Solheim (Bergen)

Øystein Bruun Ericson (Oslo)

Vibeke Kleveland (Trondheim)

Julie Høivik

SERAF

Philipp Lobmaier (MD, PhD)

Thomas Clausen (professor, PI)

Pharmaceutical industry (DnE)

Jenny Teigene and colleagues

Directorate of Health

Martin Blindheim

Ambulance services

Guttorm Brattebø (Bergen), Arne Skulberg (Oslo), and colleagues