title: Effectiveness of Scotland's National Naloxone Programme for reducing opioid-related deaths: a before (2006-10) versus after (2011-13) comparison.
abstract: OBJECTIVE
  To assess the effectiveness for Scotland's National Naloxone Programme (NNP) by comparison between 2006-10 (before) and 2011-13 (after NNP started in January 2011) and to assess cost-effectiveness.
  
  
  METHODS
  This was a pre-post evaluation of a national policy. Cost-effectiveness was assessed by prescription costs against life-years gained per opioid-related death (ORD) averted.
  
  
  METHODS
  Scotland, in community settings and all prisons.
  
  
  METHODS
  Brief training and standardized naloxone supply became available to individuals at risk of opioid overdose.
  
  
  METHODS
  ORDs as identified by National Records of Scotland. Look-back determined the proportion of ORDs who, in the 4 weeks before ORD, had been (i) released from prison (primary outcome) and (ii) released from prison or discharged from hospital (secondary). We report 95% confidence intervals for effectiveness in reducing the primary (and secondary) outcome in 2011-13 versus 2006-10. Prescription costs were assessed against 1 or 10 life-years gained per averted ORD.
  
  
  RESULTS
  In 2006-10, 9.8% of ORDs (193 of 1970) were in people released from prison within 4 weeks of death, whereas only 6.3% of ORDs in 2011-13 followed prison release (76 of 1212, P < 0.001; this represented a difference of 3.5% [95% confidence interval (CI) = 1.6-5.4%)]. This reduction in the proportion of prison release ORDs translates into 42 fewer prison release ORDs (95% CI = 19-65) during 2011-13, when 12,000 naloxone kits were issued at current prescription cost of £225,000. Scotland's secondary outcome reduced from 19.0 to 14.9%, a difference of 4.1% (95% CI = 1.4-6.7%).
  
  
  CONCLUSIONS
  Scotland's National Naloxone Programme, which started in 2011, was associated with a 36% reduction in the proportion of opioid-related deaths that occurred in the 4 weeks following release from prison.
authors.affiliation: MRC Biostatistics Unit, Cambridge, UK.|Department of Mathematics and Statistics, Strathclyde University, Glasgow, UK.
authors.forename: Sheila M
authors.initials: SM
authors.lastname: Bird
authors.affiliation: NHS Health Scotland, Public Health Science Directorate, Glasgow, UK.|Institute for Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: McAuley
authors.affiliation: Emergency Department, Western Infirmary, Glasgow, UK.
authors.forename: Samantha
authors.initials: S
authors.lastname: Perry
authors.affiliation: Addiction Services for NHS Greater Glasgow and Clyde, Possilpark Health and Care Centre, Glasgow, UK.
authors.forename: Carole
authors.initials: C
authors.lastname: Hunter
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000191:economics / Q000506:poisoning*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000191:economics / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000191:economics / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000191:economics / Q000401:mortality / Q000534:rehabilitation*; D011329:Prisoners; D012606:Scotland / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D009270:Naloxone
keywords: Before/after policy evaluation; causality; effectiveness; national naloxone programme; opioid-related deaths; prison release opioid-related deaths; statistical power; take-home naloxone