title: Engagement in a National Naloxone Programme among people who inject drugs.
abstract: BACKGROUND
  Availability of the opioid antagonist naloxone for lay administration has grown substantially since first proposed in 1996. Gaps remain, though, in our understanding of how people who inject drugs (PWID) engage with naloxone programmes over time.
  
  
  OBJECTIVE
  This paper aimed to address three specific evidence gaps: the extent of naloxone supply to PWID; supply-source (community or prisons); and the carriage of naloxone among PWID.
  
  
  METHODS
  Analysis of Scotland's Needle Exchange Surveillance Initiative (NESI) responses in 2011-2012 and 2013-2014 was undertaken with a specific focus on the extent of Scotland's naloxone supply to PWID; including by source (community or prisons); and on the carriage of naloxone. Differences in responses between the two surveys were measured using Chi-square tests together with 95% confidence intervals for rate-differences over time.
  
  
  RESULTS
  The proportion of NESI participants who reported that they had been prescribed naloxone within the last year increased significantly from 8% (175/2146; 95% CI: 7-9%) in 2011-2012 to 32% (745/2331; 95% CI: 30% to 34%) in 2013-2014. In contrast, the proportion of NESI participants who carried naloxone with them on the day they were interviewed decreased significantly from 16% (27/169; 95% CI: 10% to 22%) in 2011-2012 to 5% (39/741; 95% CI: 4% to 7%) in 2013-2014.
  
  
  CONCLUSIONS
  The supply of naloxone to PWID has increased significantly since the introduction of a National Naloxone Programme in Scotland in January 2011. In contrast, naloxone carriage is low and decreased between the two NESI surveys; this area requires further investigation.
authors.affiliation: Health Protection Scotland, Meridian Court, Cadogan Street, Glasgow G2 6QE, UK; Institute for Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK. Electronic address: andrew.mcauley@nhs.net.
authors.forename: Andrew
authors.initials: A
authors.lastname: McAuley
authors.affiliation: School of Media, Culture and Society, University of the West of Scotland, Paisley PA1 2BE, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Munro
authors.affiliation: MRC Biostatistics Unit, Cambridge CB2 0SR, UK; Department of Mathematics and Statistics, Strathclyde University, Glasgow G1 1XH, UK.
authors.forename: Sheila M
authors.initials: SM
authors.lastname: Bird
authors.affiliation: Health Protection Scotland, Meridian Court, Cadogan Street, Glasgow G2 6QE, UK; Institute for Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK.
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Hutchinson
authors.affiliation: Health Protection Scotland, Meridian Court, Cadogan Street, Glasgow G2 6QE, UK; Institute for Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Goldberg
authors.affiliation: School of Media, Culture and Society, University of the West of Scotland, Paisley PA1 2BE, UK.
authors.forename: Avril
authors.initials: A
authors.lastname: Taylor
mesh_terms: D055030:Drug Users / Q000523:psychology*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009270:Naloxone / Q000600:supply & distribution* / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000600:supply & distribution* / Q000627:therapeutic use; D011159:Population Surveillance; D011330:Prisons; D012606:Scotland / Q000453:epidemiology; D012646:Self Administration / Q000523:psychology / Q000706:statistics & numerical data; D015819:Substance Abuse, Intravenous / Q000188:drug therapy / Q000523:psychology*; D011795:Surveys and Questionnaires
chemical_list: D009292:Narcotic Antagonists; D009270:Naloxone
keywords: Injecting; Naloxone; Opioid; Overdose; PWID; Prison