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These datasets underpin the analysis presented in the agency's work. Most data may be viewed interactively on screen and downloaded in Excel format. All countries. Topics A-Z. The content in this section is aimed at anyone involved in planning, implementing or making decisions about health and social responses. Best practice. We have developed a systemic approach that brings together the human networks, processes and scientific tools necessary for collecting, analysing and reporting on the many aspects of the European drugs phenomenon. Explore our wide range of publications, videos and infographics on the drugs problem and how Europe is responding to it. All publications. More events. More news. We are your source of drug-related expertise in Europe. We prepare and share independent, scientifically validated knowledge, alerts and recommendations. About the EUDA. Drug overdose continues to be the main cause of death among problem drug users. Heroin or other opioids — often consumed alongside other central nervous system depressants such as benzodiazepines and alcohol — are present in the majority of reported fatal overdoses 1. Overdose is common among opioid users: many of them have experienced a non-fatal overdose and most have witnessed one. Death from opioid overdose is caused primarily by respiratory depression leading to cardiac arrest. Opioid overdose deaths can be prevented through timely administration of naloxone, a potent opioid antagonist drug that rapidly reverses the effects of opioid analgesics by binding to the opioid receptors in the central nervous system see Spotlight: Naloxone. Because of its effectiveness, naloxone is used by emergency personnel worldwide 2. Naloxone is a competitive opioid antagonist that can rapidly reverse the respiratory depression induced by heroin and other opioids. Therefore, it may be used as an antagonist drug to reverse opioid effects and opioid-related overdose. Naloxone is used worldwide in medical emergencies to reverse respiratory depression caused by opioid overdose. It has no effect on non-opioid drug overdoses, no dependency potential and a high safety margin. Discovered and patented at the beginning of the s, the US Food and Drug Administration FDA approved the first naloxone solution for intravenous, intramuscular and subcutaneous injection in The World Health Organization WHO added naloxone to its model list of essential medicines in , and injectable naloxone formulations have been off-patent since The use of naloxone by laypeople in emergency situations can be facilitated by formulations for nasal administration. France piloted a nasal naloxone spray in and later introduced it for distribution through low-threshold agencies. A nasal spray was approved in by the European Commission for EU-wide marketing and this medication has been introduced in several European countries since early These deaths generally occur shortly after the consumption of the substance and are commonly referred to as overdoses or poisonings. Many of those who die from opioid overdose are not alone at the time of death, suggesting that an early intervention, such as the administration of naloxone, can prevent opioid-induced deaths. However, many people who overdose fail to receive proper medical attention because their peers and other witnesses — often other drug users — do not recognise the seriousness of the situation, delay calling or do not call emergency services for fear of involving the police and legal repercussions, and do not have access to naloxone. They aim to make naloxone more readily available in places where overdoses might occur. Video: Take-home naloxone programmes in Europe — overdose prevention. The idea behind THN programmes is to expand the availability of naloxone — a medication that was traditionally available and administered only by emergency response personnel — to opioid-using peers, family members and other trained laypeople. THN programmes can also target other potential first responders to an overdose, such as frontline services that interact with opioid users including healthcare providers, staff in homeless shelters and police and prison officers. As part of these programmes, trainees learn how to correctly recognise and respond to an overdose, including administration of naloxone, before the arrival of emergency medical help. The first community-based naloxone projects in the United States and Europe started in the s Strang and McDonald, In the past 10 years they were expanded and scaled up in different European countries. Given the dramatic increases in fatal opioid overdoses over the past decade in the United States and Canada, federal, state and local governments in these countries have recently prioritised increased access to naloxone and overdose education. A variety of overdose prevention and training projects, which distribute naloxone as part of rescue kits at community-based health services to people at risk and others likely to witness an overdose, emerged in Europe in the s. Historically, the first initiatives in Europe were linked to opioid overdose death epidemics in the s and were driven by pioneer doctors in drugs services in Italy, Germany and the United Kingdom who started training non-medical staff in the management of suspected opioid overdose and giving out naloxone. Naloxone initiatives in Europe were small and remained on a local scale until Scotland and Wales launched their nationwide programmes in Today, larger regional or national THN programmes also exist in other countries with high rates of drug-related deaths, namely in Estonia, Denmark, Sweden and Norway. The timeline below illustrates the main developments. Timeline: Implementation of THN programmes United States: FDA licenses 0. Naloxone enters clinical practice in Europe in subsequent years. Italy: Experimental distribution of naloxone by doctors at public drug services in Piemont and Lazio regions. Notion of making naloxone more broadly available is mooted at International Harm Reduction Conference. Italy: Naloxone provision reported in Rome and Naples. First reported use of intranasal naloxone for overdose reversal Loimer et al. Italy: Naloxone provision continues to extend to further cities. Italy: Ministry of Health officially reclassifies naloxone as an over-the-counter medicine. Germany: Start of overdose response training and naloxone distribution in Berlin. First published report on THN distribution in peer-reviewed journal Dettmer et al. United Kingdom: Legal status of naloxone is changed to permit emergency administration of naloxone by any member of the general public Schedule 7 of the Medicines Act. United Kingdom: Scottish Lord Advocate issues guidelines enabling drug services to stock and supply naloxone. WHO Guidelines for the community management of opioid overdose published. Norway: THN programme using purpose-built atomiser for intranasal administration begins. Germany: THN pilot in Frankfurt starts. United Kingdom: Amendment to Human Medicines Regulation allows drug treatment services to provide naloxone without prescription as a life-saving precautionary measure. Estonia: Naloxone provision is extended to prisoners. France: National Commission on narcotics and psychotropic substances allows piloting of nasal naloxone spray 0. United States: Commercial launch of nasal naloxone in February France: National study of nasal naloxone for newly released inmates and drug users after withdrawal. Lithuania: Naloxone provision programme launched at drug treatment facility in Vilnius. France: National regulatory authority approves naloxone nasal spray for emergency treatment of opioid overdoses; low-threshold harm reduction centres now also allowed to dispense nasal naloxone. EU: European Commission authorises the first intranasal naloxone spray 1. United States: Surgeon General issues an Advisory that calls for more people to get access to naloxone. EU: Nasal naloxone spray commercially launched in individual European countries. Austria: THN projects launched in the Steiermark region. Sweden: National Board of Health and Welfare publishes national guidelines for naloxone programmes. Implementationof naloxone programmes by health care services strongly recommended. National overdose response plan includes naloxone. France: Since June , naloxone for IM injection in a pre-filled syringe can be obtained from pharmacies without prescription. The successful implementation of THN programmes involves widespread distribution of the medication. While the low-threshold provision of naloxone is a low-cost approach that can empower healthcare workers and people who use drugs to save lives WHO, , THN programmes have faced practical and regulatory hurdles in most countries. Although the medication naloxone is included in the pharmacopoeia of all European countries, available formulations are destined for parenteral injecting use and a medical prescription is, in general, considered a requirement. THN programmes therefore have to be managed by a physician or be implemented under medical supervision, a requirement that limits their widespread distribution. However, a number of strategies have been developed to allow non-medical personnel to receive and administer injectable naloxone and to enable the distribution of the medication to the homes of potential bystanders. Under its national naloxone programme, Norway repealed prescription requirements locally in the cities in which the programme is implemented and for the duration of the programme. To solve the bottleneck of free of charge naloxone dissemination, France enlarged the range of providers that can give out naloxone, namely extending them from only hospitals to drug treatment centres and community-based harm reduction agencies. In these settings, a prescription is not required. Since June naloxone in pre-filled syringes can be obtained without prescription in pharmacies. While naloxone remains a prescription drug and cannot be sold over the counter, it can lawfully be administered as a life-saving measure by any member of the public. Since , national legislation has allowed staff at drugs agencies in the United Kingdom to give out naloxone without a prescription to individuals who may need it to save a life. Various solutions have been found to facilitate access to naloxone when no medical doctor is available to prescribe it. In Ireland, an amendment to the Prescription Regulations was made in October to broaden access to naloxone by exempting it from prescription control in a specific establishment and by a person who has certified and accredited training. There are some limitations, including that training must be registered and maintained and that families or service providers cannot hold stock. In Denmark, where supervision during administration is required, regulations were amended to allow those trained by medical personnel to supervise naloxone use, as long as they are registered and provide a report at refill. To make naloxone more readily available, patients in opioid dependence treatment in Germany have, since , been able to receive a prescription for the medication, which allows costs to be reimbursed by health insurance. The prescribing doctor is, however, required to provide patients with full information about the administration and side effects of naloxone and has an obligation to keep detailed records. Mail order has been appointed as an alternative in the United States, where many states make naloxone available over the counter in certain shops. The internet and the postal system could be a fast and efficient way to get naloxone to those who need it, although there are remaining regulatory challenges, as it is still technically a prescription drug and, therefore, mailing it may be illegal in some places. The FDA is moving to change its status nationally. The United States and Canada are experiencing the largest opioid death epidemics in their history. Despite widespread media attention and repeated public health alerts, fatal overdoses continue to rise. The latest data from the United States Scholl et al. In Canada, opioid overdose deaths had risen to 8 in Seth et al. In response to this significant increase, special efforts to simplify and improve naloxone availability through pharmacy dispensing have recently been made. In the United States, many states have changed their policies and legislation. For example, in , 44 states permitted naloxone to be prescribed for administration to a person with whom the prescriber does not have a prescriber-patient relationship third-party prescribing and state laws authorise the lay administration of naloxone Prescription Drug Abuse Policy System, Naloxone Overdose Prevention Laws, Pharmacy naloxone dispensing is strongly encouraged Davis and Carr, and most states have laws designed to protect healthcare professionals who prescribe and dispense naloxone from civil and criminal liabilities, as well as Good Samaritan laws to protect people who administer naloxone or call for help during an opioid overdose emergency. Numerous communities in the United States are also training non-medical first responders, such as police and fire-fighters, to administer naloxone in cases of suspected overdose Davis et al. In Canada, the prescription status of naloxone was changed in March to increase access to naloxone. Pharmacies are now able to dispense nasal naloxone to those in need and emergency responders are able to use it without a prescription. Top of page. Research on community-based programmes has reaffirmed that drug users, their peers and other potential first responders are both ready and able to be trained to recognise overdoses and to administer naloxone correctly Clark et al. A systematic review of the effectiveness of take-home naloxone programmes found that overdose mortality was reduced through programmes combining naloxone provision with overdose education and first aid training EMCDDA, Table 1 summarises the main findings of the published literature reviews on this topic. Do opioid overdose prevention programmes OOPPs with naloxone distribution reduce fatal and non-fatal overdose rates among participants? Are OOPPs effective at increasing non-medical bystander knowledge of prevention and risk factors, and recognition of opioid overdose? Non-medical people trained in OOPPs can administer naloxone effectively and apply additional strategies. The appropriateness of responses to overdose varies significantly A standardised OOPP tool would allow for consistent measurement across studies. To assess the effect of take-home emergency naloxone and educational intervention on knowledge improvement, naloxone use, management of overdoses witnessed and death as a result of overdose. Educational and training interventions with naloxone provision for opioid-dependent patients and their peers is effective in improving knowledge and creating positive attitudes towards naloxone. Effectiveness of bystander naloxone administration and overdose education programs: a meta-analysis. To synthesise the effect estimates of studies reporting quantitative outcomes and reports on the effectiveness of naloxone administration by bystanders in reversing overdoses. To assess whether overdose response training increases knowledge of overdose recognition and management. Nine studies four on bystander naloxone administration and five on analysis of training effectiveness. Are take-home naloxone programmes effective? Systematic review utilising application of the Bradford Hill criteria. With the increase in the implementation and diffusion of THN programmes worldwide, albeit mainly as pilot schemes and without formal evaluation, real-life evidence on their effectiveness is growing. In the United States, where implementation is most advanced and more than laypeople have been trained by community-based organisations, 26 overdoses were reversed by trained THN participants in the first 8 years Wheeler et al. The model showed a high level of cost-effectiveness in the UK context Langham et al. Populations with an elevated risk of overdose, such as recently released prisoners, may particularly benefit from better naloxone availability. The effects of different levels of regulations as regards naloxone access were studied in the United States Abouk et al. This study found that only laws allowing the widest access, through direct dispensing by pharmacists, appeared to be useful in reducing opioid-related fatalities. In the United States and Canada, there has been a dramatic increase in the number of deaths due to illicit fentanyl. Fentanyl is a synthetic opioid that is lethal at much lower doses than other opioids and is significantly more potent by weight than heroin. The contamination of illegal drugs, such as heroin and cocaine, with fentanyl makes it difficult for even the most experienced drug user to anticipate and mitigate the likelihood of overdose. A Centers for Disease Control and Prevention CDC -funded surveillance programme in 10 US states showed that, in seven of the states, more than half of all opioid overdose deaths tested positive for fentanyl or fentanyl analogues e. Based on this programme, the CDC alerted clinicians and advised them that patients being treated for an overdose may require the administration of multiple doses of naloxone. Further details can be found in the country profiles. Availability and scope of THN programmes in Europe. In , the legal framework for establishing such programmes had been created in Cyprus and preparatory steps for introducing naloxone were taken in Finland. Injectable naloxone solution is a cheap, generic medication and is available in different strengths 0. Emergency response teams and hospital emergency departments frequently give naloxone by intramuscular injection, which allows them to rapidly administer naloxone when intravenous access is not readily available. In , the first nasal naloxone spray delivering 4 mg of naloxone per dose 0. Nasal sprays ease the administration of naloxone even further and improve safety avoiding potential needle-stick injuries when treating a patient population at high risk of blood-borne illnesses. Research on the bioavailability of concentrated naloxone nasal spray showed that it is suitable for emergency administration in the community, where rapid restoration of respiratory function is essential for reversing opioid overdose Mundin et al. Variable: EUR per pack. Different numbers of atomizers included in the packages, each containing one dose. No assembly required Needle-less delivery Nyxoid: pan-European marketing authorisation Nalscue: marketing authorisation in France Narcan: approved in the United States and Canada; not available in Europe. France was the first country in Europe to license, in , a nasal naloxone spray with a strength of 0. Authorised initially in the context of a trial, the product received national marketing authorisation in In the same year, naloxone was listed among medicinal products that may be dispensed in hospitals, drug treatment centres and public harm reduction facilities in France without prescription. The European Commission authorised a naloxone nasal spray of 1. Apart from the medication and application device, naloxone emergency kits typically contain first-aid instructions and gloves, often a protective face mask for the mouth-to-mouth ventilation technique and, in some cases, a copy of the prescription or another document certifying the rightful possession of the medication. According to the latest available data, the highest number of individuals have been trained in the Scottish national naloxone programme 23, , followed by Norway 10, , Catalonia 6, , Denmark 3, and Estonia 3, The total number of kits given out via take-home naloxone programmes in Scotland is 46,, and has reached around 25, in France, and 13, in Norway. In Italy, an estimated 15, vials of naloxone are distributed through drugs agencies on an annual basis. For more detail see country profiles and factsheets. At the time of writing, the price for single-dose ampoules of generic injectable naloxone varied between EUR 2 and EUR 3, resulting in a cost of between EUR 5 and EUR 10 per overdose kit, which typically contains two ampoules and syringes. Kits containing a syringe pre-filled with 2 ml of naloxone solution, providing up to five individual doses for use during one emergency were reported to cost between EUR 35 GBP 25 and EUR During the nasal naloxone trial in France the product came in a pack containing four nasal spray devices delivering 0. A price of EUR per pack, following the trial, was anticipated. A new nasal spray delivering 1. They have been updated in August Geographical coverage: Graz Steiermark Type: pilot project Setting: community Organiser: Caritas Kontaktladen Key dates : 2-year pilot project, starting November Target groups : people who use drugs PWUD People trained : 50 Nov August , the training is still ongoing Kits given out : about 70 Nov — Aug , because some of the first atomisers already expired. Target: kits. Completing the free of cost 1- to 1. Kits contain two single-dose atomisers, delivering 1. It has been documented that one training participant successfully reversed the opioid overdose of a friend by using the naloxone spray distributed in the pilot project. Training for staff members of specific facilities e. The constant and active promotion of the THN project and the training option is necessary to keep it present in the mind of the target group. In response to a surge in opioid overdose deaths in , the Danish Ministry of Health initiated an overdose prevention scheme including user-administered naloxone, based on the experiences of a take-home naloxone THN pilot project in Copenhagen in The scheme aims to reduce the number of potentially fatal poisonings and the injuries and adverse effects of non-fatal opioid overdoses through user-managed Naloxone combined with an educational programme. Training and hand-out of naloxone are aimed at people who use opioids, their relatives and others who are in contact with people who use drugs PWUD , for example police officers and staff at municipal drug facilities, other treatment institutions, shelters and drop-in centres. Expanding take-home naloxone trainings nationally, guidelines for opioid substitution treatment OST were amended to include the provision of naloxone training and in , the Copenhagen SundhedsTeam was appointed as national coordinating body for the implementation of naloxone trainings in municipal opioid substitution treatment OST clinics across Denmark. Over the period it is planned to train approximately local trainers in 66 municipalities as multipliers, who will then continue to deliver THN education, based on the model and training material delivered by the coordinator. Over the course of subsequent take-home naloxone projects, several naloxone products have been used, including injectable naloxone in pre-filled syringes with and without mucosal atomizer device; two different nasal products, which were not marketed in Denmark were used with special permission from the Danish Medicines Agency. Since a nasal naloxone spray was authorised in by the European Commission for the EU and became available in Denmark in , it has replaced the previously used nasal products. In Denmark, naloxone is a medicine that can only be prescribed by a medical doctor MD. Trained laypeople are allowed to administer naloxone to reverse an overdoses, while it remains the responsibility of the doctor to ensure proper training and continuous supervision. An in-depth course directly supervised by the coordinating MD ensures that trainers have a deeper understanding of overdose reversal and that they are able to pass that knowledge on to members of the community. Trainers who educate at OST clinics in Denmark receive a standardised 4-hour training course which fulfils the requirements for the MD to delegate naloxone according to the rules. Follow-up and quality assurance is carried out via a questionnaire that has to be filled in when the naloxone given out to training participants has been used for an overdose reversal. All training participants have to demonstrate practical knowledge in overdose reversal during the structured training and receive a signed participant card as proof of participation and competences. As the programme is currently set up in Denmark, the final responsibility for proper education and overdose reversal lies with the MD overseeing it. While it still remains a challenge that naloxone can only be provided on prescription, this requirement also provides the opportunity to follow-up on the training and the delivery of naloxone and monitor how the naloxone is used by the training participants, which is considered as an asset for the documentation of the project. The Danish THN programme faces many challenges in maintaining its continuity and guaranteeing its sustainability since it is implemented as project for limited periods of time, with lack of continuous governmental funding. The programme was launched in September and is carried out by healthcare providers rehabilitation and substitution treatment facilities mostly in cooperation with harm reduction services in the three Estonian counties where injecting drug use is most prevalent and as mobile service all over Estonia. Healthcare providers counsel people who use drugs and potential bystanders and give out naloxone kits to those who have completed the training. Naloxone is a prescription medication which can only be provided i. Counselling is repeated whenever the clients requires. Since June , naloxone kits are also distributed to prisoners on release. Naloxone kits given out by the programme contain nasal naloxone 1. In autumn , mobile harm reduction services were launched in Estonia and naloxone is part of the service package. Potential bystanders of overdose are only able to have access to naloxone when the prescription is correctly formalised, and they can only administer it in case of a medical emergency. There is a need for a more formal Good Samaritan law, exempting those who intervene from criminal liability. Healthcare providers and nurses often work together conducting the counselling, but only healthcare providers can prescribe naloxone. It would be an advantage to also allow nurses and non-medical staff to be involved in the distribution of the medication. Non-injectable naloxone, available since October , simplifies service delivery and may thus benefit the Estonian take-home naloxone programme by broadening it to include additional professional groups police and pharmacists for example. Naloxone is a medication that can be accessed without prescription. In October , nasal naloxone formulations were removed from list I of poisonous substances for human medicine and can since be provided without medical prescription. Consequently, dispensing does not require a medical prescription; however, naloxone is still a medication only available in pharmacies. In July , a temporary authorisation for a nasal naloxone spray 0. The study assessed the usefulness of nasal naloxone distribution among newly released inmates and among users after opioid withdrawal. It resulted in the granting of general marketing authorisation for the nasal spray product in , and the broadening of access to it in low-threshold agencies CAARUD since May The 2ml syringe includes 5 doses of 0,4 ml and comes with two needles. During the trial, the dispensing of nasal naloxone was limited to medical doctors practising in a CSAPA setting, in hospital addiction medicine departments, in emergency departments, or in any other departments in which an addiction liaison and treatment ELSA team operates and to those working in prison treatment units. Naloxone supply was exclusively restricted to pharmacists in charge of dispensing at hospital pharmacies and in treatment centers for addiction CSAPAs. In April , in the context of the lockdown related to the Covid epidemic the Ministry of Health published a reminder about the properties of naloxone, the pharmaceutical formulations available in France nasal spray and injectable , the delivery patterns and specific resources like the online training developed by the association SAFE. Two documents answering Frequently Asked Questions were created, the first one for drug users and the second one for health professionals. Geographical coverage: In , THN projects are conducted or starting in 19 cities, spread over seven of the 16 Federal states with a clear concentration in the south and west of Germany. Training in overdose emergency response including the provision of take-home naloxone to heroin users for community-based overdose management in Germany has its roots in the pioneering work of a Berlin-based NGO. The pilot scheme in provided trainings in emergency response for heroin users combined with the prescription of naloxone for trainees to take home for use in emergencies. In recent years, the provision of naloxone trainings has been scaled up, and the number of cities with trainings has risen from two in in Berlin and Frankfurt to 19 in As part of a state-funded project in Bavaria that includes a scientific research component, naloxone take home trainings also take place in prison. Since the beginning of , inmates can partake in a training shortly before they are released; naloxone is handed out on the day of release. Until November , 27 inmates had been trained in the use of naloxone, among them 13 women. All naloxone programmes in Germany consist of drug emergencies training in which first aid techniques, risks and signs of overdose as well information about the use and effects of naloxone are communicated and during which the application of the medication is trained. Emergency kits contain naloxone, disposable gloves, a protective tissue for mouth-to-mouth resuscitation, and information on emergency response. Two online resources are available to guide the implementation of drug emergency training and the distribution of naloxone to laypeople. In the light of an increasing number of drug-related deaths, the German drug commissioner advocated for an extended access of laypeople to naloxone 1. While numbers of drug-related deaths have stabilised in the past years, they remain high and opioids remain the major cause of drug-related deaths. Funded by the Bavarian Ministry of Health a scientific model project assessing the use of nasal naloxone spray in community-based overdose prevention 'BayTHN — Take-Home-Naloxon in Bayern' was launched in October The project is being implemented under the leadership of the University of Regensburg in cooperation with the Ludwig-Maximilian-University of Munich and the University of Bamberg. Various Bavarian addiction care facilities at the five locations Regensburg, Munich, Nuremberg, Ingolstadt and Augsburg are also involved. The Bavarian Ministry of Health is supporting the project until the end of the year with , euros. In the first 22 months of the project, 70 overdose reversals were achieved, using the naloxone provided by the project 2. Sustainability, in particular continuous funding, remains a problem for some of the projects. Additionally, naloxone remains a prescription-only medication. It can be given out in the context of THN programmes, provided patients are trained in its administration and know about the side effects. Some NGOs report problems related to finding a doctor willing to collaborate in the projects. Take-home naloxone can only be prescribed to an opioid dependent person, but the fact that - in case this person suffers an overdose - the administration of the medication will be made by another person to whom it was not prescribed, creates legal uncertainties. Initiatives calling for an exemption of naloxone from prescription requirements are underway. Pressemitteilung Nr. The first naloxone programme in Ireland was launched in as a Health Service Executive HSE Naloxone Demonstration Project in four locations, and expanded to a further three locations in Training is aimed at people who use drugs PWUD , and their peers; at staff of drugs and health services, and at outreach workers. An evaluation report covering the first two years of the pilot project documents that a total of kits were distributed and people trained. Training is delivered in a video-based session and further online resources are provided. The aim is to expand and achieve national coverage with the outcome of the existing programme. Availability of naloxone is still an issue, and the implementation of a reimbursement scheme is not completed. In , regulations were changed providing and exemption from the prescription requirement for people who had completed training and were registered as participants in the programme, however naloxone still cannot be stocked by peers or staff. Naloxone distribution in Italy started in the form of local initiatives in When naloxone was reclassified in as an over-the-counter drug, a wider range of harm reduction providers started distributing naloxone. Based on data covering , a survey conducted by experts from the umbrella organisation Forum Droghe in described the characteristics of current naloxone training and distribution. The main target group are people who use drugs PWUD and their peers, as well as harm reduction staff and outreach workers. Around 15 naloxone vials were reported to have been distributed in among more than 59 clients at 55 harm reduction service providers taking part in a survey. Naloxone kits contain an ampoule of injectable naloxone and a syringe. Several training materials have been produced Ronconi et al. Italy has been the first country in the European Union where naloxone is available without medical prescription. Nevertheless, naloxone cannot be publicly displayed in pharmacies, and a survey among harm reduction staff and clients confirms that pharmacies play only a very minor role in the distribution of naloxone in Italy. The project started in as a local pilot project at the main drug treatment centre in the Lithuanian capital, which then became the Republican Centre for Addictive Disorders RCAD. Since , on initiative of RCAD, all of its branches are included in the now regular programme. The 'Resolution on the naloxone provision in low-threshold services for the prevention of opioid overdose' adopted by the Minister of Health of the Republic of Lithuania at the end of aims at making naloxone more available by allowing the distribution of naloxone to people who use drugs PWUD and their family members. Distribution at three low-threshold agency started in as a pilot project and was extended to 5 cities after one year. Naloxone kits contain an ampoule with generic naloxone, a syringe set, first aid instructions and the emergency telephone number. They are distributed on prescription to patients on discharge from drug treatment after passing a training course on overdose management and naloxone use and to clients at low-threshold agencies after a consultation with a medical doctor. From , nasal naloxone kits will be available to police officers in Vilnius. Based on the above mentioned resolution, low-threshold agencies with cooperation contracts with medical centres were allowed to start naloxone distribution in the form of a pilot project. However, the requirement that only a medical doctor can prescribe and hand out the naloxone kit has limited the involvement of low threshold centers in naloxone provision. Funding of the take-home naloxone distribution also remains a problem. Currently, no funds are allocated for a regular programme of naloxone provision through low threshold agencies. A pilot project to address this is under development by the National Focal Point. Naloxone is currently only available through drug treatment centers or low-threshold agencies. To increase the availability of naloxone in other settings, a group of Vilnius Police officers, mainly working in the most problematic area of Vilnius, will receive overdose intervention training and will be equipped with nasal naloxone kits from September onwards. In , a pilot take-home naloxone THN project was introduced in Norway in the context of an overdose prevention campaign in Bergen and Oslo. The beneficiary groups are diverse: people who use drugs and their peers and next of kin; staff and outreach workers at drugs facilities and other potential bystanders of overdose, such as police and prison staff. In the first years of the project, the naloxone was given out in a pre-filled syringe. It was however applied instead of by injection as nasal spray, with the use of a commercially available mucosal atomisation device. Besides the two spray dispensers, the naloxone kit contains first aid instructions, a protective mask for mouth-to-mouth resuscitation, a carrier card and a manual. The naloxone project has expanded and since the start of the programme until April , a total of around 13 naloxone kits have been distributed. In the same period, 10 people have been trained, including both the people trained for the first time and repeatedly. Moreover, the Ministry of Health and Care Services has included the THN project as one of the responses in the new four-year overdose strategy Currently, 15 prisons give out naloxone kits to prisoners on release. In order to distribute the naloxone spray, the Norwegian drugs regulatory authority gave special permission to the project: as the medication is not provided by injection, no prescription is required to obtain it. Expansion to detox units and treatment facilities is planned for the future. There is an issue of price increase following regulatory approval. A waiver of need for individual prescription has been implemented. An electronic registry should be developed to identify those who overdose more often. Training on overdose risk factors, overdose emergency management and naloxone use takes place in drug treatment facilities, therapeutic communities, detox units, drug consumption rooms and other facilities of the network. Kits include a naloxone ampoule and syringe set, first aid instructions, infection prevention tools, such as swabs, gloves and a protective cloth for mouth-to-mouth resuscitation. Training and naloxone distribution takes place at low-threshold agencies, treatment centres and OST. Since the start of the project in until July , a total of 6 people had been trained in overdose response and 3 naloxone kits been distributed. The workshops are aimed at training multipliers who then spread their knowledge on different health issues among their peers, which exponentially increases the impact of the intervention. Abstinence-oriented services in Catalonia are less involved in the distribution of naloxone because they consider giving out naloxone kits to those in treatment to be contradictory. Some PWUD users are insufficiently aware of their overdose risk and unwilling to carry it. To expand the reach of the programme, financial incentives for drug users to attend the trainings should be provided. Training should also become more flexible, and involve more peers. A medical prescription continues to be required for treatment by emergency medical services, in harm reduction centres and drug consumption rooms DCRs. Naloxone is not available within therapeutic communities. The future aim of the Catalan THN is to expand to the prison setting, possibly using the nasal spray form of naloxone. IIn late and early , the Swedish National Board of Health and Welfare published national information packs on overdose risks and overdose prevention as well as national guidelines for naloxone programmes. The information packs were developed in collaboration with the Public Health Agency of Sweden and external experts and they address overdose risks and the use of naloxone. Separate versions are available directed at those using opioids and their relatives, and at professionals. These naloxone guidelines strongly recommend that healthcare services implement naloxone programmes. Several regulatory changes were made to increase the availability of naloxone to opioid users and in pre-hospital settings. Since the new regulations came into force, take-home naloxone programmes have been rapidly implemented and are in mid available in a majority of the regions. National data on these programmes are not yet available. It is planned to implement naloxone programmes also in prison. In , the legal status of naloxone changed to permit emergency administration of the medication by any member of the general public. THN pilot schemes in Scotland and Wales became national programmes in The predominant naloxone product used in the UK schemes is injectable naloxone delivered in a pre-filled syringe, but more recently nasal naloxone is also being used. Naloxone is able to be distributed by drug treatment services across the whole of the UK and without prescription, but data on kits distributed are not available for England or Northern Ireland. However, in order to make the medication available to those in need, an update to the Human Medicines Act made in enables drug services to supply naloxone without prescription. Thisregulation allows people working in or for drug treatment services to supply naloxone that their service has obtained to others, if it is being made available to save a life in an emergency. In February , the regulation was amended in order to widen the type of products containing naloxone hydrochloride that drug treatment services are able to supply to include naloxone hydrochloride that is for non-parenteral administration nasal naloxone for the purpose of saving life in an emergency. Abouk, R. Bird, S. Clark, A. Davis, C. Dettmer, K. Giglio, R. Loimer, N. McDonald, R. Minozzi, S. Mueller, S. Mundin, G. Rando, J. Scholl, L. Seth, P. National report: Apparent opioid-related deaths in Canada January to December Web Based Report. Wheeler, E. Williams, A. Homepage Quick links Quick links. GO Results hosted on duckduckgo. Main navigation Data Open related submenu Data. Latest data Prevalence of drug use Drug-induced deaths Infectious diseases Problem drug use Treatment demand Seizures of drugs Price, purity and potency. Drug use and prison Drug law offences Health and social responses Drug checking Hospital emergencies data Syringe residues data Wastewater analysis Data catalogue. Selected topics Alternatives to coercive sanctions Cannabis Cannabis policy Cocaine Darknet markets Drug checking Drug consumption facilities Drug markets Drug-related deaths Drug-related infectious diseases. Recently published Findings from a scoping literature…. Penalties at a glance. Frequently asked questions FAQ : drug…. FAQ: therapeutic use of psychedelic…. Viral hepatitis elimination barometer…. EU Drug Market: New psychoactive…. EU Drug Market: Drivers and facilitators. Statistical Bulletin home. Quick links Search news Subscribe newsletter for recent news Subscribe to news releases. Breadcrumb Home Publications Topic overviews Take-home naloxone — topic overview. Take-home naloxone — topic overview. Take-home naloxone. Introduction What is naloxone and why is it important? Spotlight: Naloxone Substance name : naloxone hydrochloride. Molecular formula: C19H21NO4 Naloxone is a competitive opioid antagonist that can rapidly reverse the respiratory depression induced by heroin and other opioids. Overview What are take-home naloxone programmes? Spotlight: Widening naloxone access in the United States and Canada The United States and Canada are experiencing the largest opioid death epidemics in their history. Evidence Research on community-based programmes has reaffirmed that drug users, their peers and other potential first responders are both ready and able to be trained to recognise overdoses and to administer naloxone correctly Clark et al. Do non-medical bystanders trained in OOPPs respond correctly to witnessed opioid overdoses? Systematic review utilising application of the Bradford Hill criteria To apply the Bradford Hill criteria to: describe the impact of THN provision on overdose-related mortality in opioid users assess the safety of THN provision by quantifying adverse events associated with naloxone administration 22 studies THN reduced deaths by overdose With the increase in the implementation and diffusion of THN programmes worldwide, albeit mainly as pilot schemes and without formal evaluation, real-life evidence on their effectiveness is growing. Spotlight: Fentanyl requires higher naloxone dosing In the United States and Canada, there has been a dramatic increase in the number of deaths due to illicit fentanyl. Country profiles. Challenges and solutions No training for partners, family members or close friends available yet. Download Factsheet. Short description In response to a surge in opioid overdose deaths in , the Danish Ministry of Health initiated an overdose prevention scheme including user-administered naloxone, based on the experiences of a take-home naloxone THN pilot project in Copenhagen in Challenges and solutions In Denmark, naloxone is a medicine that can only be prescribed by a medical doctor MD. Download factsheet. Short description Naloxone distribution in Italy started in the form of local initiatives in Challenges and solutions Italy has been the first country in the European Union where naloxone is available without medical prescription. Short description The project started in as a local pilot project at the main drug treatment centre in the Lithuanian capital, which then became the Republican Centre for Addictive Disorders RCAD. Challenges and solutions Based on the above mentioned resolution, low-threshold agencies with cooperation contracts with medical centres were allowed to start naloxone distribution in the form of a pilot project. Short description In , a pilot take-home naloxone THN project was introduced in Norway in the context of an overdose prevention campaign in Bergen and Oslo. Challenges and solutions In order to distribute the naloxone spray, the Norwegian drugs regulatory authority gave special permission to the project: as the medication is not provided by injection, no prescription is required to obtain it. Challenges and solutions Abstinence-oriented services in Catalonia are less involved in the distribution of naloxone because they consider giving out naloxone kits to those in treatment to be contradictory. Download factsheet Scotland Wales. A systematic review of community opioid overdose prevention and naloxone distribution programs. Non-medical people trained in OOPPs can administer naloxone effectively and apply additional strategies OOPPs may increase knowledge on prevention and the risk of overdoses The appropriateness of responses to overdose varies significantly A standardised OOPP tool would allow for consistent measurement across studies. Preventing fatal overdoses: a systematic review of the effectiveness of take-home naloxone. Educational and training interventions with provision of THN decrease overdose-related mortality Educational and training interventions with naloxone provision for opioid-dependent patients and their peers is effective in improving knowledge and creating positive attitudes towards naloxone. To review the literature on bystander and non-medical administration of naloxone To synthesise the effect estimates of studies reporting quantitative outcomes and reports on the effectiveness of naloxone administration by bystanders in reversing overdoses To assess whether overdose response training increases knowledge of overdose recognition and management. Lay administration of naloxone is both safe and effective Overdose prevention training should be implemented. To apply the Bradford Hill criteria to: describe the impact of THN provision on overdose-related mortality in opioid users assess the safety of THN provision by quantifying adverse events associated with naloxone administration. Short description The programme was launched in September and is carried out by healthcare providers rehabilitation and substitution treatment facilities mostly in cooperation with harm reduction services in the three Estonian counties where injecting drug use is most prevalent and as mobile service all over Estonia. Challenges and solutions Potential bystanders of overdose are only able to have access to naloxone when the prescription is correctly formalised, and they can only administer it in case of a medical emergency. Short description In October , nasal naloxone formulations were removed from list I of poisonous substances for human medicine and can since be provided without medical prescription. Challenges and solutions During the trial, the dispensing of nasal naloxone was limited to medical doctors practising in a CSAPA setting, in hospital addiction medicine departments, in emergency departments, or in any other departments in which an addiction liaison and treatment ELSA team operates and to those working in prison treatment units. Short description Training in overdose emergency response including the provision of take-home naloxone to heroin users for community-based overdose management in Germany has its roots in the pioneering work of a Berlin-based NGO. Challenges and solutions In the light of an increasing number of drug-related deaths, the German drug commissioner advocated for an extended access of laypeople to naloxone 1. Short description The first naloxone programme in Ireland was launched in as a Health Service Executive HSE Naloxone Demonstration Project in four locations, and expanded to a further three locations in Short description IIn late and early , the Swedish National Board of Health and Welfare published national information packs on overdose risks and overdose prevention as well as national guidelines for naloxone programmes.

Buying Drugs in Addis Ababa: A Quantitative Analysis

How can I buy cocaine online in Dushanbe

The remaining private pharmacies and druggist shops are to be nationalized with further extension of government control over the private sector of the economy. In we examined the utilization of private and government pharmacies in Addis Ababa by different socioeconomic groups. We found a distinct preference for government retailers, largely due to their lower drug prices and larger inventories. Due to the usual limitations of pharmacy based studies, particularly sampling bias, we recommended that population based studies of drug retailing and utilization be carried out Kloos et al. The objective of this study is to examine relationships between disease prevalence, disease perception, decision making in drug selection and geographic and socioeconomic accessibility of retailers in drug purchasing in Addis Ababa. This is a preview of subscription content, log in via an institution to check access. Institutional subscriptions. Unable to display preview. Download preview PDF. Arragie, Messele Toxicity of Kosso Hagenia abyssinica. Acute Toxicity in Mice. Ethiopian Medical Journal 84— Google Scholar. Bedassa, A. Brown, K. American Journal of Clinical Nutrition — Buschkens, W. Assen Netherlands : Van Gorcum. Thesis, Johns Hopkins University, Baltimore. Dodge, R. Ethiopian Medical Journal 19— Dotsenko, A. Dotsenko, ed. Addis Ababa: Artistic Printers. Freij, Lennard, Nystrom, L. Scandinavian Journal of Medicine 12 Supplement : 1— Friedman, P. Prevalence and Natural History. British Journal of Venereal Diseases — Fraser, H. World Health Forum 6: 63— Gagon, J. Gebre-Medhin, M. Gedebou, Messele and Tassew, A. Bulletin of the World Health Organization 73— Giel, R. Social Science and Medicine — Article Google Scholar. In Studies in African and Asian Demography. Haragewoin, M. East African Medical Journal — Kitaw, Yayeyirad, Gebray, A. Ethiopian Medical Journal — Unpublished report. Addis Ababa. Ethnomedicine 2: — Journal of Ethiopian Studies 77— Ethnomedicine 4: 63— Ethiopian Medical Journal. Addis Ababa: Ministry of Health. World Health Statistics Quarterly 15— Lester, Francis T. Manzur, J. Ethiopian Journal of Health Development 1: 65— Abbay — Messing, Simon D. American Anthropologist — Addis Ababa: United Printers. Nordberg, E. Ethiopian Medical Journal 25— Olsson, B. Community Dental and Oral Epidemiology 7: 37— Osterwald, R. Journal of the History of Medicine and Allied Sciences — Parry, E. Munich: Weltforum Verlag. Plorde, D. Rokos, L. Ethiopian Medical Journal 7: 11— Sekhar, C. East African Medical Journal. Tropical Doctor — Shannon, Garry W. Social Science and Medicine 85— Silverman, Milton The Drugging of the Americas. Berkeley: University of California Press. Slater, P. Journal of the Royal Society of Health 3 : 87— Bulletin of the World Health Organization 67— Ethiopian Medical Journal 35— World Health Statistics Quarterly — Ethiopian Medical Journal 1—6. Ethiopian Medical Journal 49— Ethiopian Medical Journal 1—5. Tsega, Edemariam, Landells, J. Sinet Ethiopian Journal of Science 1: 99— Workneh, Fikre, and Giel, R. Tropical and Geographical Medicine — Culture, Medicine and Psychiatry 1: — Download references. You can also search for this author in PubMed Google Scholar. Reprints and permissions. Kloos, H. In: van der Geest, S. Culture, Illness, and Healing, vol Springer, Dordrecht. Publisher Name : Springer, Dordrecht. Print ISBN : Online ISBN : Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Policies and ethics. Skip to main content. The Context of Medicines in Developing Countries. Access this chapter Log in via an institution. Chapter EUR Softcover Book EUR Hardcover Book EUR Tax calculation will be finalised at checkout Purchases are for personal use only. Preview Unable to display preview. Pharmacies in informal settlements: a retrospective, cross-sectional household and health facility survey in four countries Article Open access 09 September Exploring the status of retail private drug shops in Bangladesh and action points for developing an accredited drug shop model: a facility based cross-sectional study Article Open access 11 July Drug prescribing patterns at primary health care level and related out-of-pocket expenditures in Tajikistan Article Open access 06 October Google Scholar Bedassa, A. Google Scholar Brown, K. Google Scholar Buschkens, W. Google Scholar Dodge, R. Google Scholar Dotsenko, A. Google Scholar Friedman, P. Google Scholar Fraser, H. Google Scholar Gagon, J. Google Scholar Gebre-Medhin, M. Google Scholar Giel, R. Google Scholar Haragewoin, M. Google Scholar Lester, Francis T. Google Scholar Manzur, J. Google Scholar Messing, Simon D. Google Scholar Nordberg, E. Google Scholar Olsson, B. Article Google Scholar Osterwald, R. Article Google Scholar Parry, E. Google Scholar Plorde, D. Google Scholar Rokos, L. Google Scholar Sekhar, C. Google Scholar Shannon, Garry W. Google Scholar Slater, P. Article Google Scholar Download references. Authors Helmut Kloos View author publications. View author publications. Rights and permissions Reprints and permissions. About this chapter Cite this chapter Kloos, H. Copy to clipboard. Publish with us Policies and ethics. Search Search by keyword or author Search. Navigation Find a journal Publish with us Track your research.

How can I buy cocaine online in Dushanbe