Effectiveness of Scotland's National Naloxone Programme for reducing opioid-related deaths: a before (2006-10) versus after (2011-13) comparison

AimsTo 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. DesignThis 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. SettingScotland, in community settings and all prisons. InterventionBrief training and standardized naloxone supply became available to individuals at risk of opioid overdose. MeasurementsORDs as identified by National Records of Scotland. Look-back determined the proportion of ORDs who, in the 4weeks 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. FindingsIn 2006-10, 9.8% of ORDs (193 of 1970) were in people released from prison within 4weeks 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 12000 naloxone kits were issued at current prescription cost of 225000. Scotland's secondary outcome reduced from 19.0 to 14.9%, a difference of 4.1% (95% CI=1.4-6.7%). ConclusionsScotland'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 4weeks following release from prison.