Broad-scale overdose education and naloxone distribution- 5-year follow-up of a regional program in Skåne County, Sweden.

Background: Opioid use disorder is a chronic disorder with a high risk of overdose-related morbidity and mortality where a large proportion of these can be averted by timely administration of the antidote naloxone. For naloxone to be present when and where overdoses occur, broad-scale overdose education and naloxone distribution (OEND) must be established. A regional naloxone program was implemented in 2018, in Skåne County, Sweden. This five-year follow-up aims to describe all naloxone-related lay-person events, whether recommendations previously described in the literature were met, and to further investigate events conducted by individuals reporting overdose reversals with naloxone on three or more occasions ('Supersavers').

Methods: Between June 2018 and June 2023, data was collected in six-month intervals from 52 participating units, containing information on trained individuals, gender, year of birth and distributed naloxone kits. Upon naloxone replenishment, patients were asked whether previous naloxone had been used for overdose reversals on someone else, or themselves, had been lost, stolen, or given to someone else. Targets for naloxone distribution and program enrolment were set to a minimum of 20 kits per annual opioid overdose death, and 100 individuals at-risk per 100,000 inhabitants, respectively.

Results: Training and initial kits were provided to 2685 individuals at risk of own opioid overdose. Upon refill (n = 2,364), naloxone had been used for overdose reversal in 39% (n = 926) situations. In total, 5900 naloxone kits were distributed. Distribution target in relation to opioid overdose mortality was met annually, while the enrolment target was first met during the second year. The core group of Supersavers represent 9% (n = 50) of participants returning for refill while reporting 54.5% (n = 292) of all overdose reversals.

Conclusions: Broad-scale naloxone training and distribution reaches a large proportion of individuals at risk of opioid overdose. A continuous focus and priority in supporting units with a high prevalence of individuals witnessing overdose events is of great importance as these individuals report a large proportion of overdose reversals. Likewise, it is of great importance to provide these individuals, i.e. Supersavers, with needed and sufficient support for their continued essential work intervening in overdose situations.

Trial Registration: Naloxone Treatment in Skåne County- Effect on Drug-related Mortality and Overdose-related Complications, NCT03570099, registered 26 June 2018.