Environmental Scan Naloxone Access and Distribution in Canada
Notice bibliographique
Résumé
In response to an epidemic of opioid overdose deaths attributed to prescription and illicit opioid use, distribution of the opioid antagonist naloxone has been identified in Canada and abroad as a key emergency measure to effectively prevent rising mortality (1,2). The current environmental scan was produced in order to better understand current practices and programs aimed to distribute naloxone for use in suspected opioid overdose, to assess uptake of these programs across Canadian provinces and territories (P/Ts), and to understand barriers related to knowledge and evidence in the use of naloxone, as well as operational obstacles to achieving widespread population coverage. Publicly funded take-home naloxone (THN) programs have been rolled out across every province and territory in Canada in response to the current opioid crisis. All publicly funded THN programs offer naloxone free of charge to those at risk of opioid overdose, while the majority of these programs also target any person who self-identifies as being at risk of witnessing an opioid overdose (including friends or family of people who use drugs). All provinces offer kits with the injectable formulation of naloxone as part of their publicly-funded program, while three P/Ts (Ontario, Quebec, and the Northwest Territories) also offer the nasal naloxone spray. Nasal naloxone spray is also available to clients of Veterans Affairs Canada, and through the NonInsured Health Benefits (NIHB) Program (benefits for First Nations individuals who present a valid status card and personal health number to confirm their eligibility). In most P/Ts, naloxone is made available through a number of different sites and organisations, including community pharmacies, shelters, medical centres, and treatment service centres, although some jurisdictions are limited in their ability to distribute naloxone due to geographical considerations and regulations related to provincial drug scheduling. While population access to naloxone has improved substantially across the country, there remain some jurisdiction-specific operational, geographic, knowledge/evidence, and policy barriers to access. Importantly, there are several unanswered questions regarding the safety and effectiveness of different naloxone routes of administration, dosing, and the extent of training needed to effectively respond to an overdose and administer naloxone. Evidence regarding the benefit of distributing naloxone broadly (as opposed to only specific at-risk populations) is needed. There are also ethical considerations including how to collect robust health data while protecting low-barrier access environments and respecting patient anonymity, and whether it is appropriate to provide naloxone kits to minors. Additional considerations include identifying the most effective overdose response strategy more generally (outlining actions to take beyond administering naloxone, such as chest compressions, rescue breaths, calling 911, etc., and the order to take them in), as well as in the development of program evaluation practices and performance indicators. Consolidating existing evidence, suggesting areas for future research, and building consensus among stakeholders may help improve naloxone access and ensure equitable outcomes in Canada. Finally, there is continued recognition of the complex social, political, and legal solutions needed to address the state of the opioid crisis in Canada, as well as for the need to address continued stigma around drug use, integrate harm reduction practices, and support a holistic model of care in order to best confront the upstream factors leading to overdose, addiction, and substance use.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,006 | 0,016 |
| Études des sciences et des technologies | 0,004 | 0,001 |
| Communication savante | 0,003 | 0,001 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,018 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».