Heroin

Diamorphine

Naloxone Availability in Norway

"Naloxone is the most common antidote used for overdoses. It is normally ambulance personnel who administer naloxone in connection with opioid overdoses, and doses are administered by intramuscular or intravenous injection. It is now being discussed whether naloxone in the form of a mouth spray should be available to others as well, as first aid for someone who has overdosed
until the ambulance arrives."

Cost-Effectiveness of Naloxone Distribution

"Naloxone distribution was cost-effective in our base-case and all sensitivity analyses, with incremental costs per QALY [Quality-Adjusted Life-Year] gained much less than $50 000 (Table 2 and Appendix Figure 3, available at www.annals.org; see Appendix Table 3, available at www.annals.org, for detailed results of selected analyses). Cost-effectiveness was similar at starting ages of 21, 31, and 41 years; the greater QALY gains of younger persons were roughly matched by higher costs.

Benefits from Naloxone Distribution

"Naloxone distribution to heroin users would be expected to reduce mortality and be cost-effective even under markedly conservative assumptions of use, effectiveness, and cost. Although the absence of randomized trial data on naloxone distribution and reliance on epidemiologic data increase the uncertainty of results, there are few or no scenarios in which naloxone would not be expected to increase QALYs [Quality-Adjusted Life-Years] at a cost much less than the standard threshold for cost-effective health care interventions.

Providing Naloxone to Prisoners at Risk of Opioid Overdose on Release in Scotland

"SPS [Scottish Prison Service] developed an intervention to provide naloxone to prisoners at risk of opioid related overdose on release from prison, as part of the National Naloxone Programme, in recognition of the increased risk of overdose in the first four weeks following release from prison custody. The naloxone is packed in with their personal belongings, which are stored at reception, then supplied to the prisoner on release from custody.

Efficacy of Heroin-Assisted Treatment

"Over the past 15 years, six RCTs [Randomized Controlled Trials] have been conducted involving more than 1,500 patients, and they provide strong evidence, both individually and collectively, in support of the efficacy of treatment with fully supervised self-administered injectable heroin, when compared with oral MMT, for long-term refractory heroin-dependent individuals.

Heroin Trafficking and Seizures in the Americas

"Most heroin (and morphine) trafficked in the Americas is smuggled from Mexico to the United States, with far smaller quantities smuggled from Colombia and Guatemala. Analysis of heroin samples in the United States over the past decade shows the increasing predominance of Mexico (90 per cent of samples analysed in 2015) as a source country of the drug, while the importance of countries in South America (3 per cent) has declined markedly. South-West Asia accounted for around 1 per cent of the samples analysed in 2015.10

Non-Injection Means of Ingestion As A Reason For Growth in Heroin Use Among Young People

Non-Injection Means of Ingestion As A Reason For Growth in Heroin Use Among Young People: "We do think that the expansion in the world supply of heroin, particularly in the 1990s, had the effect of dramatically raising the purity of heroin available on the streets, thus allowing for new means of ingestion. The advent of new forms of heroin, rather than any change in respondents’ beliefs about the dangers associated with injecting heroin, very likely contributed to the fairly sharp increase in heroin use in the 1990s.

Barriers to Naloxone Access

"A more prosaic, but no less important, legal barrier to widespread naloxone access is the Food and Drug Administration’s (FDA) classification of naloxone as a prescription drug. This means that public health and harm reduction agencies cannot distribute naloxone like condoms or sterile syringes. Instead, naloxone must be prescribed by a properly licensed health care provider after an individualized evaluation of the patient.

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