Natural or synthetic opioids can be used therapeutically, recreationally, and children may be unintentionally exposed to them.¹ Opioid addiction and abuse is a major medical and social problem all around the world.^1,2 The opioids exert their biologic effects through interactions with multiple opioid receptors (μ, δ and κ). The μ-opioid receptor is attributed to respiratory depression - a main hazard of severe opioid overdose which is potentially fatal.^1,3–5

Opioid antagonists are commonly used as rescue medications to reverse severe opioid-induced respiratory depression.^4,6 Naloxone is a non-selective, short-acting opioid receptor antagonist which acts on the μ-, δ- and κ-opioid receptors.² It has been approved by Health Canada as an opioid antagonist since 1994.⁷ The most common use of naloxone is for the treatment of opioid overdose in both hospital and out-patient settings, and in rapid detoxification (being given intravenously [i.v.] when combined with other medications).² Other routes of administration include intramuscular, subcutaneous, intranasal and through an endotracheal tube.^1,8

The administration of naloxone in a home or community setting for overdose prevention may be an attractive option to reduce over-dose related deaths as it appears to be feasible and safe.⁹ In Canada, there are at least four cities with local overdose prevention and response programs involving naloxone dispensing, while British Columbia has recently launched a provincial program.¹⁰ Currently in Ontario, naloxone is not listed on the formulary or available through the province’s Exceptional Access Program.¹¹

The purpose of this review is to assess the evidence of the clinical effectiveness and cost-effectiveness of the administration of naloxone in a community or home setting versus naloxone administered by a health professional. Evidence-based guidelines and recommendations for the dosing of naloxone in this setting will also be discussed.