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Cited by 248Opioid Use Disorder TreatmentSubstance Abuse Treatment and OutcomesHIV, Drug Use, Sexual Risk

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

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Bird, Sheila M., McAuley, Andrew, Perry, Samantha, Hunter, Carole·2016·Addiction
DOI 10.1111/add.13265PMC PMC4982071
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Abstract

Aims: To 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. Design: This 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. Setting: Scotland , in community settings and all prisons. Intervention: Brief training and standardized naloxone supply became available to individuals at risk of opioid overdose. Measurements: ORDs as identified by National Records of Scotland . Look‐back determined the proportion of ORDs who, in the 4 weeks 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. Findings: In 2006–10, 9.8% of ORDs (193 of 1970) were in people released from prison within 4 weeks 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 12 000 naloxone kits were issued at current prescription cost of £225 000. Scotland 's secondary outcome reduced from 19.0 to 14.9%, a difference of 4.1% (95% CI = 1.4–6.7%). Conclusions: Scotland '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 4 weeks following release from prison.

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  • Bird et al. showed, again with methods from data science, the effectiveness of their intervention: the number of deaths decreased significantly.

    “They showed, again with methods from data science, the effectiveness of their intervention: the number of deaths decreased significantly.”

    From AI for the Common Good?! Pitfalls, challenges, and ethics pen-testing (2019) · cites this paper as [31]

    The Findings (page unavailable) report a statistically significant reduction in the proportion of opioid-related deaths occurring within four weeks of prison release and estimate 42 fewer such deaths in 2011–13. The Conclusion (page unavailable) says this reduction may be due to the naloxone programme. The claim overstates the result by implying a significant decrease in deaths overall and attributing that decrease definitively to the intervention. (LLM, conf=0.88)

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  • Bird et al. used a data-science analysis to show the prevalence of lethal overdoses among addicts recently released from prison, and then handed out emergency overdose kits and gave basic information on how to administer the antidote.

    “The authors used a data-science analysis to show the prevalence of lethal overdoses among addicts recently released from prison (at which time addicts are even more vulnerable than usual due to the enforced abstinence while in prison), and then instead of arguing for an awareness campaign 'to avoid drugs' or 'avoid overdosing', handed out emergency overdose kits and gave basic information on how”

    From AI for the Common Good?! Pitfalls, challenges, and ethics pen-testing (2019) · cites this paper as [31]

    The Results (page not provided) report the proportion of opioid-related deaths occurring within four weeks of prison release, and the Introduction describes brief training and naloxone-on-release in Scotland. But that proportion is not the prevalence of lethal overdose among people released from prison. The authors evaluated Scotland’s programme; the paper does not say they personally distributed the kits or delivered the training. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Scotland's National Naloxone Programme was followed by a 36% reduction in the proportion of opioid-related deaths in prisoners during the 4 weeks following their release from prison.

    “A before (2006-10) -after (2011-13) comparison of Scotland’s National Naloxone Programme found a 36% reduction in the proportion of opioid-related deaths in prisoners during the 4 weeks following their release from prison after the program was initiated [39].”

    From Effectiveness of naloxone distribution in community settings to reduce opioid overdose deaths among people who use drugs: a systematic review and meta-analysis (2025) · cites this paper as [39]

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1 of the 31 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. [10]Bird S. M., Fischbacher C. M., Graham L., Fraser A. Impact of Scottish prisons' opioid substitution therapy on drugs‐related deaths soon after prisoner‐release. Addiction 2015; 110: 1617– 24. 25940815 PMC4744745
  2. [26]Rapid responses to British Medical Journal article (editorial). Available at: http://www.bmj.com/content/333/7569/614 (Archived at http://www.webcitation.org/6amOTQaGB on 14 August 2015) (accessed 14 August 2015).

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Authors
Bird, S. M., McAuley, A., Perry, S., & Hunter, C.
Affiliations
  • University of Strathclyde (GB)
  • National Health Service Scotland (GB)
  • Western Infirmary (GB)
  • National Health Service (GB)
Corresponding author
Bird, Sheila M.
ORCID
Venue
Addiction
Publisher
Wiley
Published
2016-02-04
Volume
111
Issue
5
Pages
883-891
ISSN
  • 0965-2140 (ISSN-L)
  • 1360-0443
DOI
10.1111/add.13265
PMC
PMC4982071
OpenAlex
W2191045458
Cited by
248
References
31
Citations by year
2026: 14 · 2025: 17 · 2024: 20 · 2023: 18 · 2022: 13 · 2021: 42 · 2020: 24 · 2019: 23 · 2018: 29 · 2017: 30 · 2016: 14 · 2015: 1 · 2014: 1
FWCI
26.39
Type
journal article
Language
en
Open access
Licence
Locations
  • Addiction (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Strathprints: The University of Strathclyde institutional repository (University of Strathclyde) (submittedVersion, public-domain)
  • ResearchOnline (Glasgow Caledonian University) (submittedVersion, other-oa)
Funders
  • Scotland's official statisticians
  • National Forum on Drug Related
  • National Naloxone Advisory Group (NNAG)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
Keywords
death, naloxone, opioid overdose, prisoner release, harm reduction, cost-effectiveness, life-years gained, prescription drug costs, drug policy, Scotland, prison health care, hospital discharge, pre- and post-assessment, opioid use disorder, heroin-assisted treatment, secondary care
MeSH terms
Adult, Aged, Analgesics, Opioid, Cost-Benefit Analysis, Female, Humans, Male, Middle Aged, Naloxone, Narcotic Antagonists, Opioid-Related Disorders, Prisoners, Scotland, Treatment Outcome

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