SynthesisHarm reduction journal2022
How do naloxone-based interventions work to reduce overdose deaths: a realist review.
Synthesis in Harm reduction journal, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
17 citing papers in PubMed, 37 citations in OpenAlex.
- Recruiting a National Sample of First Response Agencies to Participate in an Overdose Prevention Research Project: Randomized Controlled Trial and Feasibility Study.JMIR formative research · 2026Trial
- National review of state laws on opioid antagonists in Kindergarten-12th grade schools across the United States.Harm reduction journal · 2026Review
- Reframing Buprenorphine as a Pharmacologic Modifier of Opioid-Induced Respiratory Depression in the Fentanyl Era.Pharmaceuticals (Basel, Switzerland) · 2026Article
- Illicit drug supply, naloxone availability, and overdose mortality in the fentanyl era: a systematic review.Health affairs scholar · 2026Review
- A short-duration telementoring pain management programme for Medicaid: impact on clinician outcomes.Health education research · 2025Article
- Naloxone dosing by non-medical first-responders at opioid overdoses: findings from a qualitative interview study.Harm reduction journal · 2025Article
- Overdose risk environment for people who use drugs in New Jersey: Imagining possible points of intervention for harm reduction practitioners.Research square · 2025Article
- A Scoping Review of the Utilization of Opioid Use Treatment, Harm Reduction, and Culturally Tailored Interventions Among Racial/Ethnic Minorities in the United States.International journal of mental health and addiction · 2025Article
- Implementation and Evaluation of a Bystander Naloxone Training Course.The western journal of emergency medicine · 2024Article
- The Feasibility of Using the National PulsePoint Cardiopulmonary Resuscitation Responder Network to Facilitate Overdose Education and Naloxone Distribution: Protocol for a Randomized Controlled Trial.JMIR research protocols · 2024Article
- The joy and pain of being a harm reduction worker: a qualitative study of the meanings about harm reduction in Brazil.Harm reduction journal · 2024Article
- Overdose education and naloxone distribution program design informed by people who use drugs and naloxone distributors.Preventive medicine reports · 2023Article
- Article
- Developing a single-session strategy for the implementation of take-home naloxone by community pharmacists using COM-B and design-thinking.Frontiers in health services · 2023Article
- (Re)situating expertise in community-based overdose response: Insights from an ethnographic study of overdose prevention sites (OPS) in Vancouver, Canada.The International journal on drug policy · 2023Article
- Lessons from the COVID-19 pandemic for substance misuse services: findings from a peer-led study.Harm reduction journal · 2022Article
- Barriers and Facilitators to Naloxone Access for Adolescents: A Narrative Review.Substance use : research and treatmentReview
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundNaloxone-based interventions as part of health systems can reverse an opioid overdose. Previous systematic reviews have identified the effectiveness of naloxone; however, the role of context and mechanisms for its use has not been explored. This realist systematic review aims to identify a theory of how naloxone works based on the contexts and mechanisms that contribute to the success of the intervention for improved outcomes.
methodsPre-registered at PROSPERO, this realist review followed RAMESES standards of reporting. Keywords included 'naloxone' and ' opioid overdose'. All study designs were included. Data extraction using 55 relevant outputs based on realist logic produced evidence of two middle-range theories: Naloxone Bystander Intervention Theory and Skills Transfer Theory.
resultsHarm reduction and/or low threshold contexts provide a non-judgemental approach which support in-group norms of helping and empower the social identity of the trained and untrained bystander. This context also creates the conditions necessary for skills transfer and diffusion of the intervention into social networks. Stigma and negative attitudes held by first responders and stakeholders involved in the implementation process, such as police or GPs, can prohibit the bystander response by inducing fear in responding. This interferes with skills transfer, naloxone use and carriage of naloxone kits.
conclusionsThe findings provide theoretically informed guidance regarding the harm reduction contexts that are essential for the successful implementation of naloxone-based interventions. Peer-to-peer models of training are helpful as it reinforces social identity and successful skills transfer between bystanders. Health systems may want to assess the prevalence of, and take steps to reduce opioid-related stigma with key stakeholders in contexts using a low threshold training approach to build an environment to support positive naloxone outcomes.
trial registrationPROSPERO 2019 CRD42019141003.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.