. 2023 Aug 28;195(33):E1112–E1123. doi: 10.1503/cmaj.230128

Table 1:

Summary of recommendations on take-home naloxone distribution and use by community overdose responders in Canada

Topic	Recommendation	Strength of recommendation	Quality of published academic and grey literature evidence
Route of administration	THN programs should offer both intramuscular and intranasal formulations of naloxone, so that people accessing naloxone kits can choose their preferred formulation.	Conditional	Very low
Kit contents	All THN kits should include: A recognizable carrying case Non-latex gloves A rescue breathing mask Instructions on naloxone administration: Instructions on how to administer naloxone should be designed in collaboration with people who use these kits THN programs can use previously developed instructions or develop their own in collaboration with the affected community Intramuscular THN kits should include: Three or more 0.4 mg/mL naloxone ampoules or vials, according to program discretion and local experience (more ampoules or vials may be necessary in communities with high prevalence of illicitly manufactured fentanyl and other potent synthetic opioids) A syringe and needle for each ampoule or vial of naloxone Alcohol swabs Ampoule breaker (in kits containing ampoules) Intranasal THN kits should include: Two 4 mg/0.1 mL intranasal devices	Strong	Very low
Overdose response	Response to suspected opioid overdose should depend on the skill and comfort level of the responder. People accessing services at THN distribution sites may be trained on overdose response through their peers, using online resources, a CPR training course or training developed by THN programs. Trained community responders should follow these steps: Apply vigorous verbal and physical stimuli Call EMS^* Administer naloxone^† If the individual experiencing overdose is in respiratory depression, provide rescue breathing If the individual experiencing overdose is in cardiac arrest, provide conventional CPR, including rescue breathing and chest compressions THN distribution sites without capacity to offer overdose response education should direct people to services that offer training, if needed.	Strong	Very low

Topic

Recommendation

Strength of recommendation

Quality of published academic and grey literature evidence

Route of administration

THN programs should offer both intramuscular and intranasal formulations of naloxone, so that people accessing naloxone kits can choose their preferred formulation.

Conditional

Very low

Kit contents

All THN kits should include:

A recognizable carrying case
Non-latex gloves
A rescue breathing mask
Instructions on naloxone administration:
Instructions on how to administer naloxone should be designed in collaboration with people who use these kits
THN programs can use previously developed instructions or develop their own in collaboration with the affected community

Intramuscular THN kits should include:

Three or more 0.4 mg/mL naloxone ampoules or vials, according to program discretion and local experience (more ampoules or vials may be necessary in communities with high prevalence of illicitly manufactured fentanyl and other potent synthetic opioids)
A syringe and needle for each ampoule or vial of naloxone
Alcohol swabs
Ampoule breaker (in kits containing ampoules) Intranasal THN kits should include:
Two 4 mg/0.1 mL intranasal devices

Strong

Very low

Overdose response

Response to suspected opioid overdose should depend on the skill and comfort level of the responder. People accessing services at THN distribution sites may be trained on overdose response through their peers, using online resources, a CPR training course or training developed by THN programs.
Trained community responders should follow these steps:

Apply vigorous verbal and physical stimuli
Call EMS^*
Administer naloxone^†
If the individual experiencing overdose is in respiratory depression, provide rescue breathing
If the individual experiencing overdose is in cardiac arrest, provide conventional CPR, including rescue breathing and chest compressions

THN distribution sites without capacity to offer overdose response education should direct people to services that offer training, if needed.

Strong

Very low

Note: CPR = cardiopulmonary resuscitation, EMS = emergency medical services, THN = take-home naloxone.

We acknowledge that many people who use drugs do not feel safe calling EMS, especially in jurisdictions where police commonly attend EMS calls for overdose.

^†

There is differing guidance on the order of naloxone administration and resuscitation. Our recommendation does not address order of response interventions.