Take home naloxone program started in Estonia
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31.10.2013

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The take home naloxone program in Estonia was launched in September 2013. The program started with training on naloxone/ overdose prevention and naloxone distribution for 20 persons. Among them mostly people who inject drugs (PWID), some patients of Opioid Substitution Therapy (OST), some outreach workers and few partners of the PWID. 500 kits with the pre-filled naloxone syringes has been ordered for this year. The work started in two sites - one in Tallinn and one in North-Eastern region of the country in the city of Jõhvi. Naloxone in pre-filled syringes is not a licensed medical product in Estonia. Fortunately it has been licensed in EU (UK) this spring that allows to import it specifically for the national naloxone program based on the special authorization from State Agency of Medicines. The Prenoxad Injection is used.
Program design. In Estonia it is not possible to distribute naloxone for civil society organizations. Legislation supports only distribution of the naloxone by medical doctors as it is a prescription drug. Therefore the program is structured so that healthcare institutions, mostly drug treatment agencies (doctors), and needle-syringe programs (NSP) work in collaboration. NSPs spread the information among the target groups, recruit trainees and arrange trainings at least once a week. Doctors come to the NSP to conduct the training and after the training and knowledge test they distribute naloxone. No prescriptions are actually written, but so-called patient lists are generated and distribution of naloxone is documented according to national legislation. The program is largely based on the Scottish experience and is fully funded by the state.
Program development. Increase is planned both in number of sites and kits next year. It is planned to distribute at least 1000 kits and to gradually involve all harm reduction services in the program. Geographically program will be expanded first of all to other cities in the North-East - Kohtla-Järve and Narva.
How it became possible? The main driver behind the launch of the naloxone program was high number of the overdose related death in Estonia during recent years and increasing awareness of the problem both on political and on grass-root level. The program became possible thanks to the joint effort of different governmental agencies (including State Agency of Medicines, National Health Board), drug treatment and harm reduction organizations who joined the program lead by National Institute for Health Development to elaborate the best model for Estonia. Initiative was supported by international colleagues from Eurasian Harm Reduction Network and Scotland.
For more information please write to National Institute for Health Development, Department of the Infectious Diseases and Drug Abuse Prevention at nneo@tai.ee 
(EHRN | New take home naloxone program started in Estonia)