Conflict of Interest Statement
The ILCOR Continuous Evidence Evaluation process is guided by a rigorous ILCOR Conflict of Interest policy. The following Task Force members and other authors were recused from the discussion as they declared a conflict of interest: none applicable
The following Task Force members and other authors declared an intellectual conflict of interest and this was acknowledged and managed by the Task Force Chairs and Conflict of Interest committees: AM Orkin, A Kubica, AM Subic, and B dos Santos were authors of the scoping review used for the adoplment process.
Published Synthesis Citation
Dos Santos B, Farzan Nipun R, Maria Subic A, Kubica A, Rondinelli N, Marentette D, Muise J, Paes K, Riley M, Bhuiya S, Crosby J. Virtual opioid poisoning education and naloxone distribution programs: A scoping review. PLOS digital health. 2024 Jun 7;3(6):e0000412.
Confirmation of Task Force ADOLOPMENT team
FA
Anna Maria Subic
Alexandra Kubica
Aaron Orkin
Nathan Charlton
Content Expert
Bruna dos Santos bsantos@pqwchc.ca
Search Strategies
Initial results from re-run of search
- Full list of included articles, included articles from updated search, are included in supplementary Excel and Word Documents.
- 1445 additional studies screened – searches in EMBASE and CINAHL have not been re-run yet due to errors in the search strategy.
- Title, abstract, and full text review was completed by two reviewers, AMS and AK.
- Data was extracted and consensus reached by two reviewers, AMS and AK.
- Original search last on June 1, 2023, except for the grey literature search, which was conducted on July 27, 2023.
- Search run on: OVID MEDLINE, OVID Embase, EBSCO CINAHL, OVID PsycINFO, The Cochrane Library, SCOPUS, and ERIC
- Grey literature searched: Canadian Agency for Drugs and Technologies in Health (CADTH) Grey Matters website, the System for Information on Grey Literature in Europe (OpenGrey), and TRIP Pro
- Search strategy available from: https://doi.org/10.1371/journal.pdig.0000412.s002
Updated search:
- Run in OVID MEDLINE (June 2025), OVID PsycINFO (June 2025), The Cochrane Library (Sept 2025), SCOPUS (Sept 2025), and ERIC (Sept 2025); OVID Embase and EBSCO CINAHL have not been rerun due to errors in search strategy
- Grey literature search rerun in September 2025 in: Canadian Agency for Drugs and Technologies in Health (CADTH) Grey Matters website, the System for Information on Grey Literature in Europe (OpenGrey), and TRIP Pro
Inclusion and exclusion criteria
Population: People at risk of opioid poisoning or likely to witness opioid poisoning or otherwise interested in OPEND program participation.
Concept: Any opioid poisoning education programming with or without naloxone distribution that is conducted entirely at a distance and without in-person interaction between that program personnel and participant.
Context: Worldwide.
Inclusion Criteria: RCTs, non-randomized clinical trials and observational studies about remote opioid poisoning education and naloxone distribution. Literature in all languages will be included if it has an English abstract. All years will be included in the search.
Exclusion Criteria: Conference proceedings, reviews, protocols, case reports, commentaries, and letters to the editor will be excluded.
Open Science Registration
Dos Santos B, Nipun R farzan, Subic AM, Kubica A, Rondinelli N, Marentette D, et al. Remote Opioid Poisoning Education and Naloxone Distribution Programs: A Scoping Review Protocol. 2023 Jun 14 [cited 2023 Jun 26]; Available from: https://osf.io/ew9rq
Task force Insights
The opioid poisoning and drug toxicity crisis is a complex and multi-faceted public health epidemic. Opioid-related harms can affect people of all communities, ages, and socioeconomic status. Opioid poisoning education and naloxone distribution (OPEND) programs are powerful tools against the opioid poisoning crisis. These programs educate on the effects of opioid poisoning, how to respond to opioid poisoning, and stigma, as well as distribute naloxone. OPEND programs destigmatize and legitimize harm reduction measures and increase understanding of naloxone use in opioid poisoning emergencies. However, there remain several barriers to consistent OPEND program access, such as stigma and program location. Rural, remote, small, and mid-sized communities experiencing the opioid poisoning crisis face unique barriers to treatment and opioid poisoning education, such as stigma due to smaller population, and geographical issues accessing resources due to transportation difficulties, distance, and dispersed population.
Due to the COVID-19 pandemic, health services that were previously only conducted in person were adapted to be conducted remotely and across long distances, demonstrating the potential of remote OPEND programs. While such programs existed pre-pandemic and were shown to be effective in improving knowledge of opioid poisoning response, they have not yet been implemented as alternatives to in-person OPDEN programs. In this review, we aim to support the development of future remote OPEND programs by compiling an overview of existing remote OPEND programs and their advantages and disadvantages.
Narrative summary of evidence identified
Forty-two studies were eligible for inclusion in the study: 20 quasi-experimental pre-post design studies, 13 descriptive studies, 6 randomized controlled trials, 2 program evaluations, and 1 non-randomized controlled trial. The studies were published from 2016 to 2025; thirty-eight studies were based in the United States of America, two were conducted in Australia, one took place in Canada, and one was based in Norway.
Participant demographics: fourteen of the included studies included interventions for anyone interested in participating in them, with a large focus on laypersons. Eight studies included interventions targeted for people with lived or living experiences of opioid use, and seven others focused on medical, nursing, and pharmacy students. The remaining studies focused on health professionals (n=5), family or friends of people with lived experience of opioid use (n=2), first responders (n=2), law enforcement officers (n=2), individuals on community supervision (n=1), and school workers (n=1).
Interventions: Many studies reported on internet-based interventions (n=35): nine video-based interventions, seven video-conferencing interventions, five course-based interventions, three slide presentations, three website-based interventions, and one intervention delivered by drone. Of these, nine interventions also provided naloxone via mail. There were additionally four telephone-based interventions, which all provided mail-delivered naloxone. Interventions which reported duration of educational component ranged from five minutes to two hours, with interventions typically lasting 20 minutes. Nine studies used a self-directed approach. The predominant themes among the educational components among interventions were how to respond to, how to recognize, and how to prevent opioid poisoning emergencies.
Findings:
- Most interventions led to an immediate increase in knowledge regarding opioid
- poisoning and naloxone use.
- A few studies observed successful opioid poisoning reversals using distributed naloxone.
- Many programs showed short-term knowledge gain; however, some studies found that knowledge declined within three months after training.
- Participants exhibited improved attitudes towards people who use opioids; however, stigma reduction was not consistent across all interventions.
- High participant satisfaction rates were reported for most interventions.
- Most participants found virtual formats convenient and accessible.
Limitations:
Commonly reported limitations included lack of generalizability of study results, small sample size, absence of longitudinal data, self-reported questionnaire bias, lack of comparison to in-person interventions, no follow-up for participants who responded to an opioid poisoning post-intervention, lack of validity of tools used, low response rates, and lack of randomizations.
Conclusions:
Virtual OPEND works well in improving knowledge and preparedness on opioid poisoning response, especially when combined with naloxone distribution, and can be a life-saving intervention and critical alternative to in-person training, particularly in underserved areas. However, more controlled studies and long-term follow-up are needed to measure knowledge retention over time, real-world naloxone use, and long-term behaviour changes in opioid response. In addition, future virtual OPEND should focus on reaching marginalized populations, such as people of colour, people living in rural and remote areas, and people experiencing homelessness.
Good Practice Statement:
Virtual and in-person opioid poisoning education and naloxone distribution programs are effective and appropriate for improving knowledge and preparedness on opioid poisoning response, especially when combined with naloxone distribution. Virtual programs, in particular, can teach opioid poisoning response anywhere there is a need, such as rural and underserved communities, and can provide life saving education on opioid poisoning response with or without naloxone distribution.
Narrative Reporting of Task force discussions
The Task Force discussed the following concepts:
- That both in-person and virtual opioid poisoning education are effective and appropriate for improving knowledge and preparedness.
- That in jurisdictions with no existing naloxone distribution program, virtual overdose prevention and response training is still effective in providing education on recognizing and responding to opioid poisoning.
- That the learnings from the included studies are useful wherever there is a need for opioid poisoning response, and that virtual opioid poisoning education and naloxone distribution is able to reach communities which would otherwise be unlikely to receive opioid poisoning education and naloxone distribution.
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