Evaluating the Implementation of Government Funded Nasal Naloxone Distribution in Norway: Obstacles and Success Factors

First published: 29 March 2019 | Last updated: 20 May 2019


Philipp Lobmaier took his medical degree in Leipzig (Germany) in 2004 and relocated to Norway the same year where he then got the opportunity to work on his PhD in addiction medicine at the University of Oslo. He defended his PhD thesis on naltrexone implant treatment for opioid dependent, pre-release inmates in 2010 and continued to work at the Norwegian Addiction Research Centre in Oslo with clinical projects related to drug-involved offenders and extended-release naltrexone. At the same time he continued his clinical training in the addiction medicine and mental health field and has scheduled to become a specialist in psychiatry in 2019. From 2013 and onwards his major research interest has been the implementation and evaluation of the Norwegian nasal naloxone pilot project.

Presentation Summary

Norway has seen high rates of opioid overdose (OD) deaths during the last two decades. In June 2014, coordinated action was taken and large scale distribution of nasal naloxone to bystanders in Oslo and Bergen was implemented.

More than 500 staff received training in order to be able to distribute the nasal spray to potential bystanders. The trained staff from existing facilities that service drug users contributed significantly by distributing more than 2000 naloxone nasal sprays during the first one and a half years of the pilot project. 734 individuals requested nasal naloxone replenishment and 277 bystanders reported use for OD reversal as intended. Reversals were successful in 96 % of cases (1, 2).

Cooperation between the University, changing national governments, the Norwegian Medicines Agency (NoMA), low-threshold service facilities and the pharmaceutical industry were crucial to implement the rapid distribution of nasal naloxone to injecting drug users and their peers. Our nasal spray consists of a commercially available Mucosal Atomization Device (MAD 300) and a prefilled syringe (Prenoxad) containing 2 mg naloxone / 2 ml. Self-report of significant beneficiary effects on overdose incidents still need to be confirmed by data from the death registry and ambulance records on non-fatal overdoses. The spray used in the pilot project is an interim device that needs to be replaced as soon as comparably effective nasal sprays are available in Europe.

1.            Madah-Amiri D, Clausen T, Lobmaier P. Rapid widespread distribution of intranasal naloxone for overdose prevention. Drug Alcohol Depend. 2017;173:17-23.

2.            Madah-Amiri D, Clausen T, Lobmaier P. Utilizing a train-the-trainer model for multi-site naloxone distribution programs. Drug Alcohol Depend. 2016;163:153-6.


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