Virtual and remote opioid poisoning education and naloxone distribution programs: a scoping review

The opioid poisoning crisis is a complex and multi-faceted global epidemic with far-reaching public health effects. Opioid Poisoning Education and Naloxone Distribution (OPEND) programs destigmatize and legitimize harm reduction measures while increasing participants’ ability to administer naloxone and other life-saving interventions in opioid poisoning emergencies. While virtual OPEND programs existed prior to the COVID-19 pandemic and were shown to be effective in improving knowledge of opioid poisoning response, they were not widely implemented and evaluated. The COVID-19 pandemic brought both urgent and sustained interest in virtual health services, including harm reduction interventions and OPEND programs. We aimed to assess the scope of literature related to fully virtual OPEND programming, with or without naloxone distribution, worldwide. A search of the literature was conducted and yielded 7,722 articles, of which 31 studies fit the inclusion criteria. Type and content of the educational component, duration of training, scales used, and key findings were extracted and synthesized. Our search shows that virtual and remote OPEND programs appear effective in increasing knowledge, confidence, and preparedness to respond to opioid poisoning events while improving stigma regarding people who use substances. This effect is shown to be true in a wide variety of populations but is significantly relevant when focused on laypersons. Interventions ranged from the use of videos, websites, telephone calls, and virtual reality simulations. A lack of consensus was found regarding the duration of the activity and the scales used to measure its effectiveness. Despite increasing efforts, access remains an issue, with most interventions addressing White people in urban areas. These findings provide insights for planning, implementation, and evaluation of future virtual and remote OPEND programs. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Protocols ### Funding Statement Yes ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Since this is a scoping review of previously published summary data, ethical approval is not needed. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All relevant data are within the manuscript and its Supporting Information files.