AIMS: To assess the effectiveness for Scotland's National Naloxone Programme (NNP) by comparison between 2006-10 (before) and 2011-13 (after NNP started in January 2011) and to assess cost-effectiveness.

DESIGN: This was a pre-post evaluation of a national policy. Cost-effectiveness was assessed by prescription costs against life-years gained per opioid-related death (ORD) averted. The setting was Scotland, in community settings and all prisons.

INTERVENTION: Brief training and standardized naloxone supply became available to individuals at risk of opioid overdose.

MEASUREMENTS: ORDs as identified by National Records of Scotland. Look-back determined the proportion of ORDs who, in the 4 weeks before ORD, had been i) released from prison (primary outcome), ii) released from prison or discharged from hospital (secondary). We report 95% confidence intervals for effectiveness in reducing the primary (and secondary) outcome in 2011-13 versus 2006-10. Prescription costs were assessed against 1 or 10 life-years gained per averted ORD.

FINDINGS: In 2006-2010, 9.8% of ORDs (193/1970) were in people released from prison within 4 weeks of death whereas only 6.3% of ORDs in 2011-2013 followed prison release (76/1212, p <0.001; this represented a reduction of 3.6%). This reduction in the proportion of prison release ORDs translates into 42 fewer prison release ORDs during 2011-13, when 12,000 naloxone kits were issued at current prescription-cost of £225,000. Scotland's secondary outcome reduced from 19.0% to 14.9%, a reduction of 4.1%.

CONCLUSIONS: Scotland's National Naloxone Programme, which started in 2011, was associated with a 36% reduction in the proportion of opioid-related deaths that occurred in the 4 weeks following release from prison. [This article is protected by copyright. All rights reserved.]