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What price life?
L
ast year there were 765 deaths related to heroin and morphine in
England – a sharp rise of 32 per cent from the 579 deaths in 2012.
The reasons for this failure are the subject of much debate, with many
in the field suggesting that enforced detox and being encouraged to
leave treatment too early are strong contributory factors.
But what is certain for the growing number of service users, treatment
workers and medical professionals who have formed themselves into an action
group – now called the Naloxone Action Group (NAG) – is that many of these
deaths could have been prevented if naloxone had been available to use as an
intervention to reverse overdose.
At the Action Summit on Naloxone (from which NAG was formed) held at
Bleinheim’s headquarters in London last month, the agenda was split between
sharing information and updates on naloxone, looking at examples of good
practice from areas of effective distribution, and forming an action plan to
challenge every area of the country that was slow or reluctant to roll out
distribution and training.
Before arriving at the summit, participants had been asked to complete a
questionnaire about the availability of naloxone in their area, the drivers for
availability and the barriers to distribution both locally and nationally.
‘From participants’ responses there’s a marked variation,’ said Dr Chris Ford,
clinical director of IDHDP, who chaired the meeting. ‘One area had total provision,
most areas had nothing…. There is a definite postcode lottery. We’re going back
to the bad old days and it stinks.’
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The group identified those most at risk, with Professor John Strang referring to
evidence that more frequent deaths happened during early stages of methadone
treatment and early days of release from prison. One important factor to
concentrate on was that many people died in the presence of friends, so the
group agreed it was incredibly important – and an obvious move – to involve
these potential ‘first responders’ with naloxone distribution and training. Families
were also ‘absolutely crucial’ – ‘we want to get away from it being revolutionary to
it being normalised,’ he said.
GPs would need to prescribe naloxone to patients and authorise family
members to collect it and do the training. Oliver Standing from Adfam said that
his experience of running a bereavement project had shown that families were
10 |
drinkanddrugsnews
| December 2014
Harm reduction |
Naloxone
www.drinkanddrugsnews.com
The failure to roll out
naloxone distribution in
England prompted a
multidisciplinary group to
meet in London to campaign
for change.
DDN
reports
‘desperate to be involved’, while Jamie Bridge of the International Drug Policy
Consortium (IDPC) and the National Needle Exchange Forum (NNEF) said ‘having
family voices in this will be invaluable – it will make commissioners care.’ The
idea of involving recovery assets such as family also ‘fits beautifully into
the recovery framework’, said Fraser Shaw of Compass.
Elsa Browne of SMMGP added that her organisation had
launched an e-learning module, written by Dr Kevin
Radcliffe, to help with training. Around 100
people a month were doing it, ‘and the
evaluation is brilliant’, she said.
John Jolly, Blenheim’s
chief executive, brought the
discussion back to the critical
lack of action in England.
‘What’s happened in politics?’
he asked. ‘In May 2012 the ACMD
recommended that naloxone should
be more widely available, that the
government should ease restrictions
on supply, and that people should be
better trained to administer it.’ The ACMD
also commented on Scotland’s strategy
running, Wales’ strategy being about to run,
and England having no policy. ‘There are
some great areas of good practice in England, but it’s very patchy,’ he added.
A letter from the Department of Health was shown to the group. It was a
response to Dr Judith Yates’ letters to public health minister Jane Ellison, in
which she pressed for answers on the lack of action. The letter assured Dr Yates
that, following the ACMD’s advice, PHE and the Medicines and Healthcare
Products Regulatory Agency were ‘working on amending medicines regulations to
allow the wider distribution and administration of naloxone’. But new regulations
would not come into effect until October 2015, ‘the earliest practicable date’ to
avoid the distractions of the general election campaign.
The overwhelming reaction of the group was that this was ‘choosing to do
nothing’ as October would not be within this government. ‘We’re not happy with
the date that’s been set,’ said service user activist Kevin Jaffray. ‘A date a year
from now leaves space for another 32 per cent rise in deaths. There’s been a
constant rise since 2009.’
Steve Taylor, programme manager for alcohol and drugs at PHE, was invited to
give a response to the situation. ‘We’re not kicking things into the long grass –
things will have started to take place by October,’ he said, agreeing that ‘anybody
walking out of the door with a methadone script and not naloxone is ludicrous.’
Any changes made in October would not make a huge amount of difference,
he added, saying ‘there are things you can be doing’ that didn’t require any
change in legislation. It was our responsibility ‘as doctors and clinicians’ to
prescribe naloxone to people on methadone treatment, he said, and it could be
given to families for the named patient. ‘What is it that’s going to change, that we
don’t already do?, he asked.
PHE was looking to produce a briefing by the end of this year, using expertise
to advise on what arrangements for wider provision might be. ‘But,’ he advised
the group, ‘there is not going to be a national programme in England because of
localism.’
Rhian Hills from the Welsh Government and Kirsten Horsburgh from the
Scottish Drugs Forum shared their experience of naloxone strategy in each