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December 2014 |
drinkanddrugsnews
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Harm reduction |
Naloxone
country, both of which had shown a decline in drug-related deaths since the
strategies’ implementation. Wales had made a commitment back in 2008 to
reduce drug-related harm and deaths, and had set up a national group that
included police and paramedics. Demonstration sites had followed, evaluated by
the University of South Wales, and the main recommendation to roll out the
programme was completed in November 2011.
A decline in deaths of 53 per cent spoke for itself. ‘I don’t think it’s rocket
science,’ said Hills. ‘It’s simple, it saves lives. It’s down to commissioners – get
your priorities right.’ Involvement of service users – ‘the experts’ – had been
really important in making risk logs, and from there, distribution had been
increased to carers and their engagement encouraged. ‘Naloxone should be
second nature,’ she said.
Kirsten Horsburgh acknowledged there had been ‘challenges and barriers’ in
Scotland, starting from having one of the highest rates of drug-related deaths in
Europe. But a national naloxone programme, launched at the end of 2010, had
responded to common circumstances – that the average age of victims was 40,
that they were not in treatment and likely to have had a recent period of
abstinence, and that they were likely to die in their own or a friend’s home with
witnesses (other drug users) present.
A Patient Group Direction (PGD) had been sent out to nurses and pharmacists
in community addiction teams, needle and syringe programmes, harm reduction
teams and the Scottish Prison Service, and Lord Advocate’s Guidelines allowed
naloxone to be supplied by staff working for services in contact with people at
risk of opiate overdose, such as in hostels. Anyone supplied with naloxone had to
do training to make sure they were confident.
‘The key messages are prioritise the supply of naloxone to people who use
drugs, make it normal in services and ensure people on ORT [opioid replacement
therapy] have a supply,’ she said. ‘Make the training brief – just a ten minute
chat – and involve peer trainers. All this potentially saves hundreds of lives.’
On 4 November the World Health Organization (WHO) recommended expanding
access to naloxone, from just medical professionals to people likely to witness
an overdose in their community, including friends, family members, partners of
people who use drugs, and social workers. The report emphasised the safety of
the drug, the ease of administering it, and its potential to reduce 69,000 deaths
a year globally from opioid overdose.
The group around the table in London agreed that action was needed now,
and there was no need to wait for PHE’s October 2015 directive to make each
area of the country accountable for including naloxone in its localism agenda.
Dr Judith Yates gave the example of Birmingham’s progress – a process driven
by doctors, nurses, pharmacists and service users, rather than commissioners.
‘Naloxone kits have become normal – we hear about reversals every month,’
she said. Dr Yates had trained drug workers from local service Swanswell, who
were in turn carrying out training. ‘We don’t do risk assessments – we give
naloxone to all first responders, we give it to everyone who uses drugs,’ she
explained. ‘We have stories of residents in hostels saving each others’ lives.’
‘We’re obsessed with controlled drugs, but this is like giving an asthma
inhaler, not methadone,’ added Emily Finch of SLAM. ‘I’ve signed hundreds of
naloxone prescriptions.’
*****
At NAG’s second meeting on 21 November, the group prioritised the need to
overcome the obstacle presented by localism, which prevented England from having
a national naloxone strategy.
‘PHE’s October deadline is disappointing, but it’s less than a year away. Of more
concern is that we can’t have a national strategy because of localism,’ NAG chair
John Jolly told
DDN
. ‘We agreed the need to bring this to the attention of politicians
as well as clinicians. Naloxone distribution is not a minority sport, it’s day-to-day
business. If you’re giving opiate treatment, you should be giving naloxone.’
With thousands of doses administered by ambulances, clear messages on
distribution from the ACMD, and the Medicines Act ‘clearly empowering every
citizen to use it’, there should be no obstacle to making naloxone available in
every part of the country, he said. The recovery agenda was directly relevant: NAG
identified that those most at risk were those starting on a journey of recovery,
and emphasised the need for training alongside naloxone distribution.
‘We need to be identifying areas that are delivering good practice and naming
and shaming areas that aren’t,’ said Jolly.
DDN
‘I don’t think it’s rocket
science... It’s simple, it
saves lives. It’s down to
commissioners – get
your priorities right.’
RHIAN HILLS