Drug-related deaths are on the increase in Britain; 2,182 in 2009, the last year for which figures are available , despite the fact that they are falling in other comparable European countries. Most of these are caused by accidental overdose.
Drug treatment agencies have been concerned about this issue for many years and have been trying to address it in a variety of ways.
Drug overdoses are frequently witnessed by drug users who want to help but are scared to report the overdose, or stay with the person in crisis to give critical information about what drugs they have taken, for fear of arrest. The Lifeline Project, based in Manchester, led an initiative, adopted by many other drug treatment agencies, which involved negotiating protocols with local ambulance services to ensure that police are not routinely called to overdoses – which saves police time and encourages drug users to stay with a friend in crisis.
Many drug treatment agencies also do a lot of work with users around overdose prevention and management. The Injecting Advice website, run by Nigel Brundson provides free workshop materials which includes a section on getting drug users to sign up to an “Overdose Promise” to look after each other.
A further initiative, which is the subject of this post, is the distribution of take-home naloxone kits for opiate users and their associates. Naloxone is an opioid antagonist drug developed in the 1960s which counters the effects of opiate overdoses, greatly improving the chances of survival. It rapidly reverses the effects of heroin or methadone, the most lethal of which is the way they cause respiratory depression – the factor most closely associated with death by overdose. Naloxone can be injected into a vein or muscle (and is even available as a nasal spray)
Until 2005, naloxone programmes in the UK were rare because the medication was available on a prescription only basis. However, in that year the law was amended to permit emergency administration but any member of the public.
An evaluation of training drug users in overdose prevention and giving them naloxone kits was conducted by John Strang and colleagues in 2008. The evaluation found this approach was effective. Just how common and important this issue is was demonstrated by the fact that ten out of 172 individuals successfully administered naloxone in real overdose situations within three months of receiving the training. The authors noted that it was unlikely that naloxone by itself would succeed in reversing the growth in drug-related deaths for the simple fact that many overdoses take place when a person is alone and/or out on the street. Nevertheless, it seemed likely that the drug could play a significant part in overdose prevention.
It is therefore disappointing to report that access to naloxone kits varies considerably across England and Wales although we have no firm figures about availability. The take-home-naloxone website gives information about the areas in which it is available although this does not cover Northern Ireland. It also provides excellent naloxone training resources. Information about the availability of naloxone in Scotland (which has an even higher rate of drug-related deaths than England and Wales) will shortly be available from the Scottish Drug Services directory website – thanks to @StephenCMalloy for that information.
There are a number of current attempts to get more commissioners interested in purchasing naloxone training and take-home kits. People have used different forms of media, traditional and online to highlight naloxone’s effectiveness.
Swansea Drug Project organised a naloxone conference earlier this year and publicised the issue again on Welsh Overdose Awareness Day earlier this week when they reported that naloxone kits had been used 43 times in Swansea over the previous 18 months.
“Flat out and Back”, a short film from Jason Turner at iSore Media premiered in Birmingham last week; it follows a drug user released from prison and includes scenes of naloxone administration.
@UTurnTraining is in the final stages of producing a smartphone application to help prevent death by drug overdoses which includes step-by-step voice instructions on how to administer naloxone as well as other real-time advice on calling ambulances, administering CPR etc.
Many people in the harm reduction field and keen to promote the app in the hope that it will be a focus for spreading more awareness of the value of naloxone kits.