England lagging behind rest of the UK
The new (17 June) Advisory Council on the Misuse of Drugs (ACMD) report on naloxone (the drug used to reverse opioid overdoses) makes it clear that naloxone saves lives but that its availability, particularly in England, needs to be much more strategic to make it available to all.
The main findings from this report (which the ACMD organised itself – it was not commissioned by the government to look at naloxone) point both to the importance of naloxone as a life-saver and to the need to develop a more comprehensive roll-out of the drug, particularly in England and particularly for prison leavers. The ACMD’s principal conclusions are:
- The importance of naloxone is apparent, with evidence showing an association between administration of naloxone and a reduction of opioid overdose-related deaths.
- There has been an increase in the number of people who have been administered naloxone over the last ten years. Although data from Scotland, Northern Ireland and Wales provides a clear overview of naloxone supply, there are challenges in understanding the level of naloxone supply in England, mainly because data are not being collected in a uniform fashion.
- More work is needed to widen the access to, and increase the uptake of, naloxone in community partnerships across the UK.
- Pharmacies are a key provider of take-home naloxone, and a UK agreement on the specific role of community pharmacies in distributing naloxone would promote collaborative working across the four nations.
- Further research is needed to consider the efficacy of peer-to-peer naloxone within a range of contexts.
- Evidence suggests that the supply of take-home naloxone on release from prison is fragmented across the UK, with only a small proportion of opioid-dependent prison leavers currently being provided with naloxone, even though studies find that a high percentage of these people would willingly accept take-home naloxone upon prison release.
- There are multiple police service pilot programmes across the UK which currently deliver intranasal naloxone (Nyxoid) as a more convenient method as opposed to intramuscular devices.
The ACMD’s overall conclusion is that a national joined-up approach to promote the delivery of take-home naloxone across different sectors is necessary, supported by rigorous data recording to measure progress. Interventions are needed across a range of different sectors, ranging from delivery of take-home naloxone within community pharmacies, promotion of peer-to-peer take-home naloxone programmes, police training, and increasing take-home naloxone supply amongst prison leavers.
The table below is based on the Unlinked Anonymous Monitoring Survey of people who inject drugs (with participants from England, Wales & Northern Ireland). It shows a small but significant increase in naloxone use over recent years.
The ACMD report makes a number of recommendations. The first of which is to improve the quality of data/information on take-home naloxone, particularly in England. It recommends that Local Authority commissioners should include completion of National Drug Treatment Monitoring System questions, including on naloxone, within their service specifications and as a condition of their contracts with drug treatment providers.
Other recommendations include:
- To explore evidence-based ways in which the carriage of naloxone can be increased by those at risk of overdose and their families.
- Good examples of partnership working should be used to encourage organisations, in those areas in the UK which do not currently have extensive peer-to-peer take-home naloxone programmes, to establish them as soon as possible.
- The prison service in each of the four nations should ensure complete coverage of take-home naloxone by those people who leave prisons at all times (with specific emphasis on weekend departures). The forthcoming power for prison governors not to release vulnerable prisoners on a Friday may help in targeting this group.
- There should be additional national support and training for police in the holding and administration of take-home naloxone.
- Acute trusts (including emergency departments), mental health trusts and ambulance services should issue take-home naloxone and associated training to those at risk of opioid overdose.
- There should be contractual arrangements across the UK which allow community pharmacies to issue take-home naloxone and an associated brief intervention on opioid overdose management.