The BMJ Today: Trade wars and naloxone

A free trade agreement between the European Union and the United States is designed to meet the interests of corporations rather than patients and must be stopped in its tracks, says an editorial by John Hilary, executive director of campaign group War on Want. The Transatlantic Trade and Investment Partnership (TTIP) is a series of secret trade negotiations aimed at reducing regulatory trade barriers. But the arrangement is intended to benefit multinational companies and could prove catastrophic for the NHS, says Hilary.

The European Commission has confirmed that health services are on the table, and a leaked copy of the EU’s liberalisation offer has revealed its full ambition, he says. Not only hospital services, but medical (including midwifery and physiotherapy) and dental services are to be opened up to competition under TTIP. Individual EU member states may enter reservations to protect specific sectors, but the only one entered by the UK government is for ambulance services.

Hilary warns that the market liberalisation introduced by the 2012 Health and Social Care Act in England ensures it will be effectively impossible to take the NHS back into public hands if the EU-US deal goes through. Both the UK government and the European Commission have confirmed that the TTIP’s provisions to protect investors would grant US corporations the power to sue any future administration over such a move. Many groups are now campaigning for health services to be taken off the table altogether, just as audio-visual services have been removed from the TTIP negotiations at the insistence of the French.

Meanwhile, John Strang and colleagues describe the paradigm shift that is occurring in the treatment of heroin overdose. The move follows the launch of World Health Organization guidelines on the community management of heroin and opioid overdose and emergency administration of naloxone by people who are not medically trained.

As an estimated 69 000 people worldwide die from opioid overdose each year, ensuring that naloxone is available in high risk settings, such as probation hostels and homeless shelters, has the potential to save many lives. Strang and his fellow authors remain optimistic, but say more research is vital.

Initiatives to make naloxone more widely available have now become an international effort, with schemes having recently started in parts of North America, Europe, and Australia.

Finally, a new report from the BMA says that health professionals could do more to prevent young people ending up in police custody. It recommends early screening and identification of risk factors and substance misuse among parents or carers.

Research has shown that more than a third of children in custody had been given a diagnosis of a mental health disorder, and around 60% of children in custody have significant speech, language, or learning difficulties. These statistics suggest that vulnerable children and teenagers continue to be let down by health and social care services, and more must be done to protect young people.

Katie Howl is a work experience intern at The BMJ.