Naloxone is key is to addressing the current opioid crisis, but poor systemic distribution means it isn’t saving the lives it should, says Zoe Carre
Drug-related deaths are at record high levels across Britain. While estimates suggest that illicit opiate use is less prevalent than the use of other drugs, data show that nearly 9 in 10 drug-related deaths across the UK involved an opioid. Many of these deaths could be prevented by supplying naloxone to people likely to experience or witness an opioid overdose.
Naloxone is not a silver bullet and needs to be considered as part of a whole-system approach, but it is one part of the solution, and is a crucial component of preventing drug-related deaths. More broadly, what is needed to tackle drug-related deaths is: adequately funded drug services; prescribing Opioid Substitution Therapy (‘OST’) in optimal dose and duration, access to Heroin Assisted Treatment for those whom traditional OST has not been successful; and the establishment of Drug Consumption Rooms, which are increasingly called Overdose Prevention sites in recognition of the crisis of drug-related deaths in much of the Northern Hemisphere.
Scotland and Wales set up national naloxone programmes in 2011 and Northern Ireland followed in 2012. UK-wide regulations were subsequently introduced in 2015 to enable drug services to supply take-home naloxone without a prescription. Despite these efforts to make naloxone widely available, findings from our research for Release indicate that this has still not been achieved in England. Nationally, the estimated coverage of take-home naloxone among people who use opiates was as low as 16 per cent in 2017/18. Our research also suggests that take-home naloxone is not reaching those who most need it. People not engaged in drug treatment services and people recently released from prison are particularly vulnerable to opioid overdose. Yet, 58 per cent of local authorities did not make take-home naloxone available to clients accessing community pharmacies, such as those providing OST and/or needle and syringe programmes (‘NSP’), and 49 per cent of prisons did not supply take-home naloxone to people released from their custody. Additionally, information was requested from each of the NHS Ambulance Trusts for the research, which confirmed that ambulance services did not supply take-home naloxone to people after being treated for an opioid-related overdose. These are potentially missed life-saving opportunities.
The healthcare profession has an important role to play in preventing mortality among people who use opioids, and in particular, those who have been let down by mainstream drug treatment services. According to Public Health England guidance, “drug treatment services” that can supply take-home naloxone without a prescription includes, but is not limited to, drug services provided in primary or secondary care and pharmacies. In my view, healthcare professionals delivering drug services—namely GPs providing OST through shared care and pharmacists providing OST and NSP—have a duty to supply take-home naloxone to their patients. Likewise, other healthcare professionals—namely doctors, GPs, pharmacists, advanced paramedics, dentists and nurse prescribers working in community, inpatient and custodial settings—can and should offer take home prescriptions of naloxone to patients likely to experience or witness an opioid overdose. Even those who cannot directly supply naloxone, can and should promote it to those in need, for example by asking if they have a kit and signposting them to services that can supply take-home naloxone.
People who use opioids are an extremely stigmatised group, facing significant healthcare risks, which can be mitigated through high-quality evidence-based harm reduction interventions. Sadly, they do not always receive the treatment that they deserve because of this stigma and perceived lack of agency, particularly where treatment is driven by mistrust, paternalism or surveillance. The concern is that some healthcare professionals may not view naloxone as a priority, in part due to negative attitudes towards this patient group.
What is needed to prevent further mortality among people who use opioids—and to address the crisis of drug-related deaths sweeping Britain—is buy-in from healthcare professionals working with those likely to experience or witness an opioid overdose. Then, and only then, can we ensure that naloxone is widely available to those all those who need it.
Zoe Carre is a policy researcher at Release.
Competing Interests: Zoe Carre is a “champion” for PCM Scientific’s UK IOTOD THN programme, which receives funding from Martindale pharma via an educational grant. Zoe co-authored ‘Finding a Needle in a Haystack: Take-Home Naloxone in England 2017/18’ among other policy papers and regularly contributes to Release’s drug policy work. Zoe was previously a youth activist for Students for Sensible Drug Policy (UK) and worked in drug services across the North East of England.