Naloxone brief pres april ihra Beruit 2011


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Naloxone brief pres april ihra Beruit 2011

  1. 1. ScottishDrugsForum<br />Scottish NALOXONE ProgrammeIHRA ConferenceBeirut Lebanon Stephen MalloyNational Training & Development officer- Critical Incidents & naloxoneApril 2011<br />Co-ordinating Action on Drug Issues<br />
  2. 2. This is Scotland<br />Scottish Population<br />~5.2 Million<br />Estimated<br />Opiate/Benzo Users<br />~55000-60000<br />Local prevalence<br />varies between <br />0.2% - 3.9% of population<br />PWI opiates- 23000><br />ScottishdrugsForum<br />
  3. 3. This is not Scotland<br />ScottishdrugsForum<br />
  4. 4. Briefly outline....<br />Context setting<br />up scaled Naloxone distribution across Scotland- interplay between medical/legal/pharmaceutical/social care sectors<br />Scottish programme developments<br />Training and support available<br />Implementation<br />Scottish evaluation of naloxone programme<br />ScottishdrugsForum<br />
  5. 5. Context setting<br />The need for Overdose prevention and community based naloxone training in Scotland<br />ScottishdrugsForum<br />
  6. 6. Contrasting pictures <br />‘The evidence suggests that mortality rates declined in Spain and Italy, and were stable in Germany. In addition, the other selected countries all achieved substantially greater reductions in drug-related deaths than England and Wales between 1999 and 2004/05, with Germany and Italy exceeding a 20% reduction and Spain (six cities) reducing the drug-related mortality rate by 17%’<br /> Morgan O., Trends in overdose deaths from drug misuse in Europe: what do the data tell us? Addiction (2008) 103, 699–700)<br />UK<br /><ul><li>20% target not met in UK ‘99/’05
  7. 7. DRDs not counted as a key performance indicator in 2008-2018 drugs strategy Bird M., et al. Missing targets on drugs-related deaths, and a Scottish paradox International Journal on Drugs Policy (2009) doi:10.1016/j.drugpo.2009.10.001</li></ul>Scotland<br /><ul><li>The rate of drug deaths in Scotland is higher than other parts of the UK and Europe (EMCDDA, 2006). Most of these deaths (66%) occurred in people who were drug dependent (GROS, 2008), in their late twenties or thirties with a history of drug use and overdose (Zador. et al, 2005). </li></ul>Rome A., Shaw A., Reducing drug users risk of overdose, Scottish Government (2008)<br />ScottishdrugsForum<br />
  8. 8. Scottish DRD Trend 1997-2008<br />131% increase in drug related deaths since 1998 *<br />Drug deaths increased by 26% from ’07-’08 . <br />545 DEATHS IN 2009<br />ScottishdrugsForum<br />
  9. 9. Drug Related Deaths in Scotland (GROS) 2009-545<br />DRDs by age & sex in Scotland 2009<br />Aged under 25yrs- 71 <br />Aged 25 to 34yrs- 178<br />Aged 35 to 44yrs- 189<br />Aged 45yrs and over- 107<br />Males- 413 Females- 132<br />In 2007, 30% of Deaths in Males aged 25-34yrs were Drug Related <br />ScottishdrugsForum<br />
  10. 10. Common circumstances of DRDs’ in Scotland<br />ScottishdrugsForum<br />
  11. 11. So.........naloxone<br />
  12. 12. Firstly....Naloxone<br /><ul><li>Naloxone is a pure opioid antagonist.
  13. 13. It is indicated for coma or respiratory depression caused by opioids.
  14. 14. Naloxone can reverse the effects of overdose if used within a short period following an opioid related (poly substance use) overdose.
  15. 15. Practically safe (ex contra’s) </li></ul>ScottishdrugsForum<br />
  16. 16. Opioids ‘fit into’ receptors<br />Perfect fit- full Opioid effect <br />CNS DEPRESSANT EFFECT- reduced breathing, heartbeat, etc.<br />Euphoric effect/Sleepy/<br />”Gouchy”<br />Etc. <br />
  17. 17. Naloxone displaces opioids from receptors<br />Naloxone<br />CNS controlled functions will no longer be depressed (point to note...!!) <br />When opioids are displaced from these receptors, the person may start to experience withdrawal<br />
  18. 18. Naloxone has a temporary effect....(person could go back into Overdose state...possible but unlikely)<br />Opioid returns to receptor<br /><<<<<<<<Naloxone<br />Empty <br />Receptor><br />Signals From Receptor to Brain<br />Possible Temporary Withdrawal Pain!!!?<br />
  19. 19. Naloxone has no effect on CNS depression caused by alcoholBenzodiazepines or other (non opioid) ‘downer’ drugs<br />In Scotland, Naloxonetraining MUST be delivered<br />with other OD prevention interventions <br />ScottishdrugsForum<br />
  20. 20. Who can use Naloxone in UK<br />30th June 2005- reclassification<br />Naloxone is now on the list of prescription only medicines that can be administered parentally (by injection) by anyone for the purpose of saving a life.<br />This means that Naloxone can be given by any member of the public to a person suspected of having an opioid overdose. <br />ScottishdrugsForum<br />
  21. 21. Who can be supplied? <br />“...that the supply of naloxone, as a POM, can only be made on a named patient basis (or patients rep) using either a prescription or a Patient Group Direction (PGD).” <br />A PGD is a legal device that allows suitably qualified nurses or pharmacists to supply POMs in specific defined circumstances.<br />(National Naloxone PGD)<br />ScottishdrugsForum<br />
  22. 22. Continued...<br />“Access to supplies using a PGD is not restricted to patients who are in contact with treatment services. This is for unplanned care and is available to anyone that the nurse or pharmacist identifies as being at risk of opiate overdose irrespective of any current or previous contact with treatment services.”<br />There’s no hope of recovery if you’re dead.<br />(National Naloxone PGD)<br />ScottishdrugsForum<br />
  23. 23. Naloxone...nothing new?<br />Allylcodine- Pohl, J: Ztschr. Exper. Path. Und Therap 18, 370, 1915<br /><ul><li>H. F. Fraser, A. Wikler, A. J. Eisenman, and H. Isbell</li></ul> USE OF N-ALLYLNORMORPHINE IN TREATMENT OF METHADONE POISONING IN MAN: REPORT OF TWO CASES JAMA April 5, 1952 148:1205-1207<br /><ul><li>Early 70’s- heralded as the opioid antithesis. Evans JM, Hogg MI, Lunn JN, Rosen M. Degree and duration of reversal by naloxone of effects of morphine in conscious subjects. Br Med J 1974; 2: 589–591.
  24. 24. First ‘warnings’.....1975, an editorial in Lancet warned that in opioid addicts, “......naloxone can precipitate a severe withdrawal syndrome in dependent addicts.” Editorial: Naloxone. Lancet 1975;1:734.</li></ul>ScottishdrugsForum<br />
  25. 25. Forward in time<br />1992- J. Strang, BMJ- Should Naloxone amps be made available to IDUs?<br />Emergence of community based training and distribution-The change<br />Jersey Project -1998,Berlin Project-1999, San francisco-2001, Chicago- 2001, New Mexico-2001, Baltimore-2004, NYC-2004/5 and many other sites. <br />Several European and international programs are developed<br />Glasgow/Lanarkshire pilots/program-2006-7 *<br />Inverness pilot-2009<br />Welsh Program -2009<br />June 2009- 16 site pilot in England<br />ScottishdrugsForum<br />
  26. 26. SDF and NALOXONE<br /><ul><li>2005- SDF and Scottish Government conference
  27. 27. 2006- Multi agency/interdisciplinary/cross sector visit To USA- The wonderful CRA!
  28. 28. Major role in development of first Scottish pilot (Glasgow)
  29. 29. SDF Continue to support and influence the advancement of Naloxone development
  30. 30. in Scotland</li></li></ul><li>Examples of Naloxone distribution across Scotland (pilot projects)<br />Inverness<br />2 trainers (additional 25 trainers Nov10-Jan11)<br />300+ trained in OD and Naloxone<br />350 +supplied (inc. 80+ resupplies)<br />50+ reported uses<br />Lanarkshire<br />24 trainers, 14 who are prescribing nurses<br /> 90+ trained in Naloxone (500-600 OD only)<br /> 68+ supplied<br /> 28 reported uses<br /><ul><li>GGC
  31. 31. 120 trainers
  32. 32. 1000+ trained in OD and Naloxone
  33. 33. 500+ units supplied(?)
  34. 34. 120+ reported uses</li></ul>ScottishdrugsForum<br />
  35. 35. National Developments 09-11<br />Short life working group recommendations to NDRDF<br />National PGD and template training program, agreed by NDRDF<br />NDRDF annual report- published 2010<br />Gov. Minister announced National program<br />Scottish Prison Service estates- Naloxone training First wave <br />Lord Advocate letter extending supply to ALL workers in regular contact with people at risk of opiate related overdose<br />ScottishdrugsForum<br />
  36. 36. Ongoing issues in Scotland<br />Scottish Drugs Strategy- ‘Road to Recovery’<br />Discussions between ACMD and MHRA re classification of Naloxone<br />L.A. and services policies around storage and administration of medications <br />Work with manufacturer around product design<br />Staff awareness, competencies and capacity<br />ScottishdrugsForum<br />
  37. 37. Training and support<br />Reimbursement for Naloxone units distributed, agreed by Scottish Government- total investment £500,ooo<br />Training and national resources<br />Implementation support<br />ScottishdrugsForum<br />
  38. 38. National Naloxone Trainers<br />Stephen Malloy -National Training<br /> and Developments- Critical Incidents & naloxone<br />Lisa Ross-National Naloxone Trainer (pt) <br />Clinical Harm Reduction Nurse Specialist<br />Karen Smart- PT National Naloxone Trainer (pt)<br />Registered General Nurse- Drug death prevention co-ordinator<br />ScottishdrugsForum<br />
  39. 39. What we deliver, and what people need to know.....<br />
  40. 40. Naloxone Kit <br />assembly/administration<br />Overdose prevention<br />What <br />Naloxone is/does<br />BLS<br />Calling 999, reporting and resupply<br />
  41. 41. Overdose Awareness exercises(from SDF training manual)<br /><ul><li>Main Drugs Involved
  42. 42. Physical effects
  43. 43. Risk Factors
  44. 44. High Risk times
  45. 45. Signs and Symptoms
  46. 46. Myths
  47. 47. Correct actions
  48. 48. Calling 999</li></ul>ScottishdrugsForum<br />
  49. 49. ScottishdrugsForum<br />
  50. 50. Administered IM, 0.4mls per dose at 2-3 minute intervals.<br />ScottishdrugsForum<br />
  51. 51. making a commitment to saving lives using FIRST AID<br />ScottishdrugsForum<br />
  52. 52. Naloxone ‘Training the Trainer program’<br />Broadly;<br />2 day comprehensive course<br />Adult learning model, facilitation skills, models of delivery of naloxone training i.e. Group/pair/1 to 1/ opportunistic <br />OD Prevention/Signs and symptoms etc.<br />Naloxone and it’s actions, kit assembly, injecting technique etc.<br />Certificated Basic Life support and Naloxone use<br />Practice delivery <br />PGD, recording, monitoring and reporting (Local evaluation?)<br />Post session examination<br />Adaptable to suit local area needs and current capacity<br />ScottishdrugsForum<br />
  53. 53. Training for trainers delivery to date;<br />North Ayrshire<br />Highlands<br />Greater Glasgow and Clyde<br />Dumfries and Galloway<br />Forth Valley<br />Tayside (April)<br />across the SPS estate, with 60+ trainers.<br />Northern Ireland<br />Wales<br />Developmental and capacity building activities in ALL (except 1) other HB areas <br />
  54. 54. Local Implementation<br />ADP identify leads and drive program forward locally <br />Local adoption/adaption (if required) of PGD<br />Agreement of processes, monitoring etc<br />Cross sector/multi agency involvement<br />Across Tiers 1-4<br />Build/bolt on to local initiatives (utilise current bank of OD prevention inititives? )<br />MUST involve families and broader ‘circle of care’...(person can’t self administer)<br />ScottishdrugsForum<br />
  55. 55. Ongoing Developments<br />Peer Trainers in communities<br />Aiming for Peer led, but clinically supported/supervised sessions <br />WE WANT NALOXONE OTC<br />WE NEED naloxone Normalised and ‘as standard’ <br />WE NEED Recurring monies<br />
  56. 56. National Evaluations<br />SPS- comparative evaluation (07-09/10-12) based on survival rates of at risk individuals 4 weeks post release- Prof. Sheila Bird-Cambridge University.<br />Dataset collection throughout term of evaluation- reported uses; SAS involvement; hospitalisation; National/Local distribution vs population (dose?), DRD figures etc<br />Product monitoring information<br />ScottishdrugsForum<br />
  57. 57. Actions speak louder than words, and giving opiate users naloxone demonstrates to them that it matters whether they live or die. There is no hope of recovery if your dead. <br />
  58. 58. Stephen Malloy <br />Scottish Drugs Forum<br />ScottishdrugsForum<br />
  59. 59. Scottish Drugs Forum Contacts<br />Stephen Malloy<br /><br />Glasgow office- +44 141 221 1175<br />Mobile- +44 07920133710<br />Facebook-scottishdrugsforumnaloxone<br />Twitter- stephencmalloy<br />Linkedin- Stephen Malloy SDF<br />ScottishdrugsForum<br />