![Peer-to-peer naloxone (P2PN)
• EuroNPUD Naloxone Access and Advocacy Project peer audited access to naloxone and
demonstrated engagement of specialist services. However, doesn’t reach non-treatment
population or active using environments
• P2PN programmes engage people who use drugs (PWUDs) and others with lived
experience of drug use in the distribution of naloxone to their peers. Peers will either
attend a training session or receive a brief intervention outreach engagement before
receiving naloxone.
• There are several ways in which PWUDs can be involved in naloxone distribution:
Contracted to a drug user
group to distribute
naloxone and support the
management of opioid
overdose in the community
As a volunteer peer
worker attached to a
harm reduction or
recovery agency to reach
and lower the threshold of
the services
As an individual within a
drug user group which
autonomously distributes
naloxone and delivers peer
education through peer
networks
Mat Southwell (2019) EuroNPUD Peer-to-Peer Distribution of Naloxone Technical Briefing
Mat Southwell (NA) Saving our friends lives! Peer-to-peer distribution of Naloxone [PowerPoint presentation].](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
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EuroNPUD UK Development Project final
- 1. Peer Powering Up Harm Reduction in the UK EuroNPUD’s UK Project Team Mat Southwell, George Charlton, Mick Webb
- 2. Peer-to-peer naloxone (P2PN) • EuroNPUD Naloxone Access and Advocacy Project peer audited access to naloxone and demonstrated engagement of specialist services. However, doesn’t reach non-treatment population or active using environments • P2PN programmes engage people who use drugs (PWUDs) and others with lived experience of drug use in the distribution of naloxone to their peers. Peers will either attend a training session or receive a brief intervention outreach engagement before receiving naloxone. • There are several ways in which PWUDs can be involved in naloxone distribution: Contracted to a drug user group to distribute naloxone and support the management of opioid overdose in the community As a volunteer peer worker attached to a harm reduction or recovery agency to reach and lower the threshold of the services As an individual within a drug user group which autonomously distributes naloxone and delivers peer education through peer networks Mat Southwell (2019) EuroNPUD Peer-to-Peer Distribution of Naloxone Technical Briefing Mat Southwell (NA) Saving our friends lives! Peer-to-peer distribution of Naloxone [PowerPoint presentation].
- 3. Strengths of P2PN programmes • For example, peers have: o Privileged access to drug using venues o Privileged access to drug supply systems o Privileged access to formal and informal mutual aid networks o Privileged access to drug scenes involving purchase and use o Trust from their peers o Shared lived experiences Mat Southwell (2018) Saving our friends lives! Peer-to-peer distribution of Naloxone [PowerPoint presentation]. Mat Southwell (2019) EuroNPUD Peer-to-Peer Distribution of Naloxone Technical Briefing • When compared with other naloxone distribution programmes, P2P naloxone programmes have specific aspects that may make them more successful
- 4. Wiltshire Pioneering P2PN Scheme • The Wiltshire Scheme was initiated in 2006 by Mick Webb who was the Service User Coordinator. • The Wiltshire Scheme applied a THN approach - the prescriber would give the graduates of opioid overdose management course naloxone to take home. • Pioneering P2PN approach - the doctor filled out prescriptions retrospectively with the personal information of the course graduates who had received take-home naloxone on an outreach basis. Then a brief and focussed training was delivered opportunistically to individual or small groups of opioid users. • Pioneering project stretched the interpretation of the Medicines Act in the public interest. Critical backing from senior specialist GP (Dr Gordon Morse) and academic pharmacist with a specialist interest in drugs (Dr Jenny Scott).
- 5. Proactively Engaging Key Stakeholders The ground breaking nature of the Wiltshire P2PN Scheme required detailed attention to securing an enabling environment by strategic networking with key partners: Emergency Services - • Great Western Ambulance Service • Wiltshire Police Specialist Services - • Bath University • Specialist Drug/Alcohol services Community Based Organisation (CBO) - • Wilts Users Forum Media - • Wiltshire Times newspaper
- 6. Reach of Wiltshire P2PN Scheme • In addition, to traditional THN model where dispensing occurs after 1 hour or half-day or full-day training course, peer worker was proactive in reaching both service and non-service using populations: Service Settings: • Peer workers sit in and engage clients alongside street, mobile and static NSP • Wilts User Forum day project (drop in centre) Closed settings • Only accessible to those with “privileged access”. • Private homes and other confidential supply environments Open settings • Known parks and other discreet public spaces co-opted for using
- 7. Good news story about Wiltshire peer worker engages media “The first man was dying in the tent he calls his home in Trowbridge. His associates rang Ms Symes because they did not know what to do with someone who was about to die of a heroin overdose. She said: "When I arrived he had already gone over. He was blue, not breathing, and close to death. I tried to resuscitate him and then called the ambulance.” Wiltshire Times
- 8. Advocacy Ask 1: • Peer-led harm reduction interventions operate in a criminalized environment and need to mediate relationships with the police and Police and Crime Commissioners. Can PHE work with EuroNPUD to produce a briefing for Chief Constables and PCCs on P2PN, secondary NSP and needle patrols?
- 9. Bath Pilot - West Country Respect and Developing HeaIth and Independence • Stock out in out of town area and resulting risk behaviour gave momentum to partnership discussions • Two secondary NSPs (2NSPs) launched through using venues provide springboard for community engagement and peer-led harm reduction. Effective DCRs. • Both 2NSPs stocked with Prenoxad and 3 meeting places used by mobile dealers stocked with Prenoxad • Police noted spike in ODs in Bath. Heroin tested with support of West Country Respect. WC Respect identified drug mixing with benzos as the likely problem • Attempts to accelerate the roll out of P2PN to respond to this spike not possible because naloxone couldn’t be accessed. Challenges securing stock to support P2PN. P2PN can deliver at scale and this has budget implications. Funding in place through DHI for 2020 with delivery being achieved largely through P2PN. • Key role of technical support partner in brokering access, setting up systems and troubleshooting to secure partnership between formal provider system and fluid community network.
- 10. Advocacy Ask 2: • Naloxone should be held in a central budget held by PHE that can be drawn on by recognized THN and P2PN programmes working to agreed standards. • 2015 Medicines Act opened up access but budget constraints remain a barrier • Additional benefits re: procurement and pricing as P2PN drives up demand
- 11. “It shouldn’t be hard to save a life!!” Using Technical Support to Coproduce our Peer-to-Peer Naloxone (P2PN) Training & Supply Programme in Cleveland.
- 12. Using technical support & community mobilisation to coproduce the project. Key Features of Technical Support Model: • Embedded in the geographic area and networking with right providers and stakeholders. • Privileged access into drug using community - reach non-treatment and hard-to-reach populations • Mobilise peers to take part in the project - community commitment was there • Peer audit the system to highlight assets and identify barriers to access • Build policies and protocols to support providers to own and deliver the P2PN project • Network and build positive relationships with key stakeholders - public health, police, etc • Launch overdose prevention and management training and roll out P2PN • Co-partnership approach attracts National Press Coverage earning credit for all stakeholders • P2PN quickly demonstrates amazing potential to scale up - 200 kits given out on the streets in last 7 days • Ripple effects as news of the positive impact of the scheme spreads
- 13. Key technical lessons from our partnership approach. • Having direct access to executives & decision makers is crucial in formulating plans and driving the project forward. • There needs to be access to sufficient naloxone to meet the demand of P2PN • Use the unique skills and local awareness of people who use drugs – they have privileged access to hidden populations and are authentic and credible in their approach. • Drug user groups and peer initiatives need to be autonomous from providers so they are sustained regardless of changes in provider • Troubleshooting – responding to unexpected issues • Community mobilization is a collaborative process • P2PN is part of wider toolkit of interventions for people who inject drugs and are at risk from opioid overdose. Needle patrols or drug litter schemes next phase of work.
- 14. Advocacy Ask 3: • P2PN and other forms of peer-led harm reduction need to be positively validated in commissioning guidance and guidance to providers. • Harm reduction and community mobilization sections for template specifications should be developed to guide commissioners.
- 15. Peer Powering Up Harm Reduction UK Technical Support Project • Technical case studies on peer-led harm reduction interventions with people who inject drugs and those at risk from opioid overdose in UK and Europe – build on P2PN Technical Briefing. • Expert Meeting – gather learning and writer to develop Toolkit for Peer-led Harm Reduction Interventions with People who Inject Drugs and those at risk from Opioid Overdose • National Training – Train-the-Trainers for pairs of trainers (peer and ally) – 7 teams provided with toolkit and technical support to support implementation in year one and 10 teams supported in year two
- 16. Peer Powering Up Harm Reduction UK Technical Support Project cont. • Organisational Audits – provider organisations offered 2 days technical support to encourage tailored use of Toolkit – 3 x 2-day audits in year one – 7 x 2-day audits in year two • Option to buy into programme or buy in training and technical support. Look to create a sustainable model beyond two year programme • Potential to apply development model to other areas of peer support such as stimulant harm reduction or Hep C elimination programmes.
- 17. Peer Powering Up Harm Reduction UK Technical Support Project cont. • Organisational Audits – provider organisations offered 2 days technical support to encourage tailored use of Toolkit – 3 x 2-day audits in year one – 7 x 2-day audits in year two • Option to buy into programme or buy in training and technical support. Look to create a sustainable model beyond two year programme • Potential to apply development model to other areas of peer support such as stimulant harm reduction or Hep C elimination programmes. PLEASE TAKE Build capacity on ketamine and help fund peer development project
- 18. Advocacy Ask 4: • A set of standards in meaningful participation should be developed between PHE, provider organisations and EuroNPUD to create an ethical foundation for the project.
- 19. All Advocacy Asks: • Peer-led harm reduction interventions operate in a criminalized environment and need to mediate relationships with the police and Police and Crime Commissioners. Can PHE work with EuroNPUD to produce a briefing for Chief Constables and PCCs on P2PN, secondary NSP and needle patrols? • Naloxone should be held in a central budget held by PHE that can be drawn on by recognized THN and P2PN programmes working to agreed standards. • 2015 Medicines Act opened up access but budget constraints remain a barrier. • Additional benefits re: procurement and pricing as P2PN drives up demand. • P2PN and other forms of peer-led harm reduction need to be positively validated in commissioning guidance and guidance to providers. • Harm reduction and community mobilization sections for template specifications should be developed to guide commissioners • A set of standards in meaningful participation should be developed between PHE, provider organisations and EuroNPUD to create an ethical foundation for the project. CONTACT - EURONPUD Project Manager www.euronpud.net mat.southwell@icloud.com 07969269395 @MatSouthwell
Editor's Notes
- Highlight that the first two boxes are the two main ways – referenced slide deck mentioned that the third way was observed internationally however whether this is in Europe or not isn’t clear.
- In January last year I tried to get a Naloxone Kit in the area where I live. After making an initial call & and countless other calls and emails over a period of around 6 weeks I was emailed and told I could not have a kit. During this time and after some posts on twitter, I was contacted by a guy called from Glasgow who I had never met….. he said he would help me. 2 days later a kit came through my letter box, It seems you can get a kit 350 miles away quicker that where I lived, What I knew then and we still know now are that people are dying year on year in record numbers, and no greater than in the place where I’m from the NE. I decided that it should not be this hard to get access to Naloxone, and I vowed that I would do something about this with support from my networks. In February I went to Scotland and connected with my networks & spent 3 days with the Naloxone Peers, seeing their professionalism and their passion for what they did. They were experts for sure and I came back to the North East Buzzing man. So let me tell you what we have done about this this using technical support & community Mobilising in Boro
- •Embed myself in the geographical area finding the right providers & stakeholders who would be key to this approach. •Tap into my existing user networks to gain access to peers, hidden populations and those who were treatment naïve. •Empower peers & pwud to get on board and begin mobilizing for their project (no empowering needed) •Undertake audit & evaluation & exploration of what assets and barriers existed across the partnership. •Review provider / stakeholder governance processes & via Technical Support approach & develop P&P’s, SOP’s & Role profiles, volunteer policies where none existed. •Build positive relationships with PH, Police & wider partners in Boro ensuring buy in and a congruent approach from all involved. •Deliver Training to enable OD Prevention & the supply of Naloxone to be delivered in the community. •Go live with the P2P project on the streets of Boro gaining National Press recognition for their work & that of the Local Authority, PH Team & Police. •Use my technical support approach to mobilise & build capacity enabling peers to make supplies of 200 kits on the streets of Boro in last 7 days. •Create a ripple effect for the approach which has cascaded into other areas, what we co produce in one areas is of real value to other areas also. •We are always happy to bring the Technical support and capacity to do this work with you in partnership.
- Having direct access to executives & decision makers is crucial in formulating plans and driving the project – when we organise and mobilise things happen quick. Make Naloxone easily available, be that one kit, 10 kits or 50 kits we need to make sure the demand which will come from community mobilising & supply can be met. - Purchasing 100 kits where you have a treatment population of 1,500 will not work. Peers will find those treatment naive. Use the unique skills and local awareness of people who use drugs – they have privileged access to hidden populations and are authentic and credible in their approach. We are organising and mobilising in the community and things can change - organisations come and go, groups should survive in the event that a provider loses a contract. Accommodate unanticipated consequences (which need not be negative) – peers saying cops were a concern as kits had been seen as paraphanalie- got Kirstie from Release on the case – internal memos for all cops about the work of the peers. Demonstrate mutual respect and non-hierarchical relationships – this is a meeting of heads, hearts and hands. Don’t think Small think big - Develop community mobilisation activities in the context of larger social reforms – The Boro project stared with Naloxone – Now the peers want to begin a drug Litter collection scheme.