Training the Trainer part 1 of 6

1. Naloxone in Scotland (1)
Drugs Related Deaths
Stephen Malloy Kirsten Horsburgh
National naloxone Coordinator National Training & Development
officer
stephen@sdf.org.uk kirsten@sdf.org.uk
A national resource of expertise on drug issues

2. Overdose- a leading cause of death
in opiate users
Preventing death is our primary
objective
2

3. Stephen –
Strategy and policy influence
Workforce development
Design/delivery of competency training focusing on;
- NATIONAL NALOXONE PROGRAMME
- CRITICAL INCIDENTS
Suicide pre/inter and ‘postvention’
Bacterial infections in PWID eg. Anthrax, Clostridium
Kirsten –
Plan, develop and deliver a range of training to
support the national naloxone programme
- PEER EDUCATION NETWORKS

4. What’s delivered in the community;
Overview of 2 day ‘Training the
Trainer’ naloxone session
• Aims of Session
• Adult learning
• The ‘journey’ through training
• Facilitation/delivery skills
• Demonstration of OD prevention session, with key
messages highlighted
• Naloxone, PGD
• Practical skills- Emergency Life support and
administering Naloxone

5. Broad aims of Training the Trainer
session
 Demonstrate clear understanding of key evidence based overdose
prevention and Naloxone messages
 Able to identify/communicate observable signs of overdose
 Ability to deliver emergency life support skills training
 Ability to demonstrate the administration of naloxone
 Understand skills required for delivery/facilitation of sessions to
people at risk of overdose (and others governed by PGD)

6. Training components for the ‘Training the
Trainer’ session
• Context setting
• Method and Models of community based delivery, Adult
Learning and the training program
• Overdose Prevention exercises
• Brief overview of the National Naloxone Program
• Naloxone, its actions, kit assembly and administration
• Patient Group Direction (PGD)
• 4 step approach to learning motor skills
• Dealing with the unconscious casualty who is breathing
• Cardiopulmonary Resuscitation
• Consolidation
• Post session examination and evaluations.

7. What’s in the training for beneficiaries Naloxone Kit
assembly/administration
Overdose prevention
What
Naloxone is/does
BLS
Calling 999, reporting and resupply

8. Context setting
The need for Overdose prevention and
community based naloxone training

9. Illicit drug use at the global level
Globally, UNODC estimates that between 153 and 300
million people (3.4 to 6.6% of the population aged 15-64)
used illicit substances at least once in 2010.
Number of "problem drug users“ aged 15-64 years : 16-38 million persons (UNODC
2010)
Number of people who inject drugs aged 15-64 years : 11-21 million persons (UNODC
2010)

10. WORLD WIDE – BIG NUMBERS
ESTIMATED THAT LESS
1 IN EVERY 200 ADULTS THAN 1 IN 5 ‘PROBLEM
CLASSED AS ‘PROBLEM DRUG DRUG USERS’ ARE
USERS’ (27 MILLION PEOPLE) RECEIVING TREATMENT
APPROX. 200,000 IN 2009, 4.5
DEATHS EACH YEAR MILLION PEOPLE
DUE TO ILLICIT DRUG WERE RECEIVING
USE TREATMENT

11. Chunk up- global DRDs-We’re talking
big numbers….
• Between 104,000 – 263,000 deaths due to
illicit drug use each year
• More than half are fatal overdoses
UNODC World Drug Report 2011

12. We’re talking about a global
problem….
• Overdose- a leading cause of death in drug
users Coffin P (2008) Overdose: A Major Cause of Preventable Death in Central and Eastern Europe and
in Central Asia Recommendations and Overview of the Situation in Latvia, Kyrgyzstan, Romania,
Russia and Tajikistan. Vilnius, Lithuania: Eurasian Harm Reduction Network
• Mortality rates between 13-17 times greater
for PWID than for non using peers
Hickman M et al. (2003) Drug-related mortality and fatal overdose risk: Pilot cohort study of
heroin users recruited from specialist drug treatment sites in London. Journal of Urban Health
80: 274–8
• Between 30% and 82% of PWID experience
non fatal overdose, and 10%-20% in any given
year IHRA, (2010) Global state of Harm Reduction report.

13. Inter/national Overdose prevention
recommendations
• WHO- (naloxone on ‘Essential Medicines list’)
• CND- Commission on Narcotic Drugs
• UNODC- United Nations Office of Drugs & Crime
• ACMD- Advisory Council Misuse of Drugs
• NTA- National Treatment Agency
• NFDRD- National Forum on Drug Related Deaths

14. Some Scottish statistics
• 5.2 million Scottish population
• ~60 000 people misusing opiates and/or Benzodiazepines (ISD 2012)
• 32 648 know to services for problem drug use (ISD 2012)
• 22-25000 injecting drug users
• ~ 7,500-10,000kg of heroin consumed per year (McKeggney et.al. 2009)
• 22-25000 receiving methadone (MMT cost around £28m in ‘10)
• Illicit Drug use costs an estimated £3Bn(?) per year (SCDEA)

15. • primary mental health disorder may lead to substance misuse
• substance misuse may worsen mental health disorder
• substance misuse (intoxication/dependence) may lead to mental health
problems
• withdrawal from substance use often leads to mental health problems
• substance misuse and mental health problems may develop concurrently.

16. Scottish Drug use
• 55000-60000 opiate/benzo users (ISD 2009)
~ 1.7% of population age 15-64
Examples
GGC A&A Tayside
2.53%(95% CI 2.46 - 2.66%) 1.96%(95% CI 1.86-2.10%) 1.96%(95% CI 1.86-2.10%)
ISD Drug Misuse Stats 2010-http://www.drugmisuse.isdscotland.org/publications/09dmss/09dmss.pdf

18. Scottish DRD Trend 1996-2011
131% increase in drug related deaths since 1998 *
More than 130% increase in 10 years.

20. 2011 – 584 DRD’s in Scotland (GROS)
• UNDER • 25 – 34
25 YEARS YEARS
MALES
58 184 429
130 212 FEMALES
155
• OVER 45 • 35 – 44
YEARS YEARS

21. COMMON CIRCUMSTANCES IN FATAL
OVERDOSES
RECENT OD
EXPERIENCED BUT
SURVIVED
OLDER, MORE
EXPERIENCED INJECTOR
WITNESSES
PRESENT
RECENT ABSTINENCE
OR REDUCTION IN USE

22. Common circumstances of DRDs’ in
Scotland
Over half
of cases
*POTENTIAL
were 68%
occurred in
In more than
half the
cases, severa
In many MISSED
witnesses cases, person
by friend,
own or
friends
home
l hours had
elapsed
between
had previously
reported
OPPORTUNITIES
overdosing*
partner or
family
(2003 stat.) overdose
and death* for
member* INTERVENTION?

23. Thank You!
Stephen Malloy
Kirsten Horsburgh
Scottish Drugs Forum, Glasgow office- 0141 221 1175
www.sdf.org.uk and www.naloxone.org.uk
Email stephen@sdf.org.uk
kirsten@sdf.org.uk
Networking sites
Facebook - naloxone
LinkedIn – Stephen Malloy / Kirsten Horsburgh
Twitter - @stephencmalloy / @kirstenlh23