The need for increased availability and accessibility for naloxone in England

1. Naloxone
The need for increased availability
and accessibility in England

2. “In October 2015, legislation is expected to
be enacted that will allow wider access to
naloxone. But this should not delay the
provision of take-home naloxone to at risk
individuals now, using existing provision for
prescriptions and PGDs…”
Take-home naloxone for opioid overdose in people who use drugs
Public Health England

3. Who are NAG?
The Naloxone Action Group is
made up of a number of agencies
and individuals who have come
together to promote the wider
availability of naloxone in
England.
Scan this to visit
For more details:
nagengland.wordpress.com

4. What is naloxone
Naloxone is a medication
that reverses opiate
overdoses (eg heroin,
methadone or prescription
pain medications)
– Prescription only
– Safe to use
– Injected or intra-nasal
use

5. Why we need naloxone
There has been a 32% rise in UK heroin and
morphine related deaths
765 deaths in 2013

6. Monthly ambulance call outs in London responding
to heroin overdoses
0
5
10
15
20
25
30
35
40
45
50
Jul2009
Sep2009
Nov2009
Jan2010
Mar2010
May2010
Jul2010
Sep2010
Nov2010
Jan2011
Mar2011
May2011
Jul2011
Sep2011
Nov2011
Jan2012
Mar2012
May2012
Jul2012
Sep2012
Nov2012
Jan2013
Mar2013
May2013
Jul2013
Sep2013
Nov2013
Jan2014
Mar2014
May2014
Jul2014
Sep2014
Nov2014
Heroin Overdoses Linear (Heroin Overdoses)
Source: http://data.london.gov.uk/dataset/monthly-ambulance-service-incidents-borough/resource/d1fdc814-fa13-4bda-b4f7-f258afd2b3b3

7. “New figures show the East Midlands Ambulance
Service's use of Naloxone has increased by 73 per
cent in the last four years, with bosses saying the
drug is now saving hundreds of lives.
Paramedics used the life-saving drug on around
1,340 patients in the last financial year – a
significant rise from an estimated 978 four years
ago.”
‘Miracle drug’ is a growing lifesaver
Nottingham Post, 10 May 2014

8. Does take-home naloxone reduce
non-fatal overdose?
53%
15%
32%
Prevalence of overdose
in injecting drug users
Not overdosed
Overdosed in the
last year
Overdosed but
not in the last
year
N= 661
• Of those who had overdosed in the past
year, 85 disclosed how many times: once
(44), two times (26), three (seven), four
(two), five (two), six (one), seven (one),
eight (one), and 12 times (one): a total of
168 survived overdoses.
• For the 308 most recently survived opiate
overdoses, naloxone was given by
paramedics (58), by non-paramedics
(49), or by both (6)—ie, in 113 out of 308
overdoses.
• 284 of 308 respondents disclosed
whether they were alone at the time of
their most recent overdose: 245 were
with someone else.
Does take-home naloxone reduce non-fatal overdose? Bennett, Trevor et al. The Lancet , Volume 383 , Issue 9912 , 124 - 125

9. Naloxone is just part of a response
Naloxone is an addition
to a greater set of
overdose interventions,
you should still:
– Check ABC
– Dial 999
– Stay with them

10. Why do it?
Potential 100s of lives
can be saved
Prevents brain damage
in non-lethal OD
Reduces stigma
Keeps OD a priority
Engages at risk groups

11. “People likely to witness an opioid overdose
should have access to naloxone and be
instructed in its administration to enable
them to use it for the emergency
management of suspected opioid overdose.”
Community management of opioid overdose
World Health Organization

12. 1. Prescribe or issue naloxone via PGD(Patient
Group Direction) or Patient Specific Direction
(PSD) for everyone who uses opioids or is at
risk of relapse to use of opioids
2. Hence issue to all starting OST or visiting
NSP
– Everyone visiting GP or A+E if using
opioids
3. Can use FP10, PSD or PGD
4. Make OD management training available to all
people who might be present at OD, GP, drug
services, police, hostels, community services,
family members, carers, prison, probation
service
5. Improve understanding commissioners on it’s
importance
What you can do now!

13. What can can’t do (sort of)
Issue to non-health care workers: hostel staff,
rehabs, outreach workers, police stations,
family members
This is what the October 2015 regulations will
change
Although…
People carrying naloxone can use ‘public
service decision’ to use hence will be protected
One of the formulations currently available
(Prenoxad) can be supplied to a patient’s
representative as long as we have the written
permission from the patient

14. Naloxone e-module
Already available
Free to access
Comprehensive training
resource
Takes about an hour
Assessment + certificate
Scan this to visit
smmgp-elearning.org.uk

15. Key messages
Go out and do it!
Prioritise supply to people who use drugs
(including those not in treatment)
Ensure people on OST have it
Normalise it in services
Dispel myths
Make training brief, and to everyone
Involve peer trainers
Save hundreds of lives

16. “I didn’t know that he was using until I got
the call from the hospital. He had
accidentally overdosed on heroin and valium
and was technically dead. Three shots of
Naloxone saved his life. I’d never heard of
Naloxone before. It doesn’t bear thinking
about what life would be like if it hadn’t been
available that night.”

17. Thank you
Visit NAG England:
nagengland.wordpress.com
Save some naloxone