This document discusses opioid overdose and the use of naloxone to reverse overdoses. It provides statistics on drug-related deaths in the UK and risk factors for overdose. Naloxone is described as a temporary antidote that reverses the effects of opioid overdose by binding to opioid receptors but not activating them. The document outlines how to recognize an overdose, administer naloxone via injection, and the need to still call emergency services. Barriers to naloxone access and potential future developments are mentioned.

1. Kevin Ratcliffe FRPharmS (IP) FFRPS
Consultant Pharmacist (Addictions)
NMP Lead (BSMHFT)

2. Why am I here…….?

3. Naloxone
• 2005 – UK
Law
changed
• 2012 -
ACMD

4. Drug-related deaths in England and
Wales 2008 - 2012
Opioids (inc heroin, methadone, codeine etc.) 3554
Cocaine 291
Amphetamine 127
MDMA / ecstacy 53
Novel psychoactive substances 78
Source: ONS 2012

5. More recent headlines:
 Heroin/morphine remain the substances most
commonly involved in drug poisoning deaths. 765
deaths involved heroin/morphine in 2013; a sharp rise of
32% over 2012.
 There was a sharp increase of 21% in the number of drug
misuse deaths in England in 2013, with no change to the
number of these deaths in Wales.
 Over half (56%) of all deaths related to drug poisoning
in 2013 involved an opiate drug.
 The female mortality rate for deaths involving
heroin/morphine has been gradually increasing since
2010, and reached the highest rate on record (since 1993)
in 2013
ONS Sept 2014

6. Overdose: a serious situation
 Most heroin users will witness / experience an
overdose at some point:
‘From a sample of 155 drug using clients in South
London in 2000 :
46% had overdosed themselves;
82% had witnessed overdoses,
43 of which were fatal.’
 (Best D., Man LH., GossopM., Noble A., Strang J., 2000)

7. Opiate overdose
 Overdose causes respiratory depression and can
lead to death….
 But, most overdoses happen in the presence of other
people who could potentially prevent death with the
right training….
 ……and with naloxone

8. Risk Factors in Overdose
 Injecting rather than smoking drugs
 Mixing drugs – especially heroin, benzos, alcohol,
methadone etc. (all our respiratory depressants and
affect breathing)
 Using alone
 Variable purity of street drugs, changing dealer etc.
 Using in unfamiliar surroundings – not engaging in
normal drug-taking routine
 Using with unfamiliar people – who may not stick
around or help in an overdose situation…..

9. Risky times……..
 Loss of tolerance
 Leaving prison
 Relapse after leaving detox / rehab / hospital
 Risk of fatal overdose is 8x higher in first 2 weeks of
leaving prison than in following 10 weeks !!
 Beginning / ending substitute medication
 Difficult life events – such as bereavement, loss of
contact with children, separation / divorce

10. How to Recognise Opiate Overdose
Person unconscious, and cannot be woken -
UNROUSABLE and does not respond to noise or
touch (e.g. shoulder shake)
CYANOSIS – BLUE tinge to lips, tip of nose, eye
bags, finger tips or nails
Not breathing at all or taking slow/shallow or
infrequent breaths - DEEP SNORING / RASPING
sounds
PIN POINT pupils

11. Overdose myths – what not to do
 Do not Panic! Do not run away.
 Do not put person in a cold bath or shower
 Do not walk them around.
 Do not copy “Pulp Fiction’ - injecting
adrenalin into the heart
 Do not give stimulants, amphetamines,
cocaine, black coffee.
 Do not inject salt water.

12. But what you can do…………
 Phone 999
 ABC + naloxone
 Ambulance
 Breathing
 reCovery position
 Naloxone
 Stay with the casualty

13. Remember……..

14. Naloxone
 Temporarily reverses the effects of an opiate overdose
 No effect on overdoses resulting from the use of other
drugs
 Short acting - can begin to wear off in 20 mins
 Overdose can last for 8 hours or more (especially with
methadone)
 Only for use with continued medical support – still
need to ring 999 (buys time)
 No potential for abuse
 Naloxone precipitates WITHDRAWAL – the individual may
want to use again straight away/ become aggressive.

15. Individual response to naloxone
 To emphasize: duration of effect approx. 20 minutes
 Depends on:
 What opiate was used
 How much
 Any other drugs / alcohol
 Works in 2-3 minutes but wears off faster than the
opiate does.

16. How to use naloxone………
 Inject into a muscle
 Side of thigh area or upper arm.
 Hold needle 90 degree above skin
 Insert needle into muscle
 Slowly and Steadily push plunger as
directed
OK to go through clothes

17. “My hands were shaking. I was really
scared. But I knew that if I didn’t do
something he was going to die. Now when I
look at him, it makes me smile on the inside to
know that I saved his life.”
Service user, Birmingham 2013

18. Barriers……….
Current supply route = lots of opportunities
to drop out
 Lack of awareness
 Special circumstances (in particular, prison)
 Money….??

19. Who do you train….??

20. Naloxone supply:
 Training package (adaptable to group or 1:1 setting) –
keep it simple and keep it inclusive
 Targeted approach, but inclusive
 Testing understanding
 Pack developed that contained everything needed
 Supply at point of training via PGD
 Option for re-supply included if needed
 Service driven at each hub by the NMP (“champion”)
 Prison: training delivered by in-reach worker, but
testing and supply made on release with bridging Rx

21. What do patients/clients/service
users think ?
My friend told me about naloxone. He hadn’t
been using heroin for a few months, but lapsed
at the weekend at a mate’s house. He only
used a couple of bags but went over and died.
He’d left his naloxone at home.

22. What do patients/clients/service
users think ?
We’re not big users, just a bag or two on pay
day. This time was different. Don’t know why.
It was obvious to me he had overdosed. I
panicked a bit. Couldn’t remember all the stuff
they said, but I got him on his side and
whacked in the naloxone. He came round a bit
but then the ambulance got there. He made it,
but it scared the sh*t out of me.

23. Outcomes (end Mar 2014)
 200 kits issued in pilot phase (Feb-Mar 2013)
 1000 kits issued (Apr – Mar)
 15 known reversals
 Greater awareness – clients are asking about it.
 Other services now getting up to speed
 Unplanned prison releases are still a challenge
 Forgot to get ambulance service on-board: a big
learning !!

24. New-ish kid on the block

25. Naloxone e-module
 Already available
 Free to access
 Comprehensive training
resource
 Takes about an hour
 Assessment + certificate

26. The future…….?
 Greater availability ? – consultation
 Other products licensed ?
 Different delivery system ?