Naloxone in Scotland (1)Drugs Related DeathsStephen Malloy Kirsten HorsburghNational naloxone Coordinator National Training & Development email@example.com firstname.lastname@example.orgA national resource of expertise on drug issues
Overdose- a leading cause of death in opiate users Preventing death is our primary objective 2
Stephen –Strategy and policy influenceWorkforce developmentDesign/delivery of competency training focusing on;- NATIONAL NALOXONE PROGRAMME- CRITICAL INCIDENTS Suicide pre/inter and ‘postvention’ Bacterial infections in PWID eg. Anthrax, ClostridiumKirsten –Plan, develop and deliver a range of training tosupport the national naloxone programme- PEER EDUCATION NETWORKS
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
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)
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.
What’s in the training for beneficiaries Naloxone Kit assembly/administrationOverdose prevention What Naloxone is/does BLS Calling 999, reporting and resupply
Context settingThe need for Overdose prevention and community based naloxone training
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)
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 PEOPLEDUE TO ILLICIT DRUG WERE RECEIVING USE TREATMENT
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
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.
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
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)
• 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.
Scottish Drug use• 55000-60000 opiate/benzo users (ISD 2009) ~ 1.7% of population age 15-64ExamplesGGC A&A Tayside2.53%(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
Scottish DRD Trend 1996-2011 131% increase in drug related deaths since 1998 * More than 130% increase in 10 years.
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
COMMON CIRCUMSTANCES IN FATAL OVERDOSES RECENT OD EXPERIENCED BUT SURVIVED OLDER, MOREEXPERIENCED INJECTOR WITNESSES PRESENT RECENT ABSTINENCE OR REDUCTION IN USE
Common circumstances of DRDs’ in ScotlandOver half of cases *POTENTIAL were 68% occurred in In more than half the cases, severa In many MISSEDwitnesses cases, personby friend, own or friends home l hours had elapsed between had previously reported OPPORTUNITIES overdosing*partner or family (2003 stat.) overdose and death* formember* INTERVENTION?