On the 1st of October 2015, the UK government brought in legislation to allow naloxone to be supplied to individuals (drug users, carers, friends or relatives) in drug services without a prescription.
Before this legislation, naloxone was only available via prescription, directly to a named patient who was at risk of an overdose, or provided to peers or family members with their agreement.
What is Naloxone?
Naloxone is an opioid antagonist that can temporarily reverse the effect of an opioid overdose by competing with the opioid (e.g. heroin) for its receptors in the brain. If administered promptly it can reverse potentially fatal reductions in rate and volume of breathing, thus buying time to transfer the person to hospital. Naloxone is dispensed alongside training in basic resuscitation techniques and an imperative to telephone an ambulance before administering it. This is because the half-life of naloxone is shorter than that of heroin, meaning that the person’s condition could deteriorate again as it wears off.
Who are the target population?
The target population for this medication are those who are at risk of overdose; opiate users who have recently gone through a period of abstinence or reduced use, or those recently released from prison or treatment facilities. For example, one in 200 prisoners with a history of injecting drug use will die from a drug related cause within four weeks of release (Strang, 2013). Overdoses often happen in the drug users’ own home, with witnesses present (Strang, 1999). However, those at the scene of the overdose may be reluctant to call an ambulance due to fear of arrest for drug possession, so increasing the accessibility of naloxone is important.
Scotland and Wales were the first countries to introduce take-home naloxone in 2011, 15 years after it was promoted as a harm reduction solution in the British Medical Journal (BMJ) by John Strang in 1996. Since then evidence has been collated and policies have been put forward to make naloxone accessible to those who need it most. An assessment by Bird et al (2015) of the effectiveness of Scotland’s National Naloxone Programme (NNP), found that the proportion of opioid-related deaths in the 4-week period after prison release had reduced by 36% in comparison with the period prior to implementation in 2011.
Take-home naloxone is recommended by various government bodies and organisations. For example, the Advisory Council for the Misuse of Drugs (ACMD) recommended the take-home naloxone in 2012, and the World Health Organisation (WHO) has published the guidelines on community management of opiate overdose which includes a recommendation to use naloxone in the community.
It is argued that the use of naloxone with an opiate overdose is similar to the use of an EpiPen with severe allergies. EpiPens are provided to anyone at risk of a severe allergic reaction with the advice to carry two with them at all times for emergency use. An ambulance should be called after every use, even if symptoms are improving.
A double-blind randomised control trial (RCT) called “The N-ALIVE project (NALoxone InVEstigation)” took place in 14 prisons across the UK testing the effectiveness of providing take-home emergency naloxone to prisoners with a history of heroin use, on their release. The pilot trial was completed in 2014. A link for more information on this study can be found below.
Work at the National Addiction Centre is currently looking at the development of non-injectable forms of naloxone, including a buccal tablet, to enable even wider provision of the antidote.
The progression of non-injectable naloxone is still in development, and the information presented here is likely to be subject to frequent change.
For more information:
An open letter from Professor John Strang: preliminary advice on Naloxone
What is naloxone?
N-ALIVE trial information.
The opinions expressed in this commentary reflect the views of the author(s) and do not necessarily represent the opinions or official positions of the Society for the Study of Addiction.