People are dying because of a lack of harm reduction and access to naloxone

Lack of focus on harm reduction and shameful failure to roll out naloxone in England is leading to needless deaths. I feel deeply sad and ashamed to be part of a system that is letting this happen.

I believe the failure of Government to roll out naloxone in England and a lack of focus on and dis-investment in harm reduction and drugs services is a factor in the 32% increase in heroin/morphine related deaths. Many people I suspect are now being encouraged to leave treatment before they are ready.

There were 765 deaths involving heroin/morphine in 2013; a sharp rise of 32% from 579 deaths in 2012. Many of these fatalities could have been prevented by the use of naloxone as an intervention.

Naloxone is a medicine that is a safe, effective, with no dependence-forming potential. Its only action is to reverse the effects of opioid overdoses, and it is already used by emergency services personnel in the UK for this purpose. Naloxone provision reduces rates of drug-related death particularly when combined with training in all aspects of overdose response 

The Advisory Council on the Misuse of Drugs (ACMD) undertook a review of naloxone availability in the UK and in May 2012, its report to the Government strongly recommended that naloxone should be made more widely available, to prevent future drug-related deaths.

In Scotland and Wales, successful pilots resulted in national programmes to make naloxone widely available but there has been no similar national programme in England. Scotland has allowed naloxone to be provided to services without prescription, for use in an emergency. This enables Scottish drug treatment and homeless hostel staff to have naloxone ready for use. We urgently need the law in the UK changed to allow this.

Naloxone is available on prescription in England to people at risk of opioid overdose. However, maximum impact on drug-related death rates will only be achieved if naloxone is given to people with the greatest opportunity to use it, and to those who can best engage with heroin users.

The ACMD in May 2012 made 3 recommendations for government to take to maximise naloxone’s role in reducing drug-related deaths.

  1. Naloxone should be made more widely available, to tackle the high numbers of fatal opioid overdoses in the UK.
  1. Government should ease the restrictions on who can be supplied with naloxone
  1. Government should investigate how people supplied with naloxone can be suitably trained to administer it in an emergency and respond to overdoses

Over two years later in July 2014 Jane Ellison Parliamentary Under Secretary of State for Public Health wrote to confirm that Government would act on the recommendations by October 2015 in England. Not only does this shamefully push the issue into the post election long grass it also makes no suggestion of a national programme similar to Scotland or Wales. Perhaps we should conclude that English heroin users lives are worth less than the Welsh and Scottish ones. Think I’m cynical; sources in Public Health England tell me a roll of naloxone is not on their agenda and they have no current plans.

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4 thoughts on “People are dying because of a lack of harm reduction and access to naloxone

  1. Like you,I am shocked by the 32% rise in heroin and morphine deaths and like you I wonder at the possible causes.

    Could it be that we’ve been encouraging people to detox before they have got their heads and hearts (and social situation) in order? Could it also be partly the bedroom tax, benefits being stopped, people losing their flats?
    People might wonder how in this climate Wales has managed to keep its DRD rate static (and this would have been only in the very first few months of its naloxone programme) and Scotland has not only avoided the increase , but has even managed a small reduction in deaths over the same period.

    I am still just amazed that there are not loud and strident PHE voices calling for naloxone to be prescribed at the very least to everyone who is prescribed methadone (even if we do have to wait a year for the ‘wider provision’ regulations to come into force with I agree seems astonishing). Bring back the NTA at least for a bit of leadership and co-ordination?
    These latest terrible figures might make them sit up and take notice?

    A strong statement that naloxone kits should be prescribed for everyone who uses or has used opiates, and certainly for anyone prescribed methadone. Also something like the Scottish ‘Lord Advocates letter’ would allow us to give naloxone kits to parents, friends, outreach workers and hostel workers immediately while we wait for the committees to actually change the regulations. The WHO guidance will be out in the next few days and should say the same thing.
    Its not rocket science and its much cheaper than an epipen. Are our patients worth less than people who eat peanuts? Come on England. Catch up with Scotland.

    1. Thank you for your excellent response. Blenheim and I in the coming weeks will be seeking to join with others to create the loud and strident voice that should be coming from PHE. I will ensure your suggestions are fed into a growing call for action.

  2. Thanks for responding and taking up these important issues. Blenheim and I are keen to ensure that both the lack of access to naloxone and the issue of people exiting treatment before they are ready are addressed.

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