Case Study of Harm Reduction, Homelessness and Drug Use in Dublin, Ireland

Dublin has outperformed even best-case scenarios for COVID-19 mortality among homeless and drug using populations… the importance of strategic clarity and delivery, housing, lowered thresholds to methadone provision, Benzodiazepine (BZD) provision and Naloxone availability were key determinants of policy success. Further, given the rapid collapse in policy barriers to these interventions that COVID-19 produced, it is important to secure and protect these improved policy responses into the post-COVID19 era.

Abstract: Opioid overdose deaths are a major health issue in Australia and around the world. Programmes to provide opioid consumers with ‘take-home’ naloxone to reverse overdose exist internationally, but uptake by mainstream health services and consumers remains inconsistent. Researchers have identified a range of important educational, training and logistical impediments to take-home naloxone uptake and distribution, yet they have focused less on the social dynamics that can enhance or limit access, such as stigma.

Opioid overdose is a major public health issue associated with substantial morbidity and mortality in Australia. Indeed, nearly half the IDRS sample in 2019 reported having experienced an opioid overdose. Naloxone is an important intervention which reverses opioid overdose and has been available over-the-counter in Australia since 2016. This bulletin describes the awareness of naloxone and the take-home naloxone program in Australia, both nationally and by jurisdiction. It also explores access, use and acceptance of naloxone, and examines demographic differences for these aspects.

Adverse reactions to naloxone, such as withdrawal symptoms and aggression, are widely recognised in the literature by pharmaceutical manufacturers and clinical practitioners as standard reactions of individuals who are physically dependent upon opioid drugs following the reversal of potentially fatal opioid overdose. This paper seeks to provide a differentiated view on reactions to naloxone that may have important implications for public health and harm reduction approaches.

Drug seizure data indicate the presence of fentanyl in the cocaine supplies nationally and in New York City (NYC). In NYC, 39% of cocaine-only involved overdose deaths in 2017 also involved fentanyl, suggesting that fentanyl in the cocaine supply is associated with overdose deaths. To raise awareness of fentanyl overdose risk among people who use cocaine, the NYC Department of Health and Mental Hygiene pilot tested an awareness campaign in 23 NYC nightlife venues. Although 87% of venue owners/managers were aware of fentanyl, no participating venues had naloxone on premises prior to the intervention.

Objectives: To characterise the community pharmacy supply of naloxone by supply type — individual prescription, prescriber bag, and non‐dispensed (supplied over the counter or expired) — during 2014–2018; to examine whether the 2016 rescheduling of naloxone as an over‐the‐counter drug influenced non‐dispensed naloxone supply volume.