Reducing Opioid-Related Deaths in the UK

In recent years, there have been substantial increases in the number of people dying in the UK where illicit drugs are reported to be involved in their death. The largest increase has been in deaths related to the misuse of opioid substances; 2,677 opioid-related deaths were registered in the UK in 2015. The Advisory Council on the Misuse of Drugs (ACMD) therefore set up a dedicated working group to examine how to reduce drug-related deaths, with a focus on opioid-related deaths.

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Effectiveness of Scotland’s National Naloxone Programme for reducing opioid‐related deaths: a before (2006–10) versus after (2011–13) comparison

In 2008, the UK Medical Research Council funded the pilot phase of the individually randomized N‐ALIVE Trial to test the effectiveness of naloxone‐on‐release for reducing eligible prisoners’ Drug Related Deaths within 4 weeks of their prison release (by 30%) and during the next 8 weeks (by 20%) 16. The N‐ALIVE Trial had been due to begin in Scotland’s adult prisons but, in January 2011, was pre‐empted when Scotland became the first country internationally to introduce a centrally funded, coordinated and evaluated National Naloxone Policy (NNP).

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Review of naloxone safety for opioid overdose: practical considerations for new technology and expanded public access

Opioid overdose and mortality have increased at an alarming rate prompting new public health initiatives to reduce drug poisoning. One initiative is to expand access to the opioid antidote naloxone. Naloxone has a long history of safe and effective use by organized healthcare systems and providers in the treatment of opioid overdose by paramedics/emergency medicine technicians, emergency medicine physicians and anesthesiologists. The safety of naloxone in a prehospital setting administered by nonhealthcare professionals has not been formally established but will likely parallel medically supervised experiences. Naloxone dose and route of administration can produce variable intensity of potential adverse reactions and opioid withdrawal symptoms: intravenous administration and higher doses produce more adverse events and more severe withdrawal symptoms in those individuals who are opioid dependent.

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Consideration of Naloxone

In May 2012 the Advisory Council on the Misuse of Drugs (ACMD) released their report and advice to government on naloxone. The purpose of the report was to provide Government with advice on whether naloxone should be made more widely available, in order to prevent future drug-related deaths, and help engage and educate those most vulnerable of suffering an opioid overdose.

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Family carers and the prevention of heroin overdose deaths: Unmet training need and overlooked intervention opportunity of resuscitation training and supply of naloxone

Findings: Carers were usually parents (80%); 89% were currently caring for a heroin user of whom 49% had already had an overdose (93% involving opiates). One third had witnessed heroin being used, and 31 had witnessed an overdose. For eight carers, there had already been a death from drug overdose. There was poor knowledge of how to manage an overdose. Only a quarter had received advice on overdose management (26%) and only one third knew of the opiate antagonist naloxone (33%). The majority (88%) wanted training in overdose management, especially in emergency naloxone administration (88%). Interest in training did not differ according to carer type nor previous overdose experience.

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Prescription naloxone: a novel approach to heroin overdose prevention

The mortality and morbidity from heroin overdose have increased in the United States and internationally in the last decade. The lipid solubility allows the rapid deposition of heroin and its metabolites into the central nervous system and accounts for the “rush” experienced by users and for the toxicity. Risk factors for fatal and nonfatal heroin overdoses such as recent abstinence, decreased opiate tolerance, and polydrug use have been identified. Opiate substitution treatment such as methadone or buprenorphine is the only proven method of heroin overdose prevention. Death from a heroin overdose most commonly occurs 1 to 3 hours after injection at home in the company of other people. Numerous communities have taken advantage of this opportunity for treatment by implementing overdose prevention education to active heroin users, as well as prescribing naloxone for home use. Naloxone is a specific opiate antagonist without agonist properties or potential for abuse. It is inexpensive and nonscheduled and readily reverses the respiratory depression and sedation caused by heroin, as well as causing transient withdrawal symptoms. Program implementation considerations, legal ramifications, and research needs for prescription naloxone are discussed.

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