Stopping an overdose: the story of take-home naloxone

22 August 2017

Dependence on opioid drugs, such as heroin and many commonly used prescription painkillers, is a major international healthcare concern, with an estimated 69,000 people dying each year from opioid overdose.¹

This problem extends to Europe, where there are approximately 1.3 million opioid users at risk of overdosing, and where opioids account for the majority of the 6,000–8,000 registered overdose fatalities that occur each year.^2,3 In addition, recently published data on drug-related deaths in England, Wales and Scotland have shown, rather worryingly, that opioid-related deaths are on the rise.^4,5

Several strategies have been developed in response to the concerning high rates of opioid-related deaths; a subset of these are used to prevent overdoses from occurring, while others aim to reverse the effects of an overdose when they do occur.³ One such intervention of stopping an overdose when it does occur involves distributing naloxone, an opioid receptor antagonist, to opioid users and people likely to witness an overdose. When administered on time, naloxone is able to completely reverse an opioid overdose and thus stop a person from dying.^1,3

The life-saving potential of naloxone is the reason why, for decades, advocates have been campaigning for the implementation of take-home naloxone (THN) programmes in medical and nonmedical settings.^6,7 These schemes are incredibly important as they provide overdose education and training, and distribute naloxone kits to people at risk of overdose and those who are likely to witness one (e.g. users’ peers and hostel staff).^6,7 Furthermore, the link between THN programmes and reduced opioid-related mortality rates is strongly supported by many pieces of compelling evidence that have been published in recent years.^8,9,10

With this in mind, it is a pity that in Europe no more than 10 countries have introduced THN programmes.³ Indeed, significant barriers (legal, clinical and patient-level) preventing access to naloxone still exist in several European countries.⁶

However, the situation is changing: the number of European countries introducing THN programmes is on the rise, as is support for naloxone distribution from clinical guidelines, governments and international strategy plans.^3,11 In exciting news, the UNODC-WHO-led S-O-S Initiative was launched this year and details a much-needed strategy for reducing rates of opioid overdose deaths at a global level by increasing naloxone availability and training to all individuals likely to witness an overdose.¹²

This is one of the many much-needed steps in the right direction, but more should be done to counteract the worrying high rates of opioid overdose mortality, which in Europe are on the rise.¹³ Therefore, it is imperative for clinicians, policy-makers and governmental bodies to actively work together to provide wider access to naloxone and to overcome any remaining barriers that prevent THN programmes from being implemented. Accomplishing this will be key to saving and improving the lives of many, both across Europe and the world.

References

1. World Health Organization (WHO). Information sheet on opioid overdose. http://www.who.int/substance_abuse/information-sheet/en/ [last accessed July 2017]
2. European Monitoring Centre for Drugs and Drug Addiction. Mortality among drug users in Europe: new and old challenges for public health. 2015. http://www.emcdda.europa.eu/system/files/publications/961/TDAU14010ENN.pdf[last accessed July 2017]
3. European Monitoring Centre for Drugs and Drug Addiction. Preventing overdose deaths in Europe. http://www.emcdda.europa.eu/topics/pods/preventing-overdose-deaths [last accessed July 2017]
4. Office for National Statistics (ONS). Dataset: Deaths Related to Drug Poisoning, England and Wales. 2017. Table 6a. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/datasets/deathsrelatedtodrugpoisoningenglandandwalesreferencetable[last accessed August 2017]
5. National Records of Scotland (NRS). Drug-related deaths in Scotland in 2016. 2017. Available at: https://www.nrscotland.gov.uk/files//statistics/drug-related-deaths/drd2016/16-drug-rel-deaths.pdf [last accessed August 2017]
6. European Monitoring Centre for Drugs and Drug Addiction. Preventing opioid overdose deaths with take-home naloxone. 2016. http://www.emcdda.europa.eu/system/files/publications/2089/TDXD15020ENN.pdf[last accessed July 2017]
7. Public Health England (PHE). Take-home naloxone for opioid overdose in people who use drugs. http://www.nta.nhs.uk/uploads/phetake-homenaloxoneforopioidoverdosefeb2015rev.pdf [last accessed July 2017]
8. European Monitoring Centre for Drugs and Drug Addiction. Preventing fatal overdoses: a systematic review of the effectiveness of take-home naloxone. 2015. Available at: http://www.emcdda.europa.eu/system/files/publications/932/TDAU14009ENN.web_.pdf[last accessed July 2017]
9. Clarke AK, et al. A systematic review of community opioid overdose prevention and naloxone distribution programs. J Addict Med 2014;8(3):153-63.
10. McDonald R and Strang J. Are take-home naloxone programmes effective? Systematic review utilizing application of the Bradford Hill criteria. Addiction2016;111(7):1177-1187.
11. HM Government. 2017 Drug Strategy. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/628148/Drug_strategy_2017.PDF[last accessed August 2017]
12. United Nations Office on Drugs and Crime (UNODC) and World Health Organization (WHO). The S-O-S Initiative—Stop Overdose Safely. Available at: https://www.unodc.org/documents/commissions/CND/The_S-O-S_InitiativeStop_Overdose_Safely_-_UNODC-WHO_multi-site_study_on_community_management_of_opioid_overdose_including_emergency_naloxone.pdf[last accessed August 2017]
13. European Monitoring Centre for Drugs and Drug Addiction. European Drug Report. Trends and developments. 2017. Available at: http://www.emcdda.europa.eu/system/files/publications/4541/TDAT17001ENN.pdf_en[last accessed August 2017]