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drinkanddrugsnews
| December 2013
Opinion |
Naloxone
www.drinkanddrugsnews.com
I LIVE IN KENT
, one of 16 sites from
the 2010 NTA naloxone pilots for
families and carers of heroin/opioid
users. Locally, ‘Take Home Naloxone’
(THN) for service users, their families
or carers has since become integral to
our treatment system due to the
numerous, ongoing, successful, docu-
mented overdose reversals. Yet this
week, I received an email from a col-
league 240 miles away in NW England
asking if I knew how to help a man
living 140 miles away in Peterborough,
a city 120 miles from me.
He wanted THN for two close
friends who were just leaving prison
and – as he quite rightly understood –
were at much heightened risk of
overdose. He is highly educated and
computer literate, yet had been unable
to obtain this potentially life-saving
medicine. To see if he was overlooking
anything obvious, I did the natural thing
and Googled ‘Peterborough’ AND
‘naloxone’; however, I couldn’t find any
information about its availability, let
alone how a heroin user, their lover,
parent, son or daughter might obtain it.
The latest published UK drug-
related death data show that,
annually, Peterborough has 6.21 drug-
related deaths per 100,000
population – largely opiate-related
ie
ones for which THN is relevant. This is
pretty much the midpoint rate between
those UK localities with the highest
and lowest drug-related death rates. In
plain English, in Peterborough and
places like it, year-on-year a modest
number of opiate users die from
overdoses, some of which are almost
certainly preventable.
It’s important to emphasise that
the fact that this happened in
Peterborough is almost entirely
incidental. It’s just where one
persistent guy lives. I barely know the
city/its services and have no reason
whatsoever to think they are any
better or worse than those elsewhere.
On the contrary, Peterborough’s
services could be truly excellent in all
respects other than its THN service. I
honestly have no idea.
The crucial point is that this well-
informed, justifiably concerned friend
could have lived in numerous, similar
English cities where THN is
unavailable. Or, conversely, assorted
other areas where THN is actively
promoted. His ability to take measures
to reverse a friend’s potentially fatal
opioid overdose is determined in an
arbitrary way, according to where he
lives. A situation that would be
regarded as intolerable if it were
applied to, say, provision of patient-
held adrenaline for people with a
history of anaphylaxis from bee-stings.
Clearly, we should be cautious
about deducing too much from one
isolated case, however many hundred
miles of unnecessary communication
it involved. Nevertheless, I’d argue
that this example warrants serious
consideration for several reasons:
a)
A Peterborough citizen and taxpayer
who cares for his friends and under-
stands the risks and issues around
heroin overdose sought help via two
perceived ‘experts’ on different sides
of the country across about 500
miles, only to be told, ‘Sadly, it’s up to
your local commissioners. If they
don’t fund THN then you can’t get it.’
This seems a very potent illustration
of well-informed demand in an area
where drug-related deaths need to
be reduced.
b)
Anecdotally, harm reduction, needle
exchange, active drug user and
recovery networks often hear that the
‘THN availability problem’ is
widespread, yet no reliable mapping
of English THN outlets/availability
exists. An interactive naloxone finder
database is being developed for
Scotland in a way that could be
extended across the UK
(www.naloxone.org.uk), but England
currently lacks both coordination and
strategic vision in its approach to
THN, rendering it both less effective
than it might be and probably with
higher unit costs too.
c)
Public Health England (PHE) is
currently navigating its way through
complex political and organisational
changes and clarifying its role at a
time of economic austerity. THN is an
affordable intervention that naturally
fits within public health and could
potentially benefit from comprehensive
PHE advocacy and support. At present,
many commissioners and providers of
drug services and, vitally, many of the
people who are most likely to witness
an overdose – opiate users and their
friends, families and lovers – seem
barely aware of its existence.
Take Home Naloxone is a potentially
important test of the role that Public
Health England will fulfil in the new
system in which we are now
operating. PHE is not responsible for
the THN policy shambles it has
inherited. Nevertheless, in 12 months
time, if people who need THN to
protect the lives of those they care for
are still jumping through such
tortuous, long-distance hoops, only to
discover that they are arbitrarily
denied services that are readily
available in an adjoining locality, I
think many people may be left
questioning whether ‘public health’
has been well served, and how PHE
can in any way claim to be an agency
that serves all of ‘England’.
Neil Hunt is honorary research
fellow, The Centre for Research on
Drugs and Health Behaviour, London
School of Hygiene and Tropical
Medicine and honorary senior research
associate, School of Social Policy,
Sociology and Social Research,
University of Kent
Why in the name of
public health is
naloxone distribution
still a postcode
lottery, asks
Neil Hunt
‘THN is an
affordable
intervention
that naturally
fits within
public health
and could
potentially
benefit from
comprehensive
PHE advocacy
and support.’
LIFE
A matter of
and death