Release ’ s landmark Finding a needle in a haystack report made headlines when it revealed that while all but three of the local authorities who responded to the charity ’ s FoI request were supplying naloxone , they were doing it in such small quantities that the impact was negligible ( DDN , March 2019 , page 4 ).

‘ This life-saving medication is not reaching those who most need it ’, Release stated , with the document stressing the need for naloxone to be made easily available to people not in contact with mainstream treatment services , for example via pharmacies or peer networks . In many areas , take-home naloxone was only available ‘ through the main drug treatment provider ’, the report found , with a quarter of councils failing to provide kits to people in contact with outreach services for homeless populations , for example . If there was ever any doubt over the need for this , a St Mungos report from last year stated that in 2018 around 12,000 rough sleepers had gone without drug or alcohol treatment – the same year that recorded a 55 per cent increase in drug deaths among people sleeping rough . It also found that the number of rough sleepers with a drug problem had increased from 50 per cent to 60 per cent in just four years .

IT ' S ABOUT HARM REDUCTION ‘ Getting out as much naloxone as possible to people who don ’ t necessarily engage with standard services is really important ,’ says Megan Nash , team leader for WDP ’ s Redbridge outreach service , where all workers have carried it since the service ’ s inception . ‘ That ’ s both because it ’ s getting a lifesaving drug to the people most at risk of drug-related deaths , but it ’ s also starting a conversation about harm reduction . It allows you to have a short conversation about how to use it and about risk of overdose – what to look out for and how to prevent it .’

Crucially , it ’ s also about ‘ giving someone something ’, she points out . ‘ I think that can be a really nice engagement tool . It just feels friendlier to give someone a little present , and people can then spread the word .’ This kind of harm reduction approach can be transformative when dealing with people with very complex needs , such as the Redbridge team ’ s clients . ‘ It ’ s a way of showing you care about people , and a way of getting them in contact with services , which they may have struggled to engage with in the past as they ’ re expected to turn up at a specific time , and not intoxicated . I absolutely appreciate that it can be difficult for a lot of mainstream services to manage these kinds of clients , but just having that positive engagement and being told “ we care about you ”, that someone genuinely is worried about your safety and whether you live or die , is crucial for us .’

None of her team have ever had to administer naloxone themselves , she says , an illustration of how important it is to ‘ get it distributed – because a lot of people will be

using in hidden places . Often our service users tend to use in groups – in temporary accommodation and squats and things like that . It ’ s not as easy to see as an outreach worker , and you can ’ t be there all the time , so it ’ s really important that it gets out through people who will be in that situation .’

This kind of peer-to-peer distribution model is vital agrees her colleague Dave Targett , WDP ’ s operations manager . ‘ We had a massive squat in the city centre in Chester a year or so ago and we kept giving it to people to take in there to give to others – targeting those high-population areas is really important .’

INADEQUATE SUPPLY Another alarming finding from the Release document was that only half of prisons and one in five young offender institutions were actually providing naloxone to those leaving custody – this despite the up-to-eightfold increase in risk of a drug-related death the first two weeks after release , as a result of reduced tolerance levels . The amount of take-home naloxone being given out to people on

' We need more widespread understanding over the legality of it , the guidance , the litigation issues , safety .'

TEMPORARY CHIEF INSPECTOR JASON MEECHAM

release in 2017-18 was ‘ wholly inadequate ’, it said , with kits and training provided to just 12 per cent of opiate clients as they left custody . The report also called for take-home naloxone programmes to be extended to immigration removal centres and policy custody suites . A pioneer when it comes to the latter has been Durham Constabulary , where more than 200 police officers and civilian staff have so far received naloxone training ( DDN , May , page 13 ).

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