‘ The distribution of naloxone to opiate misusers should be seriously considered for trial and evaluation . While the problem of heroin misuse grows worldwide , the problem of deaths from accidental overdose is a problem we can address today . We have the opportunity to gather great potential health gains from tools already in our hands .’

So said a BMJ editorial co-authored by Professor John Strang – exactly a quarter of a century ago . The June 1996 article covers the points – not least naloxone ’ s ‘ negligible ’ potential for misuse – that have been debated endlessly since , and concludes by saying ‘ We may even wish to consider its legal status so it could be sold over the counter by community pharmacists ’.

Yet despite much energetic campaigning – and spiralling drug death rates – we ’ re still a long way from that , or even from naloxone being in the hands of everyone who needs it . First developed in the 1960s , naloxone has been used to reverse opioid overdose by emergency services for more than 40 years , and in 2005 was made available under UK law to be administered by anyone for the purpose of saving a life . Despite the ongoing battle for coverage , the recent launch of a landmark national naloxone campaign using posters of people with lived experience to spread awareness and challenge stigma

( DDN , May , pages 5 and 12 ) is a measure of how mainstream the naloxone message is now becoming .

WE ' VE COME A LONG WAY ‘ It ’ s come along leaps and bounds compared to how it used to be but for some reason there ’ s still reluctance in some places , which I ’ ll never understand ,’ peer support lead at the Hepatitis C Trust and longstanding naloxone champion , Philippe Bonnet , tells DDN . ‘ You ’ ve got some housing providers who still don ’ t want naloxone on their premises , for example . It doesn ’ t make sense to me . It ’ s legal , so what ’ s the problem ?’

Drug services in England and Scotland were promised a belated financial boost earlier this year ( DDN , February , page 4 ), and although it won ’ t replace the money lost through years of funding reductions , some of the cash is specifically aimed at widening naloxone provision . Ultimately , however , it ’ s still down to individual services to persuade people to actually take the kits away with them .

‘ It ’ s how you sell it , the same as with hep C testing and treatment ,’ says Bonnet . ‘ We ’ ve got people who are really vulnerable being told , “ You don ’ t want naloxone do you ?” and they ’ ll say , “ Nah , I ’ m alright ” and off they go . I think local authorities could put so much more pressure on services where there ’ s been a death . It needs to be investigated properly – “ how could we have averted this ? Did they have naloxone ? Why not ?” If it says ‘ naloxone offer refused ’ on the note and nothing else , that ’ s not good enough . People allergic

to peanuts don ’ t tend to refuse EpiPens , do they ?’

Something that ’ s always been critical is having the right local champions in place , he stresses . ‘ Somebody asked me how many kits I ’ d given out over the years – I had to think but I reckon it ’ s got to be 3,000 at least , and I must have trained 10,000 staff . That ’ s just me , so national coverage really shouldn ’ t be a problem . It ’ s about getting the right people on board who can fight your battle .’

EARLY CHAMPIONS Another early champion is harm reduction campaigner and former GP Judith Yates , who first came across naloxone in 2009 when David Best and others were working on an early paper . This studied around 70 people who were trained in overdose recognition and management and then followed up six months later after being given naloxone . ‘ Some of my patients got the kits ,’ she tells DDN . ‘ I remember one lad in particular , whose friend had died in his flat – he ’ d called an ambulance , tried CPR , done everything right . He later came back to my surgery waving a naloxone kit , and we both realised that if he ’ d had it at the time his friend would still be alive .’

Following the paper ’ s publication – Can we prevent drugrelated deaths by training opioid users to recognise and manage overdoses ? – the feeling among Yates and her colleagues was that it would inevitably lead to a ‘ big national roll out ’, she says . ‘ Nothing happened . Then in 2012 we

' For some reason there ’ s still reluctance in some places , which I ’ ll never understand .'

PHILIPPE BONNET

decided that Birmingham should get going , and we got the first 1,000 kits out by the end of 2013 , but still no one else was doing it . Ever since then it ’ s been push , shove , push , shove , which is down to stigma , I suppose .’

Could the availability of nasal naloxone make a difference in improving access ? Might the fact that it doesn ’ t involve a needle help to overcome some of those barriers ? ‘ I was delighted by nasal naloxone finally getting licensed ,’

nigelbrunsdon . com

14 • DRINK AND DRUGS NEWS • JUNE 2021

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