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she says . ‘ It ’ s such a simple thing to just squirt it up someone ’ s nose and see them start breathing . With nasal naloxone I also think there ’ s a case for having it available over the counter , which would also help to de-stigmatise it .’
‘ There are a couple of issues with it ,’ says Bonnet . ‘ The price is one , but the other is bioavailability – it ’ s definitely not the same as intramuscular . Looking at the research , with intramuscular the bioavailability is much higher and it will stay in your system for longer . Having said that , I know some people will prefer it , especially a layperson . Service users won ’ t care – they inject anyway – but people like hostel staff may well prefer it , so it definitely has its place .’
GAME CHANGER Nasal naloxone has also been a ‘ game changer ’ for the police , says Yates – ‘ they don ’ t want to be waving needles around ’. However , while more and more forces are now running pilots and embracing naloxone ’ s potential ( DDN , May , page 13 ) the issue is not without controversy . The Police Federation has expressed concerns about officers ‘ being turned into paramedics ’, while chair of the West Midlands Police Federation recently told Newsnight he was worried about members ‘ being subject to lengthy and stressful investigations ’ if someone still dies after naloxone is administered .
‘ I remember a case five or six years ago where a police officer did CPR , broke a rib and got sued , so I can understand them being wary ,’
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says Bonnet . ‘ But if you say , “ What if the guy dies ?” – well , if he ’ s going to die he ’ s going to die . Don ’ t you want to try to prevent that ?’
‘ It ’ s only the Police Federation who tend to say these things ,’ adds Yates . ‘ There ’ s no resistance from ordinary police – they ’ re the ones who find themselves in a car park with somebody blue at their feet and they ’ ve got to start doing CPR , call an ambulance and wait there . The police here in Birmingham have embraced it fully – they can save someone ’ s life and they don ’ t have to do fatal accident reports .’
On that note , it ’ s often been pointed out that – even putting aside every argument about compassion – naloxone makes sense purely on financial terms . It ’ s far cheaper to save someone ’ s life than for them to die , as more and more people are doing , year-on-year .
‘ In our drug-related death group meetings in Birmingham I always flag up the cases of people who ’ ve been found unconscious but have then died in hospital of a heroin overdose ,’ says Yates . ‘ All of them could still be alive today if the person who ’ d called the ambulance had given them naloxone . Lots of my patients over the years who I see walking down the street , they wouldn ’ t be here otherwise . Now they ’ re with their families and getting on with their lives .’
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GETTING PAST THE STIGMA From a GP perspective , Yates has previously been exasperated that people happy to prescribe methadone and buprenorphine still wouldn ’ t prescribe naloxone ( DDN , July / August 2015 , page 15 ). ‘ GPs give out EpiPens hand over fist to anyone who ’ s got a peanut allergy , but do they give out naloxone kits to everyone at risk of opiate overdose ?’ she says . ‘ No , they don ’ t .’ So how optimistic is she that we ’ ll soon be able to get it into the hands of everyone who needs it ? ‘ You need to have it with you , so even once you get past the stigma you ’ re never going to get 100 per cent cover . But there ’ s certainly scope for getting an awful lot more out there . It ’ s frustrating because it ’ s absolutely the only medicine of its kind that saves lives so quickly and cheaply . I can only think it ’ s because people have mixed feelings about people who use drugs , and whether they live or die . And sadly , of course , some people who use drugs can have mixed feelings about whether they live or die as well – they can take a Russian |
A NATIONAL NALOXONE AND OVERDOSE AWARENESS campaign is using posters of people personally affected by overdose on posters all over the country . If you spot one , take a picture and tag @ TalkingDrugs and @ Release _ drugs and they will share it on their socials . See the full range of posters at naloxone . org . uk
roulette attitude . But I ’ ve been working in this field long enough to see people come out of that pit and get on to enjoy the second half of their lives in their 30s , 40s , 50s . So never give up .
‘ There is no other medicine like naloxone ,’ she states . ‘ There ’ s nothing in the whole pharmacopeia that saves a life in two minutes with no side effects and no contraindications . If someone has a heroin overdose they don ’ t need to die , and yet we ’ re still having these conversations . We ’ ll just have to keep nagging .’ DDN
This article has been produced with support from Ethypharm , which has not influenced the content in any way .
Ingus Kruklitis | Dreamstime
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JUNE 2021 • DRINK AND DRUGS NEWS • 15 |