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PRIDE AND PREJUDICE nigelbrunsdon . com

As Overdose Awareness Day approached , the millionth kit of injectable naloxone was distributed . DDN looks back at the story of this lifesaving intervention

Naloxone was first developed in the 1960s and used by the emergency services to reverse opioid overdose . It wasn ’ t until 2005 that it was made available under UK law to be administered by anyone for the purpose of saving a life – but it would be another ten years before drug services could supply naloxone without a prescription .

Evidence swiftly mounted on the success of pilot programmes , showing overdoses were reversed each time it was used . By 2008 we were hearing from groups of clinicians and user groups who were championing the cause with tangible results – but without national guidance or support . The Scottish Government , in recognition of ever-escalating drug-related death statistics , recommended the provision of take-home naloxone ( THN ). But there were still concerns about legislation and the practicalities of obtaining a ‘ prescription-only medicine ’ and anxiety around using it .
At this point naloxone didn ’ t feature in National Treatment Agency ( NTA ) targets , but the following year the NTA announced that families and carers of injecting drug users would be trained to administer naloxone in 16 sites across England . There were calls for the pilot to be extended to drug users and their peers – those most likely to be present at the time of an overdose . By 2012 a ruling in Scotland allowed homeless hostel staff to hold naloxone ready for emergency use without prescription ; there was optimism that a wider rollout could be getting closer for the whole of the UK .
The first licensed THN product , launched in 2013 , pushed open the gate to widening access . Its distribution was still a postcode lottery and there would still be many hurdles to overcome , but pressure was building on commissioners , clinicians , treatment services and prisons to take naloxone seriously and to incorporate it as essential harm reduction .
YOU NEED TO GET ANGRY By 2014 Scotland , Wales and Ireland each had national programmes of naloxone distribution in place , but in England it had been left up to localism . Activism was audible – ‘ you need to get angry . You should all be persuading your commissioners that we need naloxone .’ Some prisons took the initiative on naloxone , but many didn ’ t . Those which introduced a THN programme to equip prisoners on release took a massive step towards protecting those vulnerable to overdose .
GPs joined the call for everyone to spread the word on naloxone . ‘ We need those of you who work with clinicians , those who commission services and those who provide education to recommend the prescribing of naloxone ,’ said our regular GP columnist Dr Steve Brinksman , while Dr Judith Yates told us : ‘ I believe that it may come to be seen as negligent to prescribe methadone without also prescribing a take-home naloxone kit .’
The Naloxone Action Group ( NAG ), a group of service users , treatment workers and medical professionals , examined the ‘ postcode lottery ’ through a survey and vowed to challenge every area of the country that was slow or reluctant to roll out distribution or training .
Release were ready to challenge non-provision through legal action , with ‘ very strong right-to-life and human rights arguments ,’ said Niamh Eastwood . Outreach worker and activist Philippe Bonnet , who delivered naloxone training at the 2015 DDN Conference , urged : ‘ Identify champions and knock down doors , and make use of the service user groups and advocacy groups that can do that on your behalf . But don ’ t take no for an answer .’
But there was still no national programme or requirement to provide naloxone in England , and the postcode lottery continued . Chris Rintoul , then lead trainer for Street Rx in Northern Ireland , was in no doubt that the Scottish Drugs Forum ( SDF ) had ‘ watered the seeds of take-home