Taking Naloxone where it matters
The overdose reversal drug is simple, cost-effective and saves lives. But it has to be with the right people at the right time to make a difference.
A few years ago, Les Chandler walked into the hostel where he was living. A man lay motionless on the sofa in the communal area. His face had turned blueish, purple and he was making desperate choking sounds in his attempts to breathe. Staff were trying to resuscitate him, but it didn’t look good. Thankfully, Les had his naloxone kit in his pocket. He quickly administered the drug and the overdose symptoms stopped almost immediately. Without it, the man would almost certainly have died. Reflecting on the incident, Les is sombre: “If naloxone was around when I used to use drugs, it would have saved a lot of lives. A lot of people dropped dead next to me who easily could have been saved.”
Naloxone is an opioid overdose reversal drug. It works by binding to opioid receptors in the brain, blocking the effect of opiates and rapidly reversing an overdose. It can be administered either through an injection or a nasal spray. It’s not an end in itself, people who have overdosed still need to be seen by emergency services, but it’s vital in keeping people alive until that point.
Yet, despite becoming increasingly well known, it isn’t always present when it needs to be. Drug related deaths in England and Scotland are at record levels, with opiates accounting for more than half of fatalities. In 2015 the law changed to widen naloxone’s availability, meaning drug services can now hand it out without a prescription. But a 2017/18 report ‘Finding a needle in a haystack’ by the charity and advocacy group Release found “the estimated national coverage of take home naloxone among people who use opiates in 2017/18 was 16 per cent.” In the face of this, some groups and individuals are now thinking outside the box to make sure naloxone is always available when needed.
During 2017 and early 2018, people who used Addaction’s treatment service in Cornwall were more likely to reject naloxone than accept it. Addaction Cornwall Operations Manager Caroline Liney describes how this statistic caused them to “rip up our old methods” putting “naloxone at the front and centre of everything we do.” This new approach has resulted in the service recording its highest acceptance rate ever.
One major change was to make people “opt out rather than opt in” to carrying the drug. Liney explains: “Previously we treated naloxone as an added extra to treatment. Staff would ask clients and family members questions like, ‘Would you like naloxone?’ Or ‘Would you like naloxone training?’ Now staff have changed tact and simply say ‘here’s your naloxone and this is what you do with it’ leaving little option for people to say no.”
The service has also drastically reduced the bureaucracy around giving out the drug. Naloxone is simple to use, but people need to complete a short training session before they’re allowed to carry it. Liney says if someone said they wanted to carry naloxone staff used to book them a slot to come back and receive the training, but, for whatever reason, a lot of people weren’t returning. Now staff give the demonstration to people on the spot. The service has also cut back on the paperwork required, streamlining the whole process. She said it’s been hard work and a bit of a culture shock, but “reading through client notes and seeing incidents when lives have been saved makes it all worth it.”
While this work is vital, people outside of structured treatment are most likely to die of a drug related cause. In Middlesbrough, a project run by George Charlton is attempting to stop naloxone being “restricted by bricks and mortar.” Charlton leads a team of five ‘peers’, who all have lived experience of drug misuse. The project, named ‘Peer to peer naloxone’, is simple in execution. Charlton and his team go out onto the streets of Middlesbrough, targeting areas known to be popular amongst drug using communities. They give out naloxone packs, training people how to use them there and then. Charlton says they can easily give out over 200 packs in a single afternoon, more than some drug services manage in a year.
Charlton had the idea for the scheme after trying and failing to get a naloxone kit from his local drug service in Durham. “I’m relatively well spoken and tenacious” he says. “If I couldn’t get a kit what chance do others have?” He travelled to Scotland and learnt from peers who’d pioneered the policy there, before securing an arms length funding grant from drug firm Ethypharm. He’s quick to point out that he didn’t invent the peer to peer approach, instead saying “my work stands on the shoulders of others who’ve come before me.” In Middlesbrough, he works alongside the local drug service and police force and says the scheme is effective because he and his team are willing to go to drug users — “even round the back of Iceland where there’s human shit and needles everywhere.”
Charlton says it’s vital that peer to peer projects like this are non-hierarchical. He says if you give peers the ability to help their friends “they will fly.” Members of his team used to occupy column inches in the local press for being in and out of prison. Now they’re on the front cover for saving lives. Charlton has found this produces a “ripple effect”, with people outside of treatment wanting to emulate their friends’ achievements. However, he doesn’t specify someone has to be in recovery to help the project. He says the approach to drug use has become “too recovery orientated” in the UK, with ‘Peer to peer naloxone’ showing the value of reducing harm without forcing people to access treatment.
Charlton’s success means the approach is now spreading beyond Middlesbrough. He’s currently working alongside Addaction’s service in Redcar and Cleveland on a 12 week pilot of the programme. Addaction plans to roll out the scheme in all its services, becoming the first national treatment provider to do so. Director of Pharmacy Dr Rachel Britton described the approach as a “no brainer”, while Redcar and Cleveland Service Manager Gary Besterfield said “it’s about being proactive, engaging people where they feel comfortable and saving lives.”
However, it’s not just drug services and activists who are innovating in order to save lives. Statistics show police officers are most likely to be first on the scene in the event of an overdose. In July 2019, the West Midlands Police Force became the first police force in England to carry naloxone. Chief Inspector Jane Bailey says being a police officer “is about preserving life”, so the idea of officers carrying naloxone makes sense. Jason Harwin, the National Police Chief’s Council Lead for drugs, agrees — “If we find someone bleeding we have bandages to give them. Naloxone is no different.”
In the pilot 50 officers received overdose and naloxone training from the charity Change Grow Live and now carry the nasal spray version of naloxone. Bailey says they decided on the nasal spray despite it being more expensive as the thought of officers carrying needles was a big barrier to getting support. Officers are also supplied with an information card to give to people when they come round, emphasising what has happened and details of local drug treatment options.
Bailey describes how there were a “minefield of issues and obstacles” in organising the pilot but “police officers were really positive, they felt they had a role to play.” This is backed up by research conducted by PHD student David Neale. Neale surveyed 205 officers in the West Midlands Police force, exploring their attitudes towards responding to drug use. 80% of officers thought drug use should be treated as a health issue and 70% agreed they should carry naloxone. Anecdotally, the officers carrying the drug have reported better relationships with drug using communities and a deeper understanding of the issues affecting them.
Elsewhere, research by King’s College London has found prisoners in England and Wales are 29 times more likely to die following the first two weeks of release compared to the general public, with the primary cause being heroin overdose. Reduced tolerance coupled with not knowing the trends in heroin potency can be a lethal combination for many. Despite this, Release’s research found just 12% of opiate using prison leavers were issued with take home naloxone in 2017/18.
Addaction runs the drug service in HMP Lincoln. Service Manager Louise Scherdel describes how her team “do their best not to take no for an answer” when they offer clients naloxone. In the weeks before someone is released, drug workers and peers who’ve been identified as ‘naloxone champions’ offer the person in question naloxone training. If they reject it, they “keep coming back.” They even have nurses on reception to offer naloxone and train people at the last moment before they leave.
Niamh Eastwood, Executive Director of Release, says a “a peer led approach is fundamental to good naloxone provision.” Scherdel agrees and says having a team of peers as naloxone champions is key to persuading people to carry the drug once they’re released. Inevitably, prisons often have a churn of people leaving and then being readmitted. She says that harnessing people’s stories of using naloxone is vital — “when someone hears first hand stories of how naloxone has saved a life, especially from someone they consider a friend, their whole perception can shift.”
Eastwood argues the scale of drug related deaths means it should be considered a public health crisis, adding that “the reason it isn’t is because we don’t value the people who are dying.” A former drug user himself, Charlton says he wouldn’t be alive today without naloxone. He describes how he was in and out of prison and had plasters all over his wrists due to self-harm — “the drug I wanted was just more, more of anything I could get.” He says his work today shows what happens when we don’t give up on people. “When we use naloxone people get to see their kids grow up, they get to take care of the people they love. The only thing it enables is breathing.”
If you or someone you love needs help or support, reach out. You can chat to a trained advisor at addaction.org.uk.
