Would you like to learn how to save a life?
Peer distribution of naloxone is the best way to get the opioid overdose reversal drug where it’s needed.
Andy struts through Redcar town centre, his bright blue naloxone hoody protecting him from the fierce north sea breeze. He bellows hello to a woman across the street and fist bumps a guy he knows from his childhood. Then he sees a man he recognises from picking up his methadone script and it’s all systems go. Andy asks if he’s heard of naloxone. He hasn’t. He asks if he’d like to learn how to save a life. He would. The two sit together on a bench outside Sports Direct. In just eight minutes Andy expertly takes him through how to respond if someone has taken an opiate overdose. With a slap on the back, he hands the man a naloxone pack to keep and waves him on his way.
It seems like he’s been doing this for years, but just three months before the programme started Andy knew very little about naloxone — “I’d never seen a pack before, I never had a clue.” Drug related deaths are at record levels in the UK, with the north east recording the highest rate of deaths in England. Now, Andy is part of a team of peers proactively taking naloxone out into the community in the coastal area of Redcar and Cleveland.
The project was set up by drug, alcohol and mental health charity We Are With You. Its Director of Pharmacy Dr Rachel Britton says treatment services have traditionally “given naloxone out to people we already know, within our own walls.” She says this means many services “don’t reach people who aren’t in treatment, despite this group being most at risk of death.” Britton says We Are With You decided to pilot the peer to peer distribution model because peers “know where people who aren’t in services hang out. They have an ability to reach out to those people in a way others may find difficult because they were/are part of that community.” Or, as Andy puts it, “people around here know me and trust me. It’s my town.”
George Charlton is an Independent Trainer and Consultant who worked with We Are With You to set up the project. Charlton says peer to peer naloxone “aims to empower and train people with lived experience of drug use to supply life saving naloxone to their friends who are at risk of dying in the community.” Chrissy, one of the five peers driving the project, feels this more than most. Five of his best friends have died due to issues with drugs and alcohol. He’d spent the past 15 years in and out of prison and was waiting for an appointment at We Are With You in Redcar and Cleveland when Charlton “kidnapped” him. Like Andy, he knew very little about naloxone, but thought the project was “a brilliant idea as I’ve walked down that path so can speak to people from that world easily.”
The group starts each day with a check in where they discuss how they’re feeling and what they plan to achieve that day. Each person’s reflections are met with cheers, while slaps on the back and warm hugs converge from all directions. Charlton says the group “feels like a family because of its non-hierarchical approach.” He argues that “for too long we’ve created a them and us mentality in drug treatment services, but We Are With You have been really keen for the peers to shape the project.” Dr Paul Hughes, Executive Medical Director at We Are With You, says “we wanted to use the organisation as an asset to bring out the unique skills of people with lived experience. So we gave them access to naloxone, the IT, a physical space, then let them shape the project from there.”
After sharing hot coffees and pastries, the group march into Redcar town centre armed with naloxone packs and an ambition to save lives. Charlton says “services in brick buildings might give out ten naloxone packs in a day, but peers can easily give out ten packs in an hour.” Chrissy immediately approaches the owner of a local cafe. She says someone overdosed directly outside a few weeks earlier, but is hesitant about receiving a prescription only medication then and there. Thankfully, Chrissy has two months of training behind him. He explains how a law change in 2015 means naloxone can be handed out without prescription, before going through the signs of overdose and how to use the injection. He leaves her with a pack which she promises to keep under the counter and saunters off grinning from ear to ear — “I proper buzz off it. Just knowing that that person who I’ve given ten minutes out of my life could go on and save someone’s life is amazing.”
Charlton says “there are some minimum standards when handing out naloxone, but we decided these aren’t good enough and we wanted to do it properly.” The peers received two months of training from multiple health professionals as well as practicing with each other and their families. The peers also met with the Chief Inspector of Cleveland Police Scott Cowie who assured them of his officers’ support. Charlton oversaw this process together with We Are With You in Redcar and Cleveland’s Community Engagement Coordinator Adrian Week’s. He says “it’s crucial that a member of staff has protected time against the project and that that person can’t be someone who’s too corporate or rigid in their thinking.” He is adamant that “this isn’t a recovery project, so it needs to be someone who has a real understanding of harm prevention.” Britton is hoping Charlton will “enthuse a whole series of Community Engagement Coordinators” as part of We Are With You’s plan to roll the project out across all its services.
But the project hasn’t been all plain sailing, with the group leaning on each other when issues from their pasts resurface. Andy says their closeness as a group helps them get through these rough patches — “we are there for each other through thick and thin.” However, Charlton is adamant that peer to peer projects shouldn’t focus disproportionately on people’s pasts. Instead he says they should “harness the peers’ lived experience, their street degree, which is absolutely vital to doing this kind of work.” Britton agrees and says that while major offences such as exploitation, sexual violence or murder would bar people from the project, for more minor offences “it has to be a judgement call on a case by case basis.”
Charlton believes when it comes to saving lives “the peers have an urgency about them which other people without their backgrounds lack.” He says the first time the peers walked through the streets in their blue naloxone hoodies it “helped them recognise they aren’t hopeless but that their experiences are so important. They have a place in life which is saving the lives of their friends.”
Andy agrees. He describes how “in my head, I’ve been a bastard for 25 years. I’ve done some naughty things. I’ve never felt like a normal person. Since I was 14 I’ve been on drugs, my dad was an alcoholic, my daughter got killed and heroin was the only thing that sorted my head out.” He admits, “I thought I’d never get the chance to redeem myself. But through giving something back to the community I start to feel like a proper member of society. Now my mum tells me she’s proud of me and social services are buzzing with how my daughter’s doing. It means the world.
“When you are on drugs people look at you and judge you. Now I want people to see me and think — Andy, he’s a good lad, he’s using his experience to help others.”
Note: This programme launched in November 2019 and ran until March 2020. It’s currently on pause due to government restrictions as a result of the coronavirus pandemic. We’ve kept in touch with the peers and we’re hoping to start the project again as soon as we’re confident we can do so safely as advised by the government.
If you’d like to find out more about how you can volunteer for We Are With You visit our website.
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