Naloxone is the opiate antagonist that can prevent overdose. In the US it's use is increasing and within the UK there are national programmes in Scotland, Wales, and Northern Ireland to distribute it, but not in England, in England it's left up to local areas to decide if they should distribute it. So, I thought it was time for a top 'ten reasons to distribute take home naloxone' article.
Making naloxone available is a great way to start a conversation about overdose and overdose risks, looking at the myths and the practicalities of what to do when a friend or family member takes too much. Most naloxone programmes include a formal conversation that they require staff to have before distribution, although it has to be pointed out that this doesn't need to be hours long (there is research showing 5 minutes may be just about the right amount of time).
Show that your organisation cares
Distribution of naloxone is a great way to show that your organisation actually cares about the health and wellbeing of people who actively use drugs. If your drug service doesn't already have an overdose prevention programme than you really have to start one. Just in case you wondered, I also mean Recovery and Rehab services should have naloxone and overdose programmes, after all one of the highest risks for overdose is when someone returns to drug use with no tolerance following a break.
Allows drug users to support themselves and each other
Rather than telling people that they are powerless in the face of the drugs they use, naloxone shows people that they can be in control of their own health promotion, and the promotion of their peers. Given access to naloxone drug users will (and do) support each other.
The best time to start an overdose program was many, many years ago. The second best time is today.
Engagement tool for treatment
Services are under continuing pressure in the UK to 'attract' more people into treatment. What better way of attracting people who actively use drugs than to provide naloxone. Show people that just because they are continuing to use that this is no barrier to using your services, and once they get to know that the attitude of the project is one that supports people and doesn't judge them they may be interested in using your other services.
Gives people a second chance
Or a third, fourth or even tenth chance. I'm not a fan of the "there is no recovery in a graveyard" type hyperbole, but there is a truth to the fact that NOT allowing people a second chance at life isn't something that any caring society should do.
It saves money
A drug related death investigation costs thousands of pounds, but the Welsh naloxone projects found that even taking training and distribution costs into account naloxone costs around £400 per life saved. You can add to this though, someone who overdoses and doesn't get help fast runs the risk of long term health issues caused by a prolonged lack of oxygen, earlier intervention of a peer that is there when someone overdoses could prevent this.
Support for families and carers
There is increasing pressure both in the UK and the US to make access to naloxone easier for families and carers (watch the 'Reach for Me' film that highlights the story of Denise Cullen who now fights for naloxone access following the death of her son Jeff). Having carer access to naloxone can help remove the feeling of powerlessness that some family members face when thinking about overdose. UK law does allow for carer access to naloxone as long as the person at risk holds a prescription.
Protects against future 'strong' batches
Public Health, the police and many drug organisations often put out warnings about strong batches of heroin causing overdoses of course that is all it amounts to, a warning, and human psychology being what it is a warning that says "drugs here are stronger" often just leads to increased drug sales. Isn't it far better to also have an antidote in place in the community already that protects people who overdose, after all as Jennifer Vanderschaeghe of the Alberta AIDS Network Society says "The best time to start an overdose program was many, many years ago."
Not just heroin users
While heroin use is an obvious focus of most readers of this website, we need to remember that opiates are in many prescribed pain medications, and that these medications are an increasing cause of accidental overdose deaths. Providing an antidote for accidental OD along with any prescriptions for these pain medications seems only logical (I'm looking at the Doctors out there on this one).
Brings other groups in
Naloxone provision brings other groups to the discussion, for instance in the US there are now many police forces that carry naloxone to allow them to respond effectively to overdoses (after all they are often first at the scene). This changes the narrative of the police being someone a drug user feels scared of to one where police are actively promoting life and wellbeing.
Ohh I promised you ten reasons and I seem to have ten already... so please consider this a special bonus reason:
NALOXONE SAVES LIVES
The website of the Naloxone Action Group campaigning for wider access to naloxone in England.
Film with Greg Scott talking about having naloxone in a family situation.
A HIT Hot Topics film with Dan Bigg talking about the rising cost of naloxone in the US.
The website for the Scottish National Naloxone Programme.
Public Health England's naloxone statement that points out there is no reason for areas to delay providing this life saving medication.
Special thanks to Eliza Wheeler, Meghan Ralston and Stephen Malloy for help in putting this article together.
Nigel Brunsdon is the owner of Injecting Advice.com. He's been working in harm reduction since the 1990's, although he's previously a frontline needle programme worker he now spends most of his time developing online resources for drugs workers and users.