Naloxone – the big hit with the long wait

Id like to discuss a campaign involving many members of the drug using community across the world. As far as campaigns go, this one should be a done deal. In fact it should of been snapped up as a central component in all our national and community drugs strategies years ago.  The benefits and results to be reaped from rolling out similar campaigns is nothing less than saving life itself and the prevention of repeated tragedy, trauma, gut-wrenching grief and endless pain and loss. What is the campaign? To get Naloxone, the drug that instantly brings a fully overdosed and dying person back to life in seconds, into the hands of every single heroin user and ideally, into the hands of their family and partners.

The reasons to implement and progress this campaigns’ agenda are, at first glance so crystal clear, so straightforward, so blindingly obvious that the average person could be forgiven for asking, “Just what is taking so long? – We need to empower people to save lives, naloxone works, its cheap and simple to use, so let’s do this!”

But, after we remove the blindingly obvious common sense and our societies desperate need to rollout these programmes in the face of rising overdose figures, we must question why we still have unacceptable dithering by authorities and a worrying lack of will to progress the agenda.

It must be considered that such delays carry the familiar hallmarks of the common ‘junkie stain’ or rather, the agenda that is stained or dismantled or even left to rot, simply through its association with drug users. However, this particular campaign, which has come in all sorts of shapes and guises, is gaining traction in areas all over the world and recently, finally, here in the UK too. It has the fangs of drug user activists in it all over the place, with programmes that are getting naloxone into the trained hands of policemen and women, family members and partners, pushing forward the idea of Naloxone as a free item or a purchase from a pharmacy by people, even bringing a used one back to get a new one etc.

There is bound to be something you can do in your own community to help push this agenda forward and to get Naloxone into the trained hands of at least every single heroin user in your neck of the woods, in the rollout towards Naloxone being in every hand, in every city across the world.

The International Doctors for Healthier Drug Policies is also taking up the mantel to push the Naloxone agenda, this article appeared the other day and gave a useful global overview. 

Naloxone*

Naloxone_banner

 

WE COULD INSTANTLY REDUCE THE NUMBER OF

OVERDOSE DEATHS IF THIS MEDICINE

WERE MORE WIDELY AVAILABLE

 

What do we do with a medicine that prevents certain death for people with a particular condition—and is safe, cheap, and easy to administer?

  1. Immediately make it accessible to those who can administer it when such a life-or-death situation arises.
  2. Make it available to no one except doctors and emergency room workers.
  3. Endlessly debate the particulars of how and when it should be widely introduced.

If you picked number one, that would seem to be a reasonable choice. Unfortunately, it would also be incorrect. With few exceptions, answers two or three apply in the vast majority of the world when it comes to the medicine naloxone.

Overdose remains a leading cause of death among people who use drugs, particularly those who inject. Increasing the availability and accessibility of naloxone would reduce these deaths overnight.

Naloxone is an effective opioid antagonist used to reverse the effects of opioid overdose. On a global scale, however, exactly how and where naloxone is used remains unclear. International Doctors for Healthier Drug Policies (IDHDP) is seeking to learn why this is and what can be done to change it.

Some form of community-based distribution programs for naloxone exist in over a dozen countries. But the quality of data pertaining to how naloxone is used is highly variable. Enhancing our knowledge about the use of naloxone will help us to better reap its benefits.

What we do know is that the availability of naloxone is growing in several countries. Scotland implemented a national program in 2010, and outcomes there have demonstrated its effectiveness in reducing drug overdose deaths. In China, it is available in an increasing number of hospitals. Canada and Estonia have pioneered programs on take-home naloxone.

And in the United States, policymakers called for greater availability and accessibility of naloxone after opioid overdose deaths more than tripled between 2000 and 2010. In some states, distribution expanded from emergency rooms, paramedic services, and needle-exchange programs to police stations. In Quincy, Massachusetts, all police began carrying naloxone [PDF] in 2010, leading to a 70 percent decrease in overdose deaths.

Last November, guidance from the World Health Organization recommended increased access to naloxone for people who use opioids themselves, as well as for their families and friends. Naloxone is also included on the WHO’sEssential Medicines List.

The role of naloxone in addressing opioid overdose was recognized for the first time in a high-level international resolution in March 2012. Members at the UN’s 55th commission on Narcotic Drugs unanimously endorsed a resolution promoting evidence-based strategies to address opioid overdose. Recently, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) published a very useful literature review of the effectiveness of take-home naloxone.

To build on these gains, we need more data. IDHDP wants to find more out about the availability and accessibility of this life-saving intervention. To that end, we’ve created the Global Naloxone Survey, an attempt to compile information about where naloxone is available, who can use it, and where it can be accessed with or without a prescription.

We then will analyze the results with the short-term goal of obtaining as much information as possible on how widely and readily available naloxone is. Subsequently, we intend to work to maximize both the availability and the accessibility of naloxone, particularly to those who are most likely to be present where and when an opioid overdose takes place.

This post first appeared on the website of International Doctors for Healthier Drug Policies

This talk on Naloxone was given at a local TEDx event, produced independently at one of the TED Conferences. In 2011, fatal drug overdoses in the UK (3,338) exceeded the number of road accident deaths (1,960). These deaths are preventable. Jamie Bridge talks here about how rethinking both product design and service design have the potential to save lives in the administration of overdose medication. Naloxone was developed in the 1960s to counter the effects of heroin overdose. It’s a staple part of ambulance crew kits, but those who need it face barriers to the drug at the point at which it could save their lives. Recently, there has been a shift in focus and design to ensure that naloxone is available to those likeliest to witness an overdose – drug users, their families and friends. The evidence shows that naloxone works, and that drug users can be empowered to save the lives of their friends.

Jamie Bridge is a passionate advocate for drug services and drug policy reform in order to protect the rights, health and well-being of vulnerable people around the world.

* Naloxone is the generic term, it is also known by its brand name which is Narcan.

 

Naltrexone

Advertisement for curing morphine addictions f...

There's been a lot of 'cures' advertised over the years...

(Updated in 2011 from an article in BP issue 2)

There has been quite a lot of developments in the uses for naltrexone, not just in the UK but around the world -and it is clearly not just a single treatment option. There are various ways of using naltrexone – and this update, taken from issue 2 and added too, looks at Naltrexone’s origins, its uses and its future.

What is Naltrexone and How Does it Work?

For heroin, (and other opiates such as methadone, morphine, palfium, codeine etc), to produce their effects – and get you stoned – they need to be able to attach themselves to small areas in the brain and nervous system called receptor sites. Naltrexone not only blocks these receptor sites, which prevents any opiates from working, but also displaces or removes any existing opiates that currently occupy those sites. Such drugs are called ‘opiate antagonists’ – they antagonise (to put it mildly!) any opiate. This means that if you take naltrexone when you have an opiate ‘habit’, you will find yourself withdrawing quickly and intensely as the opiates are rapidly (rather than slowly) removed from your receptor sites, and your body reacts to their absence. However, if you’ve already detoxed, taking naltrexone may help keep you abstinent as using heroin simply will not work. Naltrexone is sometimes referred to as a ‘non-drug’ because it doesn’t really have any effect other than blocking the effects of opiates. Naltrexone is long lasting – from 24 to 72 hours depending on the dose, and it comes as a tablet, or as an implant. It is closely related- but not the same – as Naloxone (or Narcan), the ‘pure’ opiate antagonist which doctors use for opiate overdoses; but naloxone only works when injected and lasts for only a short time – less than an hour, which is why people need to be monitored and can ‘fall back’ into overdose.

To read the rest of what is an interesting insight into Naltrexone, click here.

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