This document discusses opioid overdose and the use of naloxone to reverse overdoses. It provides statistics on drug-related deaths in the UK and risk factors for overdose. Naloxone is described as a temporary antidote that reverses the effects of opioid overdose by binding to opioid receptors but not activating them. The document outlines how to recognize an overdose, administer naloxone via injection, and the need to still call emergency services. Barriers to naloxone access and potential future developments are mentioned.
4. Drug-related deaths in England and
Wales 2008 - 2012
Opioids (inc heroin, methadone, codeine etc.) 3554
Cocaine 291
Amphetamine 127
MDMA / ecstacy 53
Novel psychoactive substances 78
Source: ONS 2012
5. More recent headlines:
Heroin/morphine remain the substances most
commonly involved in drug poisoning deaths. 765
deaths involved heroin/morphine in 2013; a sharp rise of
32% over 2012.
There was a sharp increase of 21% in the number of drug
misuse deaths in England in 2013, with no change to the
number of these deaths in Wales.
Over half (56%) of all deaths related to drug poisoning
in 2013 involved an opiate drug.
The female mortality rate for deaths involving
heroin/morphine has been gradually increasing since
2010, and reached the highest rate on record (since 1993)
in 2013
ONS Sept 2014
6. Overdose: a serious situation
Most heroin users will witness / experience an
overdose at some point:
‘From a sample of 155 drug using clients in South
London in 2000 :
46% had overdosed themselves;
82% had witnessed overdoses,
43 of which were fatal.’
(Best D., Man LH., GossopM., Noble A., Strang J., 2000)
7. Opiate overdose
Overdose causes respiratory depression and can
lead to death….
But, most overdoses happen in the presence of other
people who could potentially prevent death with the
right training….
……and with naloxone
8. Risk Factors in Overdose
Injecting rather than smoking drugs
Mixing drugs – especially heroin, benzos, alcohol,
methadone etc. (all our respiratory depressants and
affect breathing)
Using alone
Variable purity of street drugs, changing dealer etc.
Using in unfamiliar surroundings – not engaging in
normal drug-taking routine
Using with unfamiliar people – who may not stick
around or help in an overdose situation…..
9. Risky times……..
Loss of tolerance
Leaving prison
Relapse after leaving detox / rehab / hospital
Risk of fatal overdose is 8x higher in first 2 weeks of
leaving prison than in following 10 weeks !!
Beginning / ending substitute medication
Difficult life events – such as bereavement, loss of
contact with children, separation / divorce
10. How to Recognise Opiate Overdose
Person unconscious, and cannot be woken -
UNROUSABLE and does not respond to noise or
touch (e.g. shoulder shake)
CYANOSIS – BLUE tinge to lips, tip of nose, eye
bags, finger tips or nails
Not breathing at all or taking slow/shallow or
infrequent breaths - DEEP SNORING / RASPING
sounds
PIN POINT pupils
11. Overdose myths – what not to do
Do not Panic! Do not run away.
Do not put person in a cold bath or shower
Do not walk them around.
Do not copy “Pulp Fiction’ - injecting
adrenalin into the heart
Do not give stimulants, amphetamines,
cocaine, black coffee.
Do not inject salt water.
12. But what you can do…………
Phone 999
ABC + naloxone
Ambulance
Breathing
reCovery position
Naloxone
Stay with the casualty
14. Naloxone
Temporarily reverses the effects of an opiate overdose
No effect on overdoses resulting from the use of other
drugs
Short acting - can begin to wear off in 20 mins
Overdose can last for 8 hours or more (especially with
methadone)
Only for use with continued medical support – still
need to ring 999 (buys time)
No potential for abuse
Naloxone precipitates WITHDRAWAL – the individual may
want to use again straight away/ become aggressive.
15. Individual response to naloxone
To emphasize: duration of effect approx. 20 minutes
Depends on:
What opiate was used
How much
Any other drugs / alcohol
Works in 2-3 minutes but wears off faster than the
opiate does.
16. How to use naloxone………
Inject into a muscle
Side of thigh area or upper arm.
Hold needle 90 degree above skin
Insert needle into muscle
Slowly and Steadily push plunger as
directed
OK to go through clothes
17. “My hands were shaking. I was really
scared. But I knew that if I didn’t do
something he was going to die. Now when I
look at him, it makes me smile on the inside to
know that I saved his life.”
Service user, Birmingham 2013
18. Barriers……….
Current supply route = lots of opportunities
to drop out
Lack of awareness
Special circumstances (in particular, prison)
Money….??
20. Naloxone supply:
Training package (adaptable to group or 1:1 setting) –
keep it simple and keep it inclusive
Targeted approach, but inclusive
Testing understanding
Pack developed that contained everything needed
Supply at point of training via PGD
Option for re-supply included if needed
Service driven at each hub by the NMP (“champion”)
Prison: training delivered by in-reach worker, but
testing and supply made on release with bridging Rx
21. What do patients/clients/service
users think ?
My friend told me about naloxone. He hadn’t
been using heroin for a few months, but lapsed
at the weekend at a mate’s house. He only
used a couple of bags but went over and died.
He’d left his naloxone at home.
22. What do patients/clients/service
users think ?
We’re not big users, just a bag or two on pay
day. This time was different. Don’t know why.
It was obvious to me he had overdosed. I
panicked a bit. Couldn’t remember all the stuff
they said, but I got him on his side and
whacked in the naloxone. He came round a bit
but then the ambulance got there. He made it,
but it scared the sh*t out of me.
23. Outcomes (end Mar 2014)
200 kits issued in pilot phase (Feb-Mar 2013)
1000 kits issued (Apr – Mar)
15 known reversals
Greater awareness – clients are asking about it.
Other services now getting up to speed
Unplanned prison releases are still a challenge
Forgot to get ambulance service on-board: a big
learning !!
25. Naloxone e-module
Already available
Free to access
Comprehensive training
resource
Takes about an hour
Assessment + certificate
26. The future…….?
Greater availability ? – consultation
Other products licensed ?
Different delivery system ?
Editor's Notes
Some key points.
This was the big one. Train client, go to GP to write Rx, take Rx to pharmacy, wait for it to be ordered, go back a few days later etc. Now I don’t know about your patients, but I have to work hard trying to get mine just to remember and turn up to clinic appointments. Large numbers were falling at the first and second hurdles with the current system. It just wasn’t working.
Awareness not only amongst the clients about what naloxone was, but also amongst the medical profession. Even now, I get a significant amount of contact with CCGs asking about the drug, whether they should be prescribing it etc.
There were some specific issues around prison releases – a high risk time, but the prison had made it very clear that they would not be supplying an injectable product to any person that was still in custody.
I put this up because someone always asks about it. It is true that if you are not currently supplying naloxone and then start supplying it, there will be an extra cost. It has been argued that this can be offset by reduced A&E presentations, less time with coroners or on Sis etc (and that’s even if you ignore the moral imperative). When we spoke to the LMC about it, the secretary even stated that he could see a time in the not too distant future when prescribers could be held liable in an overdose situation if methadone was being prescribed without also prescribing naloxone. However, if I am honest, I used these arguments in a business case to the commissioners to secure a small amount of funding to get this project off the ground. The funding was not ongoing but has allowed time for the trust to build it into their budgeting model in forthcoming years. It costs less than 2 bags of heroin……. It lasts up to 3 years.