Post-its from Practice:
Every Step (Dec 2013)
If you have read this column before, you will know that I am always keen to promote recovery, defined by the individual in respect of their own journey and not from a political or ideological concept. That said I am reasonably long in the tooth and having worked with people who use heroin for 20 years I am well versed in the concepts of harm minimisation, and the truism "dead people don't recover" springs to mind. Harm reduction is the solid foundation on which we can build future recovery.
With this in mind the treatment system I operate within in Birmingham has now started actively encouraging service users to undergo training in the administration of naloxone for the treatment of suspected opioid overdose, alongside placing the person in the recovery position and calling an ambulance. I have been told that "people in treatment shouldn't need prescriptions for naloxone"; yet I have come across people in treatment who have used naloxone to reverse overdose in people outside of the treatment system, and I am sure we would all accept that despite people's best intentions use on top of a script occurs. There have been enough uses of naloxone in Birmingham now that I can be confident that there are people alive today, who would not have been, were it not for the availability of naloxone.
To back this up there is growing evidence from around the world that it is not only clinically effective, but that it can be safely administered by peers and reduce overdose deaths. Our service users have embraced this, but in a system with a large number of GPs operating in a community setting, it is proving more of a stumbling block to get these clinicians involved, a vital step if prescriptions are to be issued. Talking to colleagues around the UK shows that we are not alone in this.
There are a number of ways to try and address this, The National Treatment Agency [NTA] supported a number of pilot sites and in 2011 produced a report recommending this - "The NTA overdose and naloxone training programme for families and carers" (PDF).
The Medicines and Healthcare products Regulatory Agency (MHRA) has just announced a consultation on a proposal to allow wider access to naloxone for the purpose of saving life in an emergency. The consultation runs until 7 February 2014 and is available online.
At SMMGP we recognise that lack of knowledge and training are significant factors that hold clinicians back from adopting new treatment approaches and so we have committed to develop a free to access e-module that will cover the rationale behind naloxone prescribing as well as the practical aspects.
We also need those of you who work with clinicians, those who commission services and those who provide education to recommend the prescribing of naloxone. Drug related deaths from overdose remain a significant problem and I believe a widespread roll-out of naloxone could significantly reduce this. We have as much a duty of care to people who use, as we do to those at any stage of their recovery.