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Naloxone brief pres april ihra Beruit 2011
1. ScottishDrugsForum Scottish NALOXONE ProgrammeIHRA ConferenceBeirut Lebanon Stephen MalloyNational Training & Development officer- Critical Incidents & naloxoneApril 2011 Co-ordinating Action on Drug Issues
2. This is Scotland Scottish Population ~5.2 Million Estimated Opiate/Benzo Users ~55000-60000 Local prevalence varies between 0.2% - 3.9% of population PWI opiates- 23000> ScottishdrugsForum
4. Briefly outline.... Context setting up scaled Naloxone distribution across Scotland- interplay between medical/legal/pharmaceutical/social care sectors Scottish programme developments Training and support available Implementation Scottish evaluation of naloxone programme ScottishdrugsForum
5. Context setting The need for Overdose prevention and community based naloxone training in Scotland ScottishdrugsForum
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8. Scottish DRD Trend 1997-2008 131% increase in drug related deaths since 1998 * Drug deaths increased by 26% from ’07-’08 . 545 DEATHS IN 2009 ScottishdrugsForum
9. Drug Related Deaths in Scotland (GROS) 2009-545 DRDs by age & sex in Scotland 2009 Aged under 25yrs- 71 Aged 25 to 34yrs- 178 Aged 35 to 44yrs- 189 Aged 45yrs and over- 107 Males- 413 Females- 132 In 2007, 30% of Deaths in Males aged 25-34yrs were Drug Related ScottishdrugsForum
16. Opioids ‘fit into’ receptors Perfect fit- full Opioid effect CNS DEPRESSANT EFFECT- reduced breathing, heartbeat, etc. Euphoric effect/Sleepy/ ”Gouchy” Etc.
17. Naloxone displaces opioids from receptors Naloxone CNS controlled functions will no longer be depressed (point to note...!!) When opioids are displaced from these receptors, the person may start to experience withdrawal
18. Naloxone has a temporary effect....(person could go back into Overdose state...possible but unlikely) Opioid returns to receptor <<<<<<<<Naloxone Empty Receptor> Signals From Receptor to Brain Possible Temporary Withdrawal Pain!!!?
19. Naloxone has no effect on CNS depression caused by alcoholBenzodiazepines or other (non opioid) ‘downer’ drugs In Scotland, Naloxonetraining MUST be delivered with other OD prevention interventions ScottishdrugsForum
20. Who can use Naloxone in UK 30th June 2005- reclassification Naloxone is now on the list of prescription only medicines that can be administered parentally (by injection) by anyone for the purpose of saving a life. This means that Naloxone can be given by any member of the public to a person suspected of having an opioid overdose. ScottishdrugsForum
21. Who can be supplied? “...that the supply of naloxone, as a POM, can only be made on a named patient basis (or patients rep) using either a prescription or a Patient Group Direction (PGD).” A PGD is a legal device that allows suitably qualified nurses or pharmacists to supply POMs in specific defined circumstances. (National Naloxone PGD) ScottishdrugsForum
22. Continued... “Access to supplies using a PGD is not restricted to patients who are in contact with treatment services. This is for unplanned care and is available to anyone that the nurse or pharmacist identifies as being at risk of opiate overdose irrespective of any current or previous contact with treatment services.” There’s no hope of recovery if you’re dead. (National Naloxone PGD) ScottishdrugsForum
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24. First ‘warnings’.....1975, an editorial in Lancet warned that in opioid addicts, “......naloxone can precipitate a severe withdrawal syndrome in dependent addicts.” Editorial: Naloxone. Lancet 1975;1:734.ScottishdrugsForum
25. Forward in time 1992- J. Strang, BMJ- Should Naloxone amps be made available to IDUs? Emergence of community based training and distribution-The change Jersey Project -1998,Berlin Project-1999, San francisco-2001, Chicago- 2001, New Mexico-2001, Baltimore-2004, NYC-2004/5 and many other sites. Several European and international programs are developed Glasgow/Lanarkshire pilots/program-2006-7 * Inverness pilot-2009 Welsh Program -2009 June 2009- 16 site pilot in England ScottishdrugsForum
35. National Developments 09-11 Short life working group recommendations to NDRDF National PGD and template training program, agreed by NDRDF NDRDF annual report- published 2010 Gov. Minister announced National program Scottish Prison Service estates- Naloxone training First wave Lord Advocate letter extending supply to ALL workers in regular contact with people at risk of opiate related overdose ScottishdrugsForum
36. Ongoing issues in Scotland Scottish Drugs Strategy- ‘Road to Recovery’ Discussions between ACMD and MHRA re classification of Naloxone L.A. and services policies around storage and administration of medications Work with manufacturer around product design Staff awareness, competencies and capacity ScottishdrugsForum
37. Training and support Reimbursement for Naloxone units distributed, agreed by Scottish Government- total investment £500,ooo Training and national resources Implementation support ScottishdrugsForum
38. National Naloxone Trainers Stephen Malloy -National Training and Developments- Critical Incidents & naloxone Lisa Ross-National Naloxone Trainer (pt) Clinical Harm Reduction Nurse Specialist Karen Smart- PT National Naloxone Trainer (pt) Registered General Nurse- Drug death prevention co-ordinator ScottishdrugsForum
52. Naloxone ‘Training the Trainer program’ Broadly; 2 day comprehensive course Adult learning model, facilitation skills, models of delivery of naloxone training i.e. Group/pair/1 to 1/ opportunistic OD Prevention/Signs and symptoms etc. Naloxone and it’s actions, kit assembly, injecting technique etc. Certificated Basic Life support and Naloxone use Practice delivery PGD, recording, monitoring and reporting (Local evaluation?) Post session examination Adaptable to suit local area needs and current capacity ScottishdrugsForum
53. Training for trainers delivery to date; North Ayrshire Highlands Greater Glasgow and Clyde Dumfries and Galloway Forth Valley Tayside (April) across the SPS estate, with 60+ trainers. Northern Ireland Wales Developmental and capacity building activities in ALL (except 1) other HB areas
54. Local Implementation ADP identify leads and drive program forward locally Local adoption/adaption (if required) of PGD Agreement of processes, monitoring etc Cross sector/multi agency involvement Across Tiers 1-4 Build/bolt on to local initiatives (utilise current bank of OD prevention inititives? ) MUST involve families and broader ‘circle of care’...(person can’t self administer) ScottishdrugsForum
55. Ongoing Developments Peer Trainers in communities Aiming for Peer led, but clinically supported/supervised sessions WE WANT NALOXONE OTC WE NEED naloxone Normalised and ‘as standard’ WE NEED Recurring monies
56. National Evaluations SPS- comparative evaluation (07-09/10-12) based on survival rates of at risk individuals 4 weeks post release- Prof. Sheila Bird-Cambridge University. Dataset collection throughout term of evaluation- reported uses; SAS involvement; hospitalisation; National/Local distribution vs population (dose?), DRD figures etc Product monitoring information ScottishdrugsForum
57. Actions speak louder than words, and giving opiate users naloxone demonstrates to them that it matters whether they live or die. There is no hope of recovery if your dead.
