One of the key priorities of the Health Service Executive (HSE) National Service Plan 2014 is to improve health outcomes for people with addiction issues.1 One of the actions related to this is the finalisation of the implementation plan for the National Overdose Prevention Strategy (unpublished). Investigating the possibility of enhanced availability of naloxone, a drug used to counter the effects of opiate overdose, is a key element of the HSE’s overdose strategy (personal communication, Mr Joe Doyle, national planning specialist, HSE). This is important, considering opiates were implicated in 50% of all poisoning deaths in Ireland in 2011 (see article on drug-related deaths in this issue).
The proposals on how to progress the naloxone demonstration project include:
- Identify stakeholders: to include a wide range of organisations, including community, families and voluntary services.
- Product choice: e.g. pre-filled syringe or nasal formulation.
- Legislative issues: naloxone is a prescription-only medication in Ireland and can only be dispensed by a pharmacist to a named person, for their use only, and can only be administered to that person by a trained healthcare professional (which includes certain ambulance service personnel).
- Cost and evaluation: to include pharma-economic evaluation, costs of training and supply of product.
The Take Home Naloxone (THN) demonstration project started in Wales in 2009 is one of a number of UK models that have been documented.2 Its main aim was to reduce drug-related deaths in Wales and it incorporated an independent evaluation at the end of the first year. This project was possible because of a change in the legal status of naloxone in 2005 in the UK which allowed any member of the public to administer naloxone in an emergency. The project took place in six pilot sites. Drug users, their friends and families were trained in overdose prevention, including how to identify risks, how to administer naloxone, and basic cardiopulmonary resuscitation. The independent evaluation of the project found an important outcome was that those who had been trained did not rely only on naloxone but also used other life-saving measures that they had been taught by the programme; they more frequently used the recovery position and called an ambulance than those who were not trained.
The project continues in Wales and has been expanded to different pilot settings. For example, in one major hospital emergency department, staff have been trained to give THN to clients at risk of overdose when leaving the hospital. For further information see http://tinyurl.com/nkrxmvy
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1. Health Service Executive (2013) National Service Plan 2014. Dublin: Health Service Executive. www.drugsandalcohol.ie/21092
2. Bennett T, Holloway K (2011) Evaluation of the Take Home Naloxone demonstration project. Merthyr Tydfil: Welsh Assembly Government. http://wales.gov.uk/docs/caecd/research/110627naloxonefinalreporten.doc
