Transcript Dr Nigel Modern - Treatment Philosophy

Peer naloxone – present
or future?
Issues for service delivery
Nigel Modern
Current status of Take Home
Naloxone



We have good evidence of effectiveness in
individuals but not evidence which shows
effectiveness in populations
This leaves naloxone open to the ‘seat
belt’ argument
Research is in progress to resolve this
Does this prevent its
introduction into practice?



No!
However we need to accept we are
dealing with an intervention in
development with as far as I am aware no
national guidance
There are clear at risk groups at which to
target the intervention…and consensus on
good practice?
Good practice in Naloxone
prescribing(a local guideline)
The prescriber should have a continuing
duty of care towards the individual for
whom they prescribe and will normally be
a prescriber within a service where the
person is in treatment or their registered
GP
Good practice

The prescriber has an unclear duty of care
towards a person that their patient revives
using naloxone prescribed for their own
use. However naloxone has growing
international recognition and its use is
very similar to eg glucagon in diabetes
and the Epipen in anaphylaxis.
Good practice

Naloxone (in the UK) is included in the list
of parenteral drugs which can be given
‘…by anyone for the purpose of saving life
in an emergency…’ in Medicines for
Human use (Prescribing) - Miscellaneous
Amendments Order 2005 No. 1507
Target groups


Naloxone can and (perhaps?) should be
offered to all opiate users but the
following groups are particularly at risk of
overdose
i. Injecting drug users ii. Service
users in the early stages of treatment
iii. Service users with possible
lowered tolerance eg post
detoxification or on prison release
Not a ‘new drug’

Naloxone is a safe, long established and
effective medication with no addictive
potential and is not a controlled
substance
Good practice?



Current significant initiatives involve quite
complex delivery processes involving a
group training session with evaluation of
effectiveness of training
In other places services are starting to
deliver the intervention to individuals with
or without evaluated group training
Who is right?
Who is right?


Don’t know but audit of results is essential
Audit of reported naloxone use: An important part of
the role of service user advocates and staff involved in
service provision is to encourage the reporting of all uses
of naloxone so that information can be gathered to aid in
future service design. There is a defined dataset for
audit purposes and the contact number to give to service
users for this purpose is included with the information
accompanying the standard script wording.
Future planning



Currently locally services run evaluated
group training plus audit of naloxone use
In future we may in Primary Care run an
individual brief training session delivered
by drug workers who then trigger a
Shared Care GP to prescribe
This may utilise intranasal naloxone
My own current practice



I explain the use of naloxone
I provide the materials developed for the
Primary Care intitiative which is in
preparation
I provide a prescription (with tear-off quick
reference strip) to service users I come
across from the at risk groups…but I am not
entirely consistent owing to time
constraints…in fact I’m pretty bad
Unresolved issues



The usual dose IM is 400mcg but more
could be needed in some individuals
The Minijet is fiddly and multiple doses
means multiple injections
Intranasal naloxone could give flexibility of
dose, greater acceptability and availability
in the community but many feel more
evidence for its effectiveness is needed