Transcript The Scottish National Naloxone Programme: what is it and

The Scottish National Naloxone
Programme: what is it and how
did we get there?
Andrew McAuley
Public Health Adviser (Substance Misuse)
NHS Health Scotland
‘Naloxone Saves Lives’ Conference
Swansea, 19.05.11
Acknowledgements
 Lisa Ross, NHS Highland
 Stephen Heller-Murphy, Scottish Prison Service
 Jennifer Stoddart, Scottish Government
 Dr Roy Robertson, National DRD Forum Chair
National Naloxone Programme
“The aim of this national programme is to
increase the availability and awareness of
naloxone across Scotland, in order to
increase the chance of it being
administered during an opiate overdose… I
hope that the impact of increased naloxone
availability will contribute to a reduction in
fatal opiate overdoses in Scotland and I am
very grateful for your support in taking
forward this important initiative.”
Fergus Ewing, Minister for Community Safety,
01/11/10
Background
DRDs in Scotland per calendar year,
1996-2009
600
550
500
450
400
350
300
250
200
150
100
50
0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
registered in year
5-year average
likely upper
3-year average
likely lower
Source: GROS (2010)
DRDs per 100,000 population (all ages),
2009
12
10.24
10
8
6
4
3.4
2.8
1.96
2
0
Eng & Wal
N Ireland
Scotland
UK Ave.
Source: UK Focal Point (2010)
Scottish DRD circumstances
 Majority are opioid related
 Majority are ‘accidental
overdoses’
 Majority are male
 Average age is increasing
 Majority witnessed / have
others present
 ~ 50% have previously
been in prison
 Most interventions often
ineffective or too late
Sources:
Zador et al, 2005; GROS et al, 2010, Graham et al, 2011
The Journey to a National
Naloxone Programme…
Journey to a National Programme
1996
2004
2005
2005
2007
2007
2008
2009
2009
2010
2010
Strang et al propose naloxone for peer administration
Local proposals for naloxone pilots (Lanarkshire)
Scottish Advisory Committee on Drug Misuse (SACDM)
Medicines for Human Use (Prescribing) (Miscellaneous
Amendments) Order
National Forum on Drug Related Deaths Annual Report
Glasgow / Lanarkshire Pilots Launched
Glasgow Pilot Evaluation Published
Lanarkshire Pilot Published
Inverness Pilot Launched
Inverness Pilot Evaluation Published
National Forum on Drug Related Deaths Annual Report
2010
National Naloxone Programme launched!
Scottish Advisory Committee on Drug
Misuse (SACDM)
 2005 Working group on drugrelated deaths…
“those in a position to
administer naloxone should
receive appropriate training to
do so”
Legislation
 In June 2005 the ‘Medicines for Human Use
(Prescribing) (Miscellaneous Amendments)
Order 2005’ amendment of article 7 contained
provision to the administration of naloxone (by
anyone) for the prevention of overdose.
National Form on DRDs

2007 Annual Report Recommendation 3…
“With take-home naloxone being more
widely used across the world to save lives,
e.g. in Berlin, San Francisco and Chicago,
consideration should be given in Scotland to
extending take-home naloxone provision
beyond Glasgow into other areas. This
recommendation is made with the
understanding that any pilot is rigorously
evaluated to prove effectiveness.”

Scottish Govt. Response…
“Local planners should consider the findings
from the evaluations when they are
published, and decide if naloxone provision
is an intervention they would wish to adopt
in their area. Before any roll-out of the
programme, thorough training would have to
be in place that covered the use of naloxone
and overdose awareness, such as the
training programme devised for the Glasgow
pilot. Naloxone should not be distributed
without such a training programme being in
place first.”
Lanarkshire / Glasgow Pilot Results
Lanarkshire / Glasgow Pilots
Key Findings

195 clients trained & supplied, 12 saves – all by clients

Scottish drug users can be effectively trained to identify and respond to an opiate
overdose utilizing basic life support and naloxone administration skills similar to their
peers from around the world.

The majority of which can responsibly manage their own personal THN supply when
trained appropriately.
o No increase in risky behaviour
o No inappropriate use

Improved knowledge and confidence in OD awareness, BLS & naloxone post-training

A ‘buddy’ system where clients are encouraged to attend training with a friend/family
member is an effective way of engaging wider user networks who may be able to
intervene in an OD situation.
Lanarkshire / Glasgow Pilots
Key challenges
Recruitment
Follow-up
Lanarkshire / Glasgow Pilots
Media reporting
POSITIVE:
‘Addicts to be given personal supply of anti-overdose drug’, 28/05/06
‘Overdose drugs given to families of addicts’, 29/05/06
‘Saving Lives is the priority’, 30/05/06
‘Project to aid addicts may be extended’, 17/10/07
NEGATIVE:
‘Fears over anti-OD drug for addicts’, 29/05/06
‘Pressure on addicts plan’, 12/06/06
‘Addicts jag row’. 13/06/06
‘Drugs expert condemns overdose kits’, 18/11/07
Inverness Pilot
Inverness Pilot
Key Findings

First attempt to pilot naloxone in a rural area

Linked local Harm Reduction Nurse and Addictions Nurse in Porterfield Prison

Significant client engagement
o 170 clients trained (68 prisoners)

Early impact
o 37 saves, (35 by clients, 1 by family, 1 by staff)

Peer liaison worker / peer education approach

Improved confidence and self-esteem among participants

Roll-out to wider NHS Highland area confirmed from July 2010 onwards
Drug-related deaths in Inverness 2009/10
Pilot duration, July ’09 -Jun ‘10
25
20
Jan ’08 to Jun ’09
= 28 deaths
20
15
Jul ’09 to Dec’10
= 7 deaths
13
n
10
2011
5
2
= 1 death
1
0
2008
2009
2010
2011
•
64 successful OD reversals using naloxone to date
•
1 unsuccessful
(on 1st Jan)
National Forum on DRDs

2009/10 Annual Report,
Recommendation 2…
“‘Take home’ naloxone should be
available to all high risk individuals on
release from custody later this year.
This programme should be
underpinned by a detailed evaluation
which builds on data already held by
SPS for the three years preceding the
implementation date. This should be
supported by increased availability of
‘take home’ naloxone though specialist
and primary care services and the
Forum encourages the development of
local ‘take home’ naloxone
programmes where this is not already
in place.”
The National Naloxone Programme
The National Naloxone Programme
 Nationally funded roll from 1 Nov 2010 out across the
country including the prison estate (~ 6000 kits in yr 1)
 National Protocol & Guidelines (SLWG)
 PGD
 Training
 Product
 Monitoring / Evaluation
 Child Protection
The National Naloxone Programme
Media reporting
‘Free lags given OD Antidote’
18/08/10
‘Addicts will get pill to reverse heroin overdose’
18/08/10
Training
 National Naloxone
Trainers (3 posts, 2.0
WTE)
 ‘Heartstart UK’ accredited
 Cascade Model (i.e. Train
the trainer)
 1 or 2 day course
 OD Awareness /
prevention, BLS,
Naloxone
Product
 Naloxone Hydrochloride1mg/1 ml (2ml) pre-filled
syringe…
o Multi-dose
o Contained within a hard plastic case
o One step assembly process
o Cost-effective
Prison
 For all prisoners at risk of
opiate OD
 Promoted throughout
sentence
 Trained pre-release
 Co-facilitated by Nursing
and Phoenix Futures staff
Monitoring
 Mandatory minimum dataset
o Consent
o Demographics
o Prison History
o Prescription
 Optional supplementary dataset
o Contextual info on naloxone use e.g.
- Drugs Involved
- Location
- Other BLS used
- Ambulance involvement
- Outcome of use
Monitoring
 National minimum dataset aims & objectives:
o How many individual are receiving kits?
o How many kits have been issued?
o What is the rough demographic picture of those receiving kits
(gender, age, geographical location)?
o How many of the kits issued are re-supplies?
o Why are people receiving re-supplies – lost/stolen/expired/used?
o What kind of services are issuing kits?
o Where are these services located?
o What is the spread of naloxone supply across Scotland?
Evaluation
 Measures the impact of increasing the availability of
naloxone on the number of fatal opiate overdoses in
Scotland against the following baseline…
Of the total number of drug-related deaths:
i) What proportion of these were opiate related;
ii) What proportion of these were opiate related and
occurred within the first four weeks following release
from prison custody;
…in calendar years 2007,2008,2009 broken down by
gender and age groups
Ongoing support
 National Naloxone Advisory Group
 Practitioner Network (ScoNN)
 Information Materials (leaflets / posters / wallet cards)
 Letter from the CMO
 Lord Advocate Guidelines (‘letter of comfort’)
Progress to date…
 Naloxone commitment in 29 / 30 ADP areas
 > 20 services now routinely training & prescribing via
range models:
o Group
o 1 to 1
o Couples
o Home-visits
o Professional and peer-led sessions
 Prisoner take-up lower than expected
Summary
 Long road to a National Programme
 Research, advocacy and legislation all essential
 National Policy vital to improving adoption and
reach
 More research and evaluation needed
Thank you
Andrew McAuley
T: 0141 354 2935 (ext: 2935)
F: 0141 354 2901
E: [email protected]
www.healthscotland.com
www.take-homenaloxone.com