Antagonist treatment: Naloxone
Opioid overdose occurs especially frequently after release from prison. However, opioid overdose is treatable with naloxone hydrochloride, an opioid antagonist on the WHO Model List of Essential Medicines. Naloxone hydrochloride, when injected, very rapidly reverses overdose due to opioids such as heroin and/or prescription opioids such as or tramadol. Naloxone has no potential for abuse, and side-effects are rare. For more than three decades, emergency medical personnel have administered naloxone as a standard pre-hospital treatment for opioid overdose. Naloxone has been available, by prescription, to at-risk drug users and their family/friends since 1999 through select programs across the world (Yokell, 2011).
In the case of suspected opioid overdose, any respiratory arrest should be managed with assisted breathing and/or oxygen while waiting for naloxone to be administered and take effect. Naloxone is fast-acting, and adequate respiration will typically resume within 3-7 minutes of its intramuscular administration (UNODC, 2013).
Naloxone is non-addictive, may be dispensed by injection (preferably intramuscular) or nasal application, and has mild side effects when used at the correct dosage (American Society of Addiction Medicine, 2014). Overdose prevention programmes can be regarded as a potential gateway to long-term medication-assisted treatment (MAT).
In recent years, a number of programmes around the world have shown that it is feasible to provide naloxone to people likely to witness an opioid overdose, in combination with training on the use of naloxone and the resuscitation of people experiencing opioid overdose. The successful implementation of these naloxone programmes has prompted calls for widespread adoption of this approach (EMCDDA, 2016).
In their new guidelines on community management of opioid overdose, the WHO recommends that people likely to witness an opioid overdose should have access to naloxone — an effective antidote that can reverse opioid intoxication — and should be instructed in its administration (WHO, 2014). Evidence shows that take-home naloxone, complemented by educational and training interventions for peers and family members, helps decrease overdose-related mortality. With evidence on its effectiveness growing, take-home naloxone provision has gained increasing attention in recent years (EMCDDA, 2016). Naloxone should be available within prisons to reverse opioid overdoses (Sander, G., 2016).
Data from the Scottish National Naloxone Programme: https://bit.ly/2R5XnBl, which includes the provision of take-home naloxone kits to prisoners on release, indicate that since the program’s start in 2011, the number of heroin-related deaths within 4 weeks of release has decreased gradually each year, coincidental with a steady increase in the number of take-home naloxone kits provided (Bird, McAuley, Perry, Hunter, 2016).
The Scottish National Take-home Naloxone Programme has managed to raise public awareness around overdose risk factors, symptoms and emergency response through an informative project website (www.naloxone.org.uk), which features instructional videos, a ‘naloxone finder’ tool and a free overdose app for download (see also: https://bit.ly/3eYd99a).
Naloxone is a powerful tool for overdose prevention work. Three info films -
- What is Naloxone? https://bit.ly/3o4a3VA
- Instructional (2 min): https://bit.ly/3o49VW6
- «How I saved my friend with naloxone» in Bergen, Norway (4 min): https://bit.ly/3uy9JRj
Naloxone on-release - The e-course provides guidelines for naloxone provision upon release from prison and other custodial settings. The immediate time after release (“my first 48 hours out”) is a critical time for action, when the cooperation between prisons, healthcare providers and NGOs is key in ensuring continuity of care and where targeted interventions can save lives from overdose and build a path towards engagement into further treatment and rehabilitation for people who use drugs. https://harmreduction.eu/course/naloxone-on-releas
My First 48 Hours Out - This booklet was produced in the framework of the EU co-funded project “My first 48 hours out”– comprehensive approaches to pre and post prison release interventions for drug users in the criminal justice system”, implemented by the University of Applied Sciences in Frankfurt. https://bit.ly/2Q2Kpnn (translated into several languages)