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Pilot scheme shows that giving naloxone to families of drug users would save lives

BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d5445 (Published 25 August 2011) Cite this as: BMJ 2011;343:d5445
  1. Richard Hurley

A1 BMJ

A pilot scheme has shown that providing family and friends with training and the drug naloxone seems to reduce deaths from overdose among heroin users and other opioids misusers, says the English National Treatment Agency for Substance Misuse, a special health authority of the NHS.

During the pilot scheme 20 users overdosed, and carers gave naloxone to 18. All the users survived. Family members, partners, or other drug users are often first to find a user who has overdosed.

“If they can be trained in how to manage such an emergency and keep the victim alive while waiting for the ambulance, potentially hundreds of lives could be saved in the UK every year,” said Paul Hayes, chief executive of the treatment agency.

Commenting on the findings John Strang, head of the addictions department at King’s College London, said, “We are approaching a time when a clinician might be considered negligent if he or she did not tell the family of a user how to manage an overdose, particularly if the user later overdosed and was initially found alive, but then died because the family didn’t know what to do.

“The numbers in this pilot are small but they allow you to conclude that the families of users are hungry for this information.”

Some people may think that providing families with naloxone gives out a mixed message, said Professor Strang, but he added, “It is surely better for family and friends to know how to deal with an overdose emergency, even though you do everything possible to avoid it happening.”

He believes the reason the NHS has been so slow to roll out naloxone is that the novelty makes people nervous. “Empowering families feels alien; it’s similar to when Epipens [adrenaline autoinjectors] became available for people with allergies. But we must get over this: we can hardly allow deaths to occur once we establish that they could be avoided,” said Professor Strang.

He added, “What we need is a big randomised trial, which is in hand.” The N-ALIVE (NALoxone InVEstigation) study will randomise more than 50 000 prisoners with a history of heroin use to being given naloxone on release or not.

The pilot study ran from July 2009 to February 2010 at 16 drug treatment centres in England. In all, 495 carers received training in basic life support techniques, including the recovery position and cardiopulmonary resuscitation. At 15 of the centres carers were also trained to give, and provided with, naloxone.

Even though naloxone is a prescription only drug in England it is legal for it to be used by anyone for the purpose of saving a life in an emergency (see BMJ 2006;333:614, doi:10.1136/bmj.333.7569.614). Mostly, the carers in the pilot scheme gave naloxone to somebody other than the person named on the prescription.

Rick Lines, executive director of Harm Reduction International, said, “Risk of fatal and non-fatal overdose is a major concern for people who inject drugs around the world. It is also a risk that can be reduced through targeted overdose prevention programmes, including provision of naloxone. The encouraging results of the UK trial are consistent with the growing body of international evidence demonstrating that such targeted overdose prevention programmes are effective and save lives.”

Notes

Cite this as: BMJ 2011;343:d5445

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