Emergency overdose antidote to be more widely available
Author: Mark Gould
Public Health England (PHE) has announced that regulations have been amended to make naloxone, the emergency antidote for overdoses caused by heroin and other opiates or opioids, more widely available.
The main life-threatening effect of heroin and other opiates is to slow down and stop breathing. Naloxone blocks this effect and reverses the breathing difficulties.
Naloxone is a prescription-only medicine, so pharmacies cannot sell it over the counter. But drug services can supply it without a prescription. And anyone can use it to save a life in an emergency.
Under regulations that came into force in October 2015, people working in drug treatment services can supply naloxone to others that their drug service has obtained, if it is being made available to save a life in an emergency. A prescription is not needed to supply naloxone in this way.
The regulations were amended this week to include nasal naloxone. For example, a worker in a recognised drug treatment service could supply naloxone for use in an emergency to a family member or friend of a person using heroin, or to an outreach worker for a homelessness service whose clients include people who use heroin.
However Harry Shapiro the director of the drug information charity Drugwise said the availability was still not wide enough because of the POM status of naloxone. "In order to further reduce drug-related deaths, the drug should be directly available to other potential first responders including police and hostel staff."
The regulations define drug treatment services as those “provided by, on behalf of, or under arrangements made by the NHS, a local authority, PHE or the Northern Ireland Public Health Agency".
The Human Medicines Regulations (updated in 2015 and 2019) mean that commissioned drug treatment services can supply both injectable and nasal naloxone to individuals without the need for a prescription or the need for patient group directions (PGDs) or patient specific directions (PSDs).
However, PGDs and PSDs are still available and people supplying medicines can use them whenever appropriate. They may be particularly useful in some situations, such as when supplying naloxone outside of a local-authority-commissioned or NHS-commissioned drug treatment service. For example, when a police and crime commissioner is funding a service.
PHE says that when renewing a PGD or PSD it may be helpful to write to the relevant medicines management committee (or equivalent body) to state the case for renewing the PGD or PSD and referencing the above advice.
Under pre-existing legislation, police doctors can order stocks of naloxone and give it to individual police officers who may come across opiate users, for example in custody suites. Police and crime commissioners who have commissioned custody suite intervention services for drug users will need to use PGDs or PSDs.
The Regulations specify that drug services can supply naloxone products without a prescription if they solely contain naloxone.
Organisations responsible for commissioning and providing drug treatment services will, as part of normal clinical governance, need to ensure that competent individuals working in treatment services are suppling naloxone, and that the supply by them is safe.
Advice is available in the open letter from Professor John Strang, chair of the Clinical Guidelines Update Working Group, indicating “a minimum level of training in how to assemble and use the particular product” is essential and that “other training will also be helpful”.
PHE says local decisions about how best to supply naloxone in line with this guidance may determine which employees or volunteers in the drug treatment service are most suitable to supply the naloxone.