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Institute of Psychiatry, Psychology & Neuroscience
PREVENTING DEATHS FROM
HEROIN OVERDOSE AT HOME
14
Making a difference
Our research led to governments rolling
out take-home naloxone schemes for heroin
users at risk of overdose.
© Institute of Psychiatry, Psychology & Neuroscience, King’s College London
Addictions specialist Professor John Strang first promoted
the idea of ‘take-home’ naloxone – a single injection that
could be given by friends and family to revive someone
suspected of heroin overdose – in 1996. Since then,
researchers at our National Addiction Centre (NAC)
have put together a portfolio of evidence showing that
80 per cent of drug overdoses are witnessed, 80 per cent
involve heroin or opiates and 80 per cent happen at home.
They found that friends and family members want
to learn how to help in an emergency. The NAC team
designed and pioneered training for peers, relatives and
health professionals about what to do if they encounter
an overdose, and how to inject naloxone intramuscularly.
‘Most overdoses occur in the presence of other people,
and these are people who show commitment and who
could potentially prevent death if only they were properly
trained and had access to naloxone,’ says Professor Strang.
Naloxone is a fast-acting heroin overdose antidote
used by the medical profession for over 40 years. It
restores consciousness and allows crucial extra time
in which to seek or dispense medical treatment.
After several pilot schemes led by the NAC, takehome naloxone pilot programmes were launched
in Scotland (2010) and Wales (2011) and are both
measuring lives saved.
Following this, the NAC team showed that prisoners
with a history of heroin use have a staggeringly high risk
of dying from overdose in the first few weeks after release
from custody.
A study led by Professors Michael Farrell and John
Marsden found that one in every 200 released prisoners
in England who previously had a heroin habit died within
a month of leaving prison.
Professor Strang is now co-leading N-ALIVE, a major
randomised controlled trial which has already recruited
1,500 former heroin users as they are released from prisons
in England, to assess the number of lives saved when a takehome emergency dose of naloxone is given to prisoners
at the end of their sentence.
Press & Communications Office
Institute of Psychiatry,
Psychology & Neuroscience
King’s College London
De Crespigny Park
London SE5 8AF
T +44 (0)20 7848 5377
E [email protected]
Naloxone is carried by every ambulance and
administered by paramedics for emergency resuscitation
when opiate overdose is suspected. Although still a
prescription-only medicine, UK law was changed in
2005 to allow naloxone to be given by injection by
anyone in order to save someone’s life. In 2012, the UK
Government’s Advisory Council on the Misuse of Drugs
recommended that naloxone, and associated training, be
made more widely available to prevent more than 2,000
fatal opioid overdoses that happen annually in the UK.
In the USA, the Food and Drug Administration and
other national agencies are now making naloxone more
widely available through take-home schemes. In 2012,
the UN’s Commission on Narcotic Drugs passed a
resolution encouraging all UN member states to include
the provision of take-home naloxone programmes in
their national drugs policies.
In November 2014, the World Health Organisation
launched new international guidelines, with input from
staff at NAC, to stimulate wider international provision.
Naloxone is currently only licensed for use as an injection
but Professor Strang and colleagues are exploring
other possible routes to administer the drug effectively
including as a nasal spray and other non-injection routes.
Research led by Professors John Strang, Michael Farrell
& John Marsden
REFERENCES
• Strang et al. Heroin overdose: the case for take-home naloxone?
BMJ, 1996; 312: 1435
• Strang et al. Preventing opiate overdose fatalities with take-home naloxone:
pre-launch study of possible impact and acceptability. Addiction, 1999; 94:
199-204
• Strang et al. Overdose training and take-home naloxone for opiate users:
prospective cohort study of impact on knowledge and attitudes and
subsequent management of overdoses. Addiction, 2008 Oct; 103(10): 1648-57
• Farrell M. Acute risk of drug-related death among newly released prisoners
in England and Wales. Addiction, 2008 Feb; 103(2): 251-5
• Strang et al. Family carers and the prevention of heroin overdose deaths:
unmet training need and overlooked intervention opportunity of resuscitation
training and supply of naloxone. Drugs: Education, Prevention and Policy,
2008; 15: 2, 211-218
• Mayet S et al. Impact of training for healthcare professionals on how to
manage an opioid overdose with naloxone: effective, but dissemination
is challenging. International Journal of Drug Policy, 2011; 22: 9-15
• Strang, J, Bird, S and Parmar, M. Take-home emergency naloxone to prevent
heroin overdose deaths after prison release: rationale and practicalities for the
N-ALIVE randomised trial. Journal of Urban Health, 2013; 90(5): 983-996
• Williams, A., Marsden, J. & Strang, J. Training family members to manage
heroin overdose and administer naloxone: randomised trial of effects on
knowledge and attitudes. Addiction, 2013
For more in our Making a difference series: www.kcl.ac.uk/difference