National Forum on Drug-Related Deaths in Scotland - Annual Report 2011/12

6. Update on Scotland's Naloxone Programme

6.1 The National Naloxone Programme has continued to develop and expand across Scotland. Nearly all ADP areas have established a level of local capacity to provide overdose prevention training and naloxone supply to people at risk of opioid overdose. Thousands of sessions have been delivered, either in 1 to 1 or group settings directly training and supplying kits to people who use opiates.

6.2 The first annual release of monitoring information on take home naloxone supplies^[11] was published by ISD Scotland on 31^st July 2012. This initial report presents data from the period April 2011 - March 2012. Some key findings were:

• 3445 take home naloxone kits were supplied through Scotland's naloxone programme;
• Of these, 2730 kits were supplied in a community setting and 715 by the Scottish Prison Service to prisoners at risk of opioid overdose on liberation;
• 90% of the total number of kits supplied were to people at risk (3085 kits) of a opiate overdose. The remaining kits were supplied to family members and friends (with consent of the individual) and service staff;
• 145 kits were issued as a 'repeat' supply due to reported use of the previous kit on a person at risk of opioid overdose.

6.3 As well as monitoring the supply of 'take-home' naloxone kits in Scotland, ISD were tasked by the National Naloxone Advisory Group to measure the impact of increased naloxone availability on the number of (opioid) drug related deaths in Scotland and, in particular, to monitor the number and percentage of these occurring within four weeks of prison release. ISD have conducted a baseline survey, using calendar years 2007-2009, and the results of this are included in the July 2012 naloxone monitoring report. Performance against this baseline will be measured for calendar years
2010-2013.

6.4 A series of innovative radio adverts highlighting how friends, families and people who use drugs can prevent opioid overdose deaths were launched across Central Scotland to mark International Overdose Awareness Day.

6.5 Updates and information on the National Naloxone Programme are now available on a variety of social media platforms such as:

• The website www.naloxone.org.uk is live and offers a Scottish focus but also has information from across the UK and internationally.
• Facebook page - www.facebook.com/naloxoneuk
• Twitter -www.twitter.com/NaloxoneUK
• The opiate overdose app from U-turn Training is available free on both android and iPhone platforms.

6.6 A Training and Development Officer was recruited to support the National Coordinator at the Scottish Drugs Forum to specifically look at designing, developing and implementing Naloxone Peer Education Networks. This exciting new initiative involves groups of former or stable drug users completing training for trainers and going on to deliver overdose prevention and naloxone intervention to their peers. The involvement of people who use drugs is crucial to extend the reach of the programme further into communities, particularly the hard to reach population.

6.7 With support from the National Naloxone Advisory Group, NHS Health Scotland (in collaboration with the Scottish Drugs Forum) led a GP engagement project to support the national naloxone programme. To date, the national programme has mainly been delivered through Statutory Addiction Services or Harm Reduction Teams. GP involvement in the programme has been much more limited. However, GPs have a particularly important role to play in reducing drug-related deaths given that they are the second most common service, after Statutory Addiction Services, which drug-related deaths victims were in contact with prior to their death. A need was therefore identified to strengthen the involvement of GPs in the national programme. With this in mind, the University of Aberdeen Centre of Academic Primary Care was commissioned to conduct a needs assessment in relation to GP engagement with the national naloxone programme. The needs assessment is the first stage of a wider GP naloxone engagement project and will be used to inform the development of a resource and support package to expand access to take-home naloxone among those at-risk of opioid overdose. The study findings published on 12 February 2013 are available on the NHS Health Scotland Website^[12]. An overdose prevention and naloxone workshop was delivered to GPs for NHS Education Scotland as part of the Continuing Development Professional (CPD) Programme.

6.8 The National Coordinator liaised regularly with key stakeholders to support final submissions for the license variation to the Medicines and Health Care products Regulatory Authority (MHRA) with the ultimate aim of ensuring a licensed community pack is available.

6.9 A two day event was held for Local Take-Home Naloxone Coordinators from across Scotland. The purpose of the event was to facilitate networking and dialogue between national leads and representatives of National Groups, allowing for the collection of qualitative feedback of their perception and experience of the local programmes. Participants were also encouraged to identify what they saw as priority areas of work for development or further consideration, both at the local and national level.

6.10 Scottish Drugs Forum continues to provide support to local areas and has facilitated over 60 'Training for Trainers' sessions to almost 600 participants.

A protocol has been devised for basic life support and naloxone administration for emergency call handlers, to ensure that people calling 999 following an opioid overdose are offered the same information in accordance with the National programme.

6.11 The key priorities for 2013 are to:

• Continue to develop Peer Education Networks across Scotland;
• Support the work of Health Boards in the delivery of Naloxone in prisons;
• Launch of the rebranded and redesigned national materials;
• Continue work with key strategic partners in order to increase the quality and reach of the naloxone programme;
• Engagement of GPs;
• Continued discussions and engagement with Police, specifically regarding the role of naloxone in custody settings;
• Finalise and launch the naloxone directory.

6.12 The overarching aim for Scotland is to ensure that the provision of naloxone supply to people at risk of opioid overdose is standardised, normalised and prioritised. If someone has a history, or active use, of opioids they should be afforded naloxone without hesitation. The number of naloxone kits being supplied to people in the community must be significantly increased in order to have an impact on the tragic number of drug-related deaths in Scotland.