NALOXONE: WHATS THE HOLD UP?

Naloxone is a type of medicine called an opioid antagonist. It blocks the actions of opioid medicines such as morphine, diamorphine, codeine, pethidine, dextropropoxyphene and methadone.

 High doses of opioids, excessive opioid intake, or abuse or overdose with these drugs can cause reduced lung function and slow, shallow breathing (respiratory depression), which can be life threatening.

 Naloxone is used to treat respiratory depression caused by opioids. Opioids produce their effects by acting on opioid receptors in the brain and nervous system. Naloxone works by blocking these opioid receptors, which in turn stops opioids from acting on them. This reverses the effects of the opioid.

Naloxone may be given by injection into a vein, muscle or under the skin, or via a drip into a vein (intravenous infusion) or nasally.

What is Naloxone used for?

  • Reversing breathing problems (respiratory depression) caused by opioids, for example following surgery, or in people taking high doses to control cancer pain.
  • Reversing breathing problems (respiratory depression) in newborn babies whose mothers were given opioids during labour.
  • Diagnosing and treating opioid overdose.

Use with caution in….

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

  • Nausea and vomiting
  • Sweating
  • Increased heart rate (tachycardia)
  • Hyperventilation
  • Increased blood pressure
  • Reversal of pain relief if larger than necessary doses are given
  • Irregular heart beat (ventricular arrhythmias)
  • Low blood pressure (hypotension)
  • Accumulation of fluid in the lungs (pulmonary oedema)

The side effects listed above are listed but are not necessarily going to effect the individual whose life is threatened by overdose. The fact is that the individual would be alive. 

 Right with the explanation as to what naloxone is I move onto the positive and in my opinion undeniable argument that it is a positive step forward in reducing the drug related fatalities associated with all opioid substances from illicit to prescription. 

 The latest statistics from the Office of National Statistics (2012) show that there were 1,706 male drug poisoning deaths and 891 female and in total 2,597 drug related deaths registered.

 Although the male statistic has decreased by 4% the female statistic has steadily increased since 2009. The highest mortality rate from substance misuse fell into the age bracket of 30-39 year olds. 

 The most commonly used substances with the highest mortality rate was opiates which accounted for 52% of the figure, (in males, slightly higher (nearly two thirds) 63%….

  • HEROIN / MORPHINE: 579.
  • TRAMADOL: 175. (more than double the number in 2008, which was 83)

 The previous years where there was a drop in numbers in male fatalities could be attributed to the fact that in 2010-11 there was a heroin shortage in the UK, This was also the case in 2012-13. In 2009 there was also an average street quality of 46% whereas in 2013 the average quality of street heroin was 15-20%. Public Health England also report that the number of those accessing treatment for heroin and / or crack addiction, including those who are returning to treatment has fallen to 64,288 (2005-06) to 47,210 (2011-12) however evidence from national crime survey states that there has been little to no variation in heroin use since their measurement began. 

 These statistics, I’m sure you’ll agree are scary and reflect the fact that opioid use is taking too many necessary lives.  

 There is no standard definition of an opioid-related overdose death.  These fatalities can be broken down to include deaths of any intent, including unintentional, suicide, homicide, or undetermined. Suicide and homicide are very different from unintentional overdose deaths, and the ‘undetermined’ category undoubtedly includes some combination of the other three in unknown proportions. There is no standard definition of an opioid related overdose death. Most fatal overdoses involving opioid analgesics entail the simultaneous use of other central nervous system depressants, such as barbiturates, benzodiazepines, and/or alcohol and there could be a greater tendency to use opioid analgesics in conjunction with these other drugs. A high proportion of substance users are polydrug users and although Naolxone does not work on other substances it does reverse the effects of the opioid in the system thus giving a greater chance of surviving an overdose situation. 

 There are a number of situations that are deemed high risk situations where overdose can be more prevalent. For instance, after a period of abstinence, incarceration, etc. Mortality rates in prisoners leaving incarceration are 10.33% times more likely to overdose compared to the general population mainstream mortality figures in those leaving prison. Female overdose rates in those leaving prison are considerably higher than in males. Generalisation of this study may differ from region to region but the statistics are similar. 

 Asurvey in an american prison which looked at a total of 76,208 individuals released from prison found that out of that number there were 2,462 deaths in the population (3.2%) th emost common cause being unintentional death, 828. Overdoses among those unintentional deaths accounted for 558, car accidents accounted for 183. Drug breakdown put heroin overdose statistics at 123, methadone at 176 and pharmaceutical substances, prescription drugs at 259. 

 Statistics of those who accessed treatment and achieved a period of abstinence is much harder to determine and as far as I’m aware the statistics have not been collated, however if there are any stats out there pertaining to this I would be grateful if someone could direct me to them via the comments. 

In may, 2012 the Advisory Counsel for the Misuse of Drugs undertook a review of  naloxone availability in the UK, presented in the attached report. 

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/119120/consideration-of-naloxone.pdf

 The purpose of the report was, as is stated in the above report hyper link, to inform the government on whether or not naloxone should be made widely available in the UK. 

 “The evidence presented in the report showed that naloxone provision reduces
rates of drug-related death. Evidence also shows that training in all aspects of
overdose response is important alongside naloxone provision, and benefits
both service users and carers. Naloxone is already available on prescription
to people at risk of opioid overdose, such as heroin users. However,
maximum impact on drug-related death rates will only be achieved if naloxone
is given to people with the greatest opportunity to use it, and to those who can
best engage with heroin users” 

 This report clearly stated that Naloxone provision is aligned with the drug strategy 2010 aim of reducing DRD’s, Which was highlighted as one of the 8 key outcomes for delivery in all recovery oriented services. Naloxone training and overdose awareness alongside psychosocial interventions were highlighted as being important factors in improving an individuals health and also in maximising their chances of a full recovery. 

 Naloxone is now licenced for community use. This means that it can be supplied to the friends, family or other representative of someone identified to be at risk, but only with the written consent from the person for whom it is to be supplied. Prenoxad Injection can only be made available once the prescriber has assessed the suitability and competence of a client or representative to administer it in the appropriate circumstances. This highlights the need for extensive drive towards training and raising awareness around the medication within our communities.  Prenoxad Injection is legal and will not result in any confiscation if the pack has not been opened.

The law allows Prenoxad Injection to be used by members of the public to save a life in an emergency. This could be a friend or family member of someone who is at risk of opioid overdose. It may be used in the home or elsewhere outside of a hospital. Prenoxad Injection is designed as an emergency rescue or first aid treatment so it does not replace the need to get medical attention as soon as possible. It is crucial that an ambulance is still called by dialling 999 and that the casualty is seen by the ambulance crew. This is because Prenoxad Injection will wear off after a short time and there is a danger of the casualty going back into an overdose.

http://www.prenoxadinjection.com/index.html

 The above link includes all relevant information pertaining to prenoxad injection (naloxone hydrochloride 1mg/1ml solution for injection) contains 2 ml naloxone hydrochloride 1 mg/ml. It covers all angles from healthcare professional to someone who is either currently using opioids or may come in contact with someone who may be in a high risk situation. 

 Another helpful and extensive resource that covers all things Naloxone related is..

http://naloxone.org.uk/

 

 

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