SOMEONES DAUGHTER, SOMEONES SON.

(The title of this blog is from a poem written by a very good friend of mine who’s words resonate with me a thousands of others globally who are joining together in advocacy for the provision of naloxone in their respective communities which can be read the end of this article)

As the fatalities rise, on a global scale , and opioid related deaths tear families and whole communities apart, there is momentum growing in the debate to get naloxone out there into the hands of everyone who would be prepared to carry this lifesaving kit, PUD’s, friends of PUD’s, family members, concerned others, street pastors, dealers, community groups who may find themselves faced with an overdose situation, in fact, absolutely anyone who had a desire to carry a kit.

With Scotland (Scotland should be releasing figures following an audit internally in the prison system over the next few months to add to the evidence that this program has successfully reduced the DRD stats in those leaving incarcertion. This will directly show that although N=ALive pilot, which is still ongoing, had the right idea, it could have been done for lot cheaper and a lot quicker. And guess what it will also show that ‪#‎prenoxad‬ works, surprised?)and Wales (An Evaluation of the Take Home Naloxone Demonstration Project can be found here) leading the way, in the UK, with national programs and Ireland not far behind, (Ana Liffey Drug Project are coming through as a glowing example of best practice when it comes to saving lives in Dublin’s fair city. Statistics in Ireland have shown that almost 4,000 PUD’s exchanged 24,000 needles at drop-in centres across Ireland last year. Merchants Quay Ireland have recently shown the extent of the country’s drug problem as demand for its services soared. These statistics are shown to be closely related to poverty and hardship when looking at demographics of need in relation to specific areas. Statistical data also showed that 75% of those accessing structured service were poly drug users, with a combination of heroin, benzodiazepines and alcohol most commonly used substances, and also the most common in related overdose situations. Design has also shown that there is a current trend which is reaching out to regional areas outside of the city and the need for services outside the city is becoming increasingly evident. There are estimated 20,000 Heroin addicts in Ireland, with 10,000 men and women on Methadone programs. With this evidence coming out that clearly shows a desperate need for the expansion of services to support the growing need and funding cuts hitting where support is most needed this is a potential time bomb waiting to explode in the face of the communities where poverty and addiction are rising) it would seem that for some unknown reason England is dragging her heels with a devastating pace that is leaving its marked evidenced in the 32% rise in drug related fatalities last year. Recently, July, there was a glimmer of hope in the form of a letter from the Department of Health to Les Iverson, chair of the ,Advisory Council on the Misuse of Drugs (who first endorsed take home naloxone in 2009), stating that following a survey by the MHRA there had been a resounding call for a national take home naloxone program. Following this there was a date set for a National Take Home Naloxone (THN) Program which, and wait for it, is, October 2015? Now although this is a shimmering silver lining to those among us who have been advocating for this for quite some time now, it is still not acceptable.

As stated, in 2013 there was a huge rise in opioid related deaths, and this is just the ones that were recorded as that.

Although we do not have 2014 statistics through, my fear is that they could well show another rise, and again in 2015. I digress and hopefully misplace my fear but the truth and evidence cannot be denied here, any death that is preventable is unacceptable. So I ask you what could possibly be the hold up with getting this out there. So far there has been no solid evidence to support a delay. Well none that could possibly warrant such Negligence towards the cost of a human life….is there?

Best practice and substantial evidence to support can be found in Scotland where the Lord advocate, the chief legal officer of the Scottish Government saw fit to sign off a national program which is showing us, over time, that there is a need for such a program wherever there is a prevalence of opioid related deaths. This also showed us that, time, is something that we do not have when it comes to getting naloxone out in the community.

“In many countries, overdose is the leading preventable cause of death among people experiencing problems with drugs. Overdose prevention measures delivered in community settings are incredibly effective; the introduction and scaling up of such measures would save lives of thousands of people” (Eurasian Harm Reduction Network (EHRN))

http://www.harm-reduction.org/library/guide-developing-and-implementing-overdose-prevention-programs-eastern-europe-and-central

Naloxone has been around since the early 60’s and has, to date, given us no reason to doubt it’s efficacy. There have been no fatalities attributed to it’s use in whatever arena it has been used, there is no diversionary value, it has no long lasting side effects that overshadow it’s benefits and yet there is still a debate as to whether it should be available in the community for the purpose of saving lives. Some might say that there is an underlying issue here as to the lives that are being saved and would argue that there is more risk associated with Epinephrine autoinjector (EpiPen), and yet there are no concerns with that and there was not the same debate or delay when it was being passed through as an injectable medication.

Naloxone has the potential to help services reach out to those who may be hard to reach in the community. People who use Drugs are extremely conscious of Criminalization, Stigma and Discrimination whenever they access any kind of service, so knowing that naloxone is safe and legal could put people at ease. Naloxone programs can provide a safe starting point to engage in more open conversations about their health and choices, like seeking out and using clean needles, regardless of whether that is legal or encouraged” Not to mention staying alive in order to promote chances of making a ‘full’ recovery. There are a number of those out there who have been on the receiving end of naloxone who have stated that that second chance was indeed a turning point in their journey.

As it stands now there is an overwhelming outcry not only from Drug User Organisations, such as International Network of People Who Use Drugs (INPUD), National Users Network, and recovering community groups and structured services such as UK Recovery Walk charity, RISE ManchesterCOPE Lincoln,morph – Southampton, NHS Highland, Scottish Drugs Forum, Release, Support. Don’t Punish, International Drug Policy Consortium, IDHDP, SUSSED , Bedford, Harm Reduction Coalition, SCUFF, Nottingham, World Health Organization, Criminal Justice Drugs Team, Leicester, Martindale Pharma, Department of Health (The list is endless and I am sorry if I have missed anyone out) but from Significant others (although following this hyper link it shows that in the scientific use of significant other there is still some work to be done), mothers, fathers, sons and daughters, and a number of professionals with regards to this becoming more widely available to those who may be witness to an overdose situation. For a number of reasons when faced with an overdose situation and calling the emergency services there is again fear around the already mentioned criminalization and stigma and therefore sometimes the emergency service are not called. Also the response time if there is any mention of substance use seems to take longer sometimes when thy are called. I’m not taking away the importance of calling the emergency services it makes perfect sense to me for those at the scene as and when it happens to be able to administer naloxone and potentially save a life alongside the services being called.

There are 150 Health and wellbeing boards (follow hyper link to find contact details for your local board) in England. At present, one third of them are actively rolling out programs, one third are in debate and discussion and the final third are still resistant yet unresponsive when questioned around this. So what barriers have they given us so far….

1: There is a risk due to it being an injectable medicines? (follow hyper link for guidance on safe use of injectable medicines) So is the epipen and insulin yet there was no problem when this was being put out there in order to save lives. (In fact the only recorded risk that I am aware of was an American police officer using it to ‘kill’ someones buzz?) No other recorded risk since the early 60’s when it was first marketed. There is no diversionary value….nothing. It does have the potential to cause problems with liver if liver is already compromised, as do most medications, but this is treatable whereas death is final.

2: It’s not licensed? Neither are a number of medications but they are still put out there around an off license route. And….there is a licensed product specifically for community use in the form of Prenoxad Injection

3: It’s not cost effective? (I know, ridiculous but a barrier none the less!!!) Well lets look at that, 20,000 for a basic overdose fatality when you look at the services cost, the coroner inquiry, the hospital bed, the machinery used, etc, not to mention the cost on the surrounding family members, emotionally, mentally and financially,  and community this cant be into monetary value! 400 estimated cost here naloxone was used successfully. In Bedfordshire alone during the last year there were 40 kits handed out and in the last three months 9 reversals, that’s, in monetary value, 720 cost of kits for all 40. lets say services were called on all situations, thats an average count, based on the estimated successful situation cost from Wales, of, 3600 which makes a grand total of under 5000. Savings on community budget in 9 highlighted cases? 175000!!!!! So in my humble opinion then damn straight it’s cost effective and there are still 9 individuals walking around breathing. This information cannot be used officially sadly due again to the current state of play, but there are a number of areas that are coming up with the same math and adding to the evidence to support community provision of naloxone, yet I am still waiting to here the evidence against!!!! (Cannot cover all evidence in all areas at present and have used my home town to demonstrate how a small group of user activist have managed to conduct a small pilot with the potential to save quite a significant amount of funding on the emergency services and in general on the community)

And to show the overview of cost effectiveness in rolling out naloxone programs….

http://www.medscape.com/viewarticle/777455?src=stfb

4: Political agenda? Lets take it back to the political agenda in the shape of the 2010 strategic agenda. It actually fits into that quite nicely into the full recovery setting by keeping people alive and giving them that second chance at recovering. And reducing drug related fatalities. But doesn’t fit in with the general election next year? Possibly why there is an October 2015 date?

So given this very basic but clear little picture what is missing? Other than another 32% of the opioid user community and some common sense? Yep, the evidence and reasoning to support the argument against..why? Because there is none?

So lets backtrack a little bit and look at the stages and times when naloxone has been highlighted and not adhered to in a number of areas.

One of the key directional questions in the 2011 JSNA Support pack for commissioners in section three on the first page of guidance in setting up a recovery oriented integrated service it clearly advocates for naloxone when asking the clear and direct question…..

•Is effective overdose awareness training and information
available? Where appropriate, is naloxone provided for service
users and their family/carers?

All drug users SHOULD have prompt access to:

•Interventions to prevent drug-related deaths and blood-borne
viruses.

•A range of early interventions, treatment and recovery support
appropriate to their needs, at all stages of their recovery journey.

(Sadly this need is not being fully met with regards to naloxone being the ideal intervention along with other recognised and structured interventions)

Effective integrated commissioning of services that achieve
positive outcomes for individuals, families and communities by:

•Effective partnership working between local authorities, health
(including mental health) and social care, and criminal justice.

(And effective service user input surely?)

•Operating transparently according to assessed need.

(Unless it involves explaining why naloxone is not recognised as a high priority need and why members of our communities are dying)

•Bringing providers together into cost-efficient delivery systems.

(Naloxone is a blatant evidenced based cost effective medicine with regards to savings on emergency services and communities on the whole with regards to emotional and mental wellbeing cost)

•Fully involving local communities.

(Providing they are in agreement with the way the agenda has been adopted and don’t put the value of human life first)

A seering indictment to the lack of support and attention to this issue from those that have the power to make the relevant changes can be found here in a blog by John Jolly Blenheim CDP who clearly calls out the English shame and highlights that People are dying because of a lack of harm reduction and again in another excellent article here…

http://recoveryreview.net/2014/09/enforced-recovery-unethical/

 As User Activists and supporters have pushed as far as they can in their respective areas, some more successful than others, Nottingham and Birmingham proving that this works and is effective, to mention two early adopters of programs. Where is Englands equivalent of the Lord Advocate? With great emphasis on the medications in recovery report, surely this should include naloxone? And although I am possibly a little dubious with regards to the review of the Orange Guidelines that is currently in progress, I find comfort in the fact that naloxone has been highlighted for discussion in that review, but fear that in other aspects there will be a price to pay.
(The following poem has been reproduced with kind permission from Lee Collingham. Nottingham rep….)
“SOMEONES DAUGHTER SOMEONES SON”

Why do we do the things we do,
Well it’s not for money that bits true,
For personal gain usually not,
It’ for what, most have forgot.

Our dream is everyone will have naloxone,
Somewhere safe in their home.
We don’t look upon ourselves as saviours,
We just think of it more we’re doing life a favour,
For someone’s daughter for someone’s son,
For their fathers and for their mum.

Is it not human nature to help someone?
Especially when all their Hope has gone,
And for those who moan about round here,
Try spending 6 months in Crimea.

See most only strive for what they can’t get,
They’re close minded and often forget,
But for the grace of God go they,
Who knows maybe it will be one day.

Our dream is everyone will have naloxone,
Somewhere safe in their home.
We don’t look upon ourselves as saviours,
We think of it more we’re doing life a favour,
For someone’s daughter for someone’s son,
for their fathers and for their mum
(c)lrcpublications

‘WE CALL ON THE GOVERNMENT‬ TO HONOUR THEIR COMMITMENT TO SOCIAL JUSTICE‬ AND RESPECT THE BASIC HUMAN RIGHT TO LIVE, AND MAINTAIN SERVICES THAT PROTECT THE MOST VULNERABLE‬ MEN AND WOMEN IN OUR COMMUNITIES, OUR VIEW IS THAT IF YOU ARE NOT PART OF OUR SOLUTION THEN YOU ARE INDEED PART OF OUR PROBLEM”
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