Naloxone: The Next Episode

---

“1996, when Dan Bigg first brought the case for community use of Naloxone, and the wider need for this medication in the user community. Overdose, a primary cause of death among those who use opioid pain medications, illicit substances, etc has been known to be a risk that can be dramatically reduced by Naloxone since 1961 when first cited. As with needle exchange, and indeed many other campaigns where the basis was firmly in the realm of public health but not commercially acceptable, if you like. drug-war politics introduced a number of hurdles which meant delays in reaching a decision—and many needless, preventable fatalities. The User / Recovering community needs to shout louder and be more forceful in its advocacy so this is appropriately approached and adequately distributed within our communities”

---

Since the start of this campaign, when HIV and HCV were also an imminent risk to the user community things have moved forward dramatically, HIV and HCV are not only treatable but amenable to numerous prevention campaigns. New HIV infections among drug users have been cut in half in the last decade, largely due to the inception of harm reduction programs and approaches such as needle exchange programs, along with effective support, education and direction from peers, and peer led NGO’s such as INPUD (International Network of People who Use Drugs) to name one, whose priority was to reduce the risks associated with BBV route transmission, health risks, etc to reduce the risks of further harm and fatality in the user community, thus reducing the risk of spreading in to the wider community.

In 2016, we have now moved into an era where there is in fact a cure now available for HCV, unfortunately those that need it most may not be able to access it due to the extortionate costs as Gilead join the opposition in the drug war extorting the most vulnerable. So in general this shows that there can be positive outcomes, if we can just overcome the greed of big pharma, and other drug war barriers, when there is a platform where we can effectively work together, the the numerous campaigns and actions of relentless peer support groups and individuals have had an amazing impact on this.

On the subject of the high price of HCV cure a court case has just been launched in USA where a legal battle has erupted over a medicaid service provider refusing to prescribe HCV medication to two Apple Health patients based on the fact it is too expensive and only to be prescribed in special circumstances, these special circumstances seem to find their basis in financial groundings. The case is based on the fact that it is technically illegal to withhold medicines on the basis of cost. And to do so would therefore be negligent by default.

So onto the case for Naloxone globally, why are we still seeing marked resistance to the wider distribution of this life saving medication. Why have we not seen similar improvements here? Nationally I am very lucky to have been in a position to see this campaign take shape and launch itself with some of the most dedicated and passionate individuals I have ever met at it’s very core keeping it’s presence on the agenda in every region. As a result of this push from the community and our supporters we have managed to get Naloxone availability reviewed and as a result new legislation promoting wider access went live on October 1st, 2015. This was an amazing step forward and campaigners were more than appreciative of the recognition of our plights that our community members were dying needlessly in record numbers, we took the changes, we analysed them, we got legal reps to analyse them and we scrutinised every word of the amendment to the medicines act, which can be found here,

Amendment to Human Medicines act (no. 3) Regulation 2015 

This stated that any provider or….

‘persons employed or engaged in the provision of drug treatment services provided by, on behalf of or under arrangements made by one of the following bodies–

(a) an NHS body; (b) a local authority; (c) Public Health England; or (d) Public Health Agency.

The explanatory note that accompanied the amendments which are in legal talk and hard to follow for the typical lay person like myself can be found here….

Explanatory Memorandum

In this it again clearly states that ‘Regulation 10 amends Schedule 17 to the 2012 Regulations to enable the prescription only medicine naloxone hydrochloride to be supplied by drug treatment services for the purpose of saving life in an emergency‘

And just to make sure I’m not missing anything out. The explanatory memorandum that accompanied the correspondance e-mails and messages is here in full pdf….

Full Exlanatory Memorandom (pdf)

Very clear and precise in it’s aims and objectives. And to make it even clearer in it’s aims and objectives, here is a little snippet from the ADHP Position Statement on Naloxone

The Public Health England guidance published to inform commissioners about the impact of naloxone and the new regulations, makes clear that the legislative change that came into force in October 2015 means that, similar to Water for Injections, naloxone is exempt from prescription only medicine requirements when it is supplied by a drug service commissioned by a local authority or NHS (or Public Health Agency in Northern Ireland or Public Health England). It may then be supplied to any individual needing access to naloxone, which could be:



someone who is using or has previously used opiates (illicit or prescribed) and is at potential risk of overdose



a carer, family member or friend liable to be on hand in case of overdose



a named individual in a hostel (or other facility where drug users gather and might be at risk of overdose), which could be a manager or other staff.

Now we can respectively look at the impact the amendment has had so far. There are still at least one third of the 152 Health and wellbeing boards that have shown no change and no signs of change. Which is unacceptable and once the information has been collated and verified as to where they are exactly there will more likely be another media campaign launched in each respective local area. Up until now the majority of campaigners have for the most part refrained from directly mentioning specific services when raising issues at national level, it has been entirely focused on legislation and initiating changes from the top down with numbers of activists on the ground preparing their communities by training and raising awareness of the campaign in general, the real advocates for change and without a doubt the real heroes of the frontline movement, My hat goes of to you guys and I have nothing but respect for every one of you. You all know who you are. Kudos.

But I believe the next stage will be more upfront and personal. The bottom line is that the individuals that providers are in charge of under their primary care are dying, statistics are rapidly rising at an alarming rate and you have the green light to do something about it, but choose not to. As I see it you should not be in the sector professing to be something you are not. It’s time to start relegating services and showing support for those who openly show compassion and understanding and really do care whether their clientelle / stakeholders live or die. It seems to be forgotten who actually is in the position of power here despite the fact the title gives it away….service providers. Providing a service that should be fit for purpose and designed with the needs and wants of the customer first, not agenda. If a service is performing badly it reflects in the actions and feedback of those who access it and if that feedback is correctly placed and consistent, then it has to have an effect on the future survival of that service.

IN the remaining two thirds there is a varied level of acceptance around the legislation and how it has been adopted. The more common report that is coming through is that the majority of providers have adopted the program and are handing out kits to their service users. Which is good but takes us back to the original amendment to legislation in 2005 where it was recognised that there was a glitch in the law, in that there was no point providing a kit that was illegal to use for anyone except the one whose name was on the prescription. This was amended to read that it could be used by anyone for the purpose of saving a life. This meant as time progressed and the law fell into place that when the current campaign came about we had the added bonus of this little clause that basically gave right of way to anyone who had a vested interest in saving lives and who might find themselves in an overdose situation, which could mean absolutely anyone with an ounce of compassion. So given the progress in the battle for Naloxone and the background leading up until now surely the 2005 amendment and the more recent 2015 amendment together in their aims would mean that anyone can present at the door of a provider where naloxone is available and either present a certificate stating that they have been trained by a recognised trainer or be trained by a recognised trainer inhouse and walk away with a life saving kit…..

Surely?                                                                   No?                                                              Why not?

Is it cost again that is rearing it’s ugly head, so let me take you back to the current court case where it is being fought that this is against human rights and discriminatory, so what if the court judges in favour of the case, and campaigners or even more pertinent Parents who have lost children or similar bring out a case here on the same basis…..just a thought.

Here’s an interesting little section of law that I have been finding interesting in it’s content and context. It’s an area known as tort law and it basically states this…

(Elements: Duty, Breach, Causation, Scope of Liability, Damages)

Duty of care

1.General Duty of Reasonable Care.

a. Imposed on all persons not to place others at foreseeable risk of harm through conduct
b. Adults Reasonable person standard (objective)
c.Children Child standard of care i.Same age, experience, and intelligence
d. Physically disabled persons reasonable person with same abilities

2. General Duty

a. Duty to act reasonably to protect persons you may come in contact with if you have:

1. Knowledge of probable danger arising.
2. Knowledge that danger may affect others other than specific individual.
3. Proximity or remoteness of the outcome is a factor to consider (scope of liability is expanded and knowledge pertaining to scope of liability)

Limited Duty Rules

a. No duty to assist, act, or rescue
Exceptions
1. Misfeasance – where you’ve caused harm through your actions
2. Special Relationship (special dependency, working relationships, business relationships)
3. Voluntary Assumption of duty
a. Must rescue in a reasonable manner
b. If have special skill set, standard of care is reasonable person with the same skills
c. If ∆ is negligence places good Samaritan rescuer in harm’s way, ∆ is also liable to rescuer
4. Innocent prior conduct – (Misfeasance)
a. Duty to act to prevent the harm from occurring
b. Duty to assist if harm does occur
5. Reliance on a gratuitous promise
6. Intentional prevention of aid by others
7. Statute

or another more understandable definition might be…..

“A failure to behave with the level of care that someone of ordinary prudence would have exercised under the same circumstances. “ The behaviour usually consists of actions, but can also consist of omissions when there is some duty of care.

 

The House of Lords decided to create a new principle of law that stated everyone has a duty of care to their neighbour, which thereby supports this particular situation. Negligence is a form of tort which evolved because some types of loss or damage occur between parties that have no contract between them, and therefore there is nothing for one party to sue the other over.

And so goes the case for Naloxone provision without restriction of access or conditional supply only.

And there I rest my case……for now.

In you have any Naloxone stories you’d like to share please send them to ….

drugactivist@gmail.com

I’d love to hear from you.

Also If you would like to share your testimony….