Naloxone is to be made more readily available next month. Public Health England’s Steve Taylor looks at how local services and commissioners can respond to this change in the law
Legislation to allow naloxone to be more widely available for those who need it is on track to be enacted next month. This follows the Advisory Council on the Misuse of Drugs (ACMD)’s recommendation in 2013 and a public consultation by the Medicines and Healthcare products Regulatory Agency in 2014 that saw wide support for the proposals.
The evidence shows that take-home naloxone given to service users, and training family members or peers in how to administer naloxone, can be effective in reversing heroin overdoses. Because it is only available as an injectable product, naloxone will remain a prescription-only medicine but the legislation will permit people working in commissioned, lawful drug treatment services to supply naloxone without a prescription to anyone needing it to prevent a heroin overdose.
Drug treatment services are generally seen to be those providing specialist services, primary care drug treatment, and needle and syringe programmes (including pharmacy-based programmes).
These services will legally be able to order naloxone and their staff will be able to supply it to individuals without needing a prescription or any other written instruction from a health professional. These individuals could be drug users themselves, or it could be family members, friends, carers or hostel managers who may need easy access to the medication.
Services that work with drug users but do not provide drug treatment would be unlikely to count as lawful drug treatment services, so would not be able to supply naloxone according to the new proposals. However, these services could arrange for people to visit another service that does supply naloxone or, using existing mechanisms, could ask a doctor to prescribe naloxone if the individual has been identified as at risk of overdose.
The legislation is about supply to individuals, so a drug treatment service will not be able to supply stocks of naloxone to another service.
Preliminary advice from the working group updating the 2007 clinical guidelines on drug misuse and dependence clarifies appropriate naloxone dosing in the case of an overdose, naloxone products that can be supplied, and training that should be provided.
Once legislated, commissioners will need to agree how any new naloxone supply works locally, including:
- What naloxone product should be supplied and how it should be packaged, if needed, to include one or more needles and a sharps box.
- Which services will be funded to supply naloxone.
- Which groups of people should be able to receive naloxone.
- How these groups might be prioritised and whether there is any limit on how much naloxone can be supplied.
- What record keeping is required to track supplies and arrange for re-supply.
- What training should be provided alongside naloxone.
PHE’s advice earlier this year – http://bit.ly/1G37cz9 – covers many of these points and PHE is now considering what further resources would be helpful to commissioners before October’s legislative change.
Steve Taylor is programme manager, alcohol, drugs and tobacco division, health and wellbeing, Public Health England