Choose life – Recovery Month and Overdose Awareness

recovmonthThe stakes have never been higher. This year’s Recovery Month and Overdose Awareness Day activities brought service users and recovery communities together with one clear goal

‘Get political’: The Recovery Walk

During the last 12 months we have seen unprecedented levels of disinvestment in treatment and recovery support services and the highest levels of drug-related deaths ever recorded. Despite Recovery Month this September, we celebrated the gains made by those in recovery, just as we celebrate improvements made by those who are managing other health conditions.

Taking part in September’s Recovery Month reinforces the positive message that behavioural health is essential to overall health; that prevention works, treatment is effective, and people can and do recover. More people than ever before across the UK organised local events, celebrating the fact that recovery from addiction to alcohol and other drugs is a lived reality in their lives and that demand for our advocacy and training services has continued to grow.

As austerity continues it is becoming apparent that the state can no longer guarantee effective, high quality treatment for all and we are hearing of funding cuts to services in England of up to 40 per cent. There has never been a more important time for recovery communities to stand up, speak out and become politically engaged. We need to highlight the fact that every day in the UK people in long-term recovery from addiction to alcohol and other drugs volunteer their time to help others and make their communities better places to live. They are truly one of the greatest assets local communities have.

We received significantly less sponsorship funding for the UK Recovery Walk than in previous years and yet it was the biggest and best so far, with more than 6,000 people in long-term recovery and their friends and families. A special thank you to all of this year’s sponsors and our amazing team of more than 300 volunteers who enabled us to be custodians of the famous UK Recovery Walk. We look forward to seeing you next year in Blackpool!

Annemarie Ward, Faces and Voices of Recovery UK. View FAVOR UK’s short film challenging negative stereotypes and stigma at



‘Let’s connect’: Recovery community

The fifth annual Lufstock event took place for three days, bringing families of the recovery community together for a camping weekend. The 250 people who attended connected as a community, creating strong friendships and lasting memories.

This followed Lancashire User Forum (LUF)’s ten-year anniversary event in Preston, attended by service users, volunteers, treatment providers, and other interested parties. It was broadcast live by BBC Radio Lancashire’s Sally Naden and Brett Davison, but the format of this special occasion was devised by the service users. As part of a packed agenda, we hosted the spoken word artist, Steve Duncan, who composed a unique poetry performance especialrecov2ly for our anniversary.

Not only was the event a resounding success; it also provided an open forum where professionals were scrutinised in regard to the landscape of the LUF over the next ten years. It built on the notion of hearing the service user’s voice and having a positive impact on all recovery communities.

Meloney Hafeji, Red Rose Recovery




‘Team spirit’: Recovery Games

More than 400 people from all over Yorkshire and Lancashire came to celebrate being drug and alcohol free at the third annual Recovery Games – an initiative from Rotherham Doncaster and South Humber NHS Foundation Trust (RDaSH) and The Alcohol and Drug Service (ADS), under the newly launched partnership of Aspire.

The games link to the five ways to wellbeing and offer an exciting platform for people in treatment and recovery and those working with them to have fun and build on the principles of connecting with each other in new ways without substances. They offer a chance to learn new skills and ways of communication, while giving time, effort and money to worthwhile causes.

They show what recovery can feel like and create momentum through forming a giant conga through the ‘festival of colour’. And most of all they show that there’s nothing better than being active, getting out and about,and feeling alive, when you’ve been stuck in a rut like Groundhog Day.

The day had a strong family theme, supporting active recovery in community and family structures. Health professionals from across services came to deliver information on cancer awareness, smoking cessation and healthier eating, as well as offering prizes. There were activities for the children – although everyone let their inner child play out on the day!

Competitors took part in canoeing, climbing and many other events on giant inflatable arenas at the local activity centre. Teams of ten from all parts of Yorkshire and Lancashire entered events throughout the day, creating a spirit of competition combined with support. The weather was fantastic, which drew in the local crowds to cheer everyone on. There was music and live entertainment throughout, with an amazing festival of colour at midday, involving all the teams.

Money from the day was raised for the Aurora cancer charity and presented to them at the New Beginnings open day and graduation on 28 September.

Stuart Green and Neil Firbank, Aspire,




‘Naloxonesaves lives’: OD Awareness Day

Drug fatalities have overtaken fatalities due to road accidents for the first time, representing a public health issue of growing proportions. In response to this, and to International Overdose Awareness Day on 31 August, we held three events in Greater Manchester, with a particular focus on raising awareness that naloxone saves lives.

An awareness event in HMP Manchester saw 25 inmates with a history of opioid use take part in animated discussions. All participants signed up for training on naloxone and will as a result receive kits on leaving prisoRecov1n. This generated much discussion among prisoners, wardens and other prison staff, with the goal of normalising overdose prevention as part of the prison’s regime.

A mixture of commissioners, service providers and frontline workers attended a similar event chaired by Hayden Duncan of Emerging Futures. Hayden recalled the successful deployment of naloxone across the West Midlands during his time as Public Health England regional manager, and challenged the North West, ‘the home of harm reduction’, to step up and take action in relation to drug-related deaths.

Finally, a public awareness event was held in the centre of Manchester. Undeterred by lashing rain, members of the Greater Manchester Recovery Federation (GMRF), and other activists, collapsed in the street and came back to life to reveal ‘Naloxone Saves Lives’ t-shirts – simple but effective, generating a great deal of interest, and basic information on naloxone was also distributed.

All good – but what emerged at every event was just how little awareness there is, not just about naloxone, but overdose prevention itself. Even those who have experienced one or multiple overdoses lack the basic knowledge to prevent drug-related deaths. Perhaps even more shocking, many of the actions people would take in overdose situations could actually make matters worse.

Despite legislation designed to widen the availability of naloxone, its distribution is patchy. Many treatment services are stepping up to the mark, but most overdoses occur among populations who are not currently engaged in treatment. Many people lacked a basic understanding of what naloxone is and what it does; however, offsetting this was the sheer willingness of people to learn about, be trained in and carry naloxone.

Perceived divisions between those who support a harm reduction or a recovery approach should not get in the way of this. These divisions are largely political and do not represent the view of recovery communities who, as part of their own health and wellbeing, have a desire to support people in any way they can.recov3

Resources are tight, those outside treatment services may be seen as harder to reach and there are many competing issues around the health agenda. However, we have recovery champions, peer mentors or volunteers in every treatment service, many active recovery communities around the country and staff within services more than willing to go the extra mile. Why are we not mobilising this huge resource?

The events in Greater Manchester were a success on many levels – awareness was raised, myths were busted and people were engaged. A Greater Manchester Naloxone Action Group was born and will push the agenda forward. However, to make a dent in the figures we need to see a more proactive approach nationally, and people could do worse than look to the West Midlands for how to do this.

Michaela Jones, in2recovery; and the Greater Manchester Recovery Forum

Promotional feature: be prepared!

Screen Shot 2016-09-30 at 12.19.42Train your staff to empower service users with life-saving naloxone, says David Swain

In the 1838 report to the House of Commons on causes of death, the coroners in England and Wales for the preceding year recorded that a third of all deaths were shown to be attributable to laudanum and other opium preparations. These were either by accidental overdose or substitution for another medicine, and needless to say, caused a ripple of concern among politicians.

In 2014 the Office for National Statistics recorded a total of 3,346 drug-related deaths across England and Wales, 1,786 of which were attributable to opiates and which sadly represented an increase from the previous year. However, the figures for Wales revealed a slightly different story, with drug-related deaths in Wales falling by 16 per cent from the previous year.

Why were things different in Wales? The reasons might include a greater acceptance of harm minimisation as the first step to recovery, thereby encouraging users not yet ready to embrace abstinence to engage with services. However, one major factor has undoubtedly been the national take-home naloxone (THN) scheme. Started in 2011, it has systematically trained service users, their families and professionals (such as hostel staff) to identify signs of opiate overdose, apply basic life support and administer intramuscular naloxone. Its take-up has been huge and THN is now an established part of the Welsh treatment landscape. Its ethos continues to be, in the words of Sarz Maxwell, consultant psychiatrist in Chicago, a desire to ‘flood the streets with naloxone’.

Of course, there are always naysayers: ‘Surely naloxone will encourage users to engage in more risky behaviour knowing that the antidote is available?’ There is no evidence that this is the case. ‘What if they give it to someone who isn’t in opiate overdose?’ In the absence of an overdose, the medication is inert. ‘Aren’t we just condoning drug use?’ Oh, please.

If handing out naloxone challenges the sensibilities of some, let’s look at what we’re achieving. Of course there is the obvious gain in lives saved, but there’s the sense of control being handed back to people who feel they have none, and the power to save a life.

Gearing up services to be able to train clients and their families to understand and be able to use naloxone is a simple matter, but it requires trainers who are able to deliver properly. Pulse Addictions provides take-home naloxone training for staff, either as a standalone session or as part of its course on risk management in substance misuse. This comprehensive training will enable staff to empower their clients to respond in emergency situations, reducing the tragedy of drug-related deaths.

Discover how Pulse Addictions can enhance your services at


Dark days review of the year 2015

There wasn’t very much to celebrate in 2015, a year that saw both England and Scotland record their highest ever number of drug-related fatalities, while a surprise outright Conservative election win heralded yet more belt-tightening and austerity…


Among ever-increasing fears about the impact of new psychoactive substances, the Ministry of JusticeDDN cover feb announces a raft of punitive measures for anyone found using or supplying them in prisons. ‘If prisoners think they can get away with using these substances they need to think again,’ warns justice secretary Chris Grayling.


DDN’s eighth national service user conference, The Challenge, proves to be the liveliest yet, with a day of powerful presentations against a background of increasing anxiety in the field. DrugScope’s State of the sector report indicates that the fears may be well founded, with more than half of survey respondents reporting a reduction in frontline staff alongside widespread concerns about job insecurity and rapid commissioning cycles. The highly controversial notion of linking treatment to benefit entitlement hits the headlines again as the prime minister commissions Prof Dame Carol Black to conduct a review into sickness benefits, while Alcohol Concern chief executive Jackie Ballard backs the call for health warnings on alcohol labels. ‘Every other bottle of poison in the supermarket has a warning label on it,’ she tells DDN.

MARCHddn march 

The government announces that it is developing plans for a general ban on the supply of all emerging drugs – the first stirrings of what is to become the controversial Psychoactive Substances Bill – and DrugScope goes into liquidation, blaming its worsening financial situation. ‘It is with a heavy heart that the board has taken this extremely difficult decision’, says chair Edwin Richards.


Five more NPS become subject to temporary banning orders, and Alcohol Concern accuses the drinks imay dnnndustry of using responsible drinking messages as just another way to promote its brands. Meanwhile, Dr Joss Bray writes in DDN that it’s time to put com­passion back into service provision.


There’s widespread surprise – not least within the party itself – when the Conservatives win a majority in the general election. The new government loses no time in announcing its ‘landmark’ blanket ban on all NPS, described by Release as ‘full blown regression’.

ddn juneJUNE

New substances are now being identified at a rate of two a week, the latest EMCDDA European drug report warns, although demand for heroin appears to be ‘stagnating’ across the continent. Delegates at the RCGP’s national drug and alcohol conference argue that GPs need to stay central to substance treatment, while the ‘Support. Don’t Punish’ campaign holds its third global day of action. Naloxone campaigner Philippe Bonnet, meanwhile, urges DDN readers to identify local champions, create networks and raise awareness of how cost-effective the intervention can be.


ddn july augustJULY/AUGUST

Bleak news as Scotland records its highest ever number of drug-related deaths, 16 per cent up on the previous year. The country still faces a ‘huge challenge in tackling the damaging effects of long-term drug use among an aging cohort’, says community safety minister Paul Wheelhouse. Prof Dame Carol black launches her review into ‘supporting benefit claimants with addictions and potentially treatable conditions back into work’ and ASH tells DDN that the Welsh government’s plans to ban the use of e-cigarettes in public places amounts to a misguided attack on an effective harm reduction tool, although the claim in a PHE report that the devices are 95 per cent less harmful than smoking tobacco proves divisive.


More grim news as England follows Scotland to announce its highest drug death toll – although fatalities in Wales are down – prompting Addaction chief Simon Antrobus to call on the government to re-think proposed cuts to local authority health spending. ‘The stakes are simply too high to do otherwise’, he states. The European Court of Justice deals a blow to Scotland’s minimum pricing plans by stating that they could breach EU trade laws, while Portuguese health minister Fernando Leal Da Costa tells the pan-European Lisbon addictions conference that Portugal’s decriminalisation approach is a ‘sensible and rational’ one that other countries could follow. Recovery month sees a vibrant range of activities across the UK, and Dave Marteau’s DDN piece on the risks of diverted methadone ruffles some feathers.


Another month, another stark report – this time from the ACMD, whose second publication on opioid replacement therapy for the Inter-Ministerial Group on Drugs warns that heroin treatment is being threatened by diminishing resources and constant rounds of ‘disruptive re-procurement’. Another group of MPs, the Home Affairs Committee, concludes that the government is rushing, and weakening, its psychoactive substances legislation, while Phoenix Futures cautions that people’s recovery is under threat from a ‘perfect storm’ of conditions in the UK’s over-heated rental market.


Chemsex hits the national headlines when a BMJ editorial calls it a ‘public health priority’ and a scathing report from the Institute of Alcohol Studies says the government’s ‘laughable’ public health responsibility deal for alcohol may be ‘worsening’ the health of the nation. Stirling University’s Rowdy Yates tells DDN that it’s time to get over the ‘residential bad, community good’ attitude, while Ian Sherwood writes that the sector needs to be braver in calling for drug law reform. The government’s spending review makes more cuts to cash-strapped local authorities, sending further shivers through a drug treatment sector expecting the worst and increasing demand for a meaningful drug strategy in the new year.


Plans are already well under way for the ninth national service user involvement conference, Get the picture. See you there!

Naloxone distribution

Steve TaylorReady for action

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 – – 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

Comment from the substance misuse sector

Letters and comment 

LettersDDN welcomes your Letters Please email the editor,, or post them to DDN, CJ Wellings Ltd, 57 High Street, Ashford, Kent TN24 8SG. Letters may be edited for space or clarity.

Naloxone no-brainer

I’ve just been reading the article talking with Philippe Bonnet about naloxone (DDN, June, page 6) and agree with what he says. Naloxone is relatively easy to deploy – the key issue in most places is the political will to do so. The administration of it is simple, the economics are a ‘no-brainer’ and the paperwork/training is so simple to implement, given that there is so much already been done in other areas around providing naloxone.

I recently worked as commissioner in Barnsley and left the area last December, where they were committed to providing every client with two kits, one for home and one to carry with them – the economics are that good. I convinced the DPH and DAAT board that this was a necessary piece of work to undertake.

Currently I’m working in Hereford­shire, retendering the substance misuse services for the county. In that there is a clear expectation that the new provider will offer naloxone across the service to those who might need/would benefit from the provision of kits. Again I would be advocating a double kit allocation per person. At the moment people are provided naloxone on script but I’ve sanctioned training for staff around this. As Philippe mentions, the cost of a lost life outweighs any cost for naloxone and associated expense. I know that Herefordshire will take this forward to reduce the risk of overdose and death.

Clive Hallam, public health commissioning manager (interim), Hereford


Prison testing

The article in your April edition (page 14) on drugs in prison was excellent. Nothing could be more logical and effective than Neil McKeganey’s proposals for mounting a massive programme of regular and exhaustive drug testing of all prisoners – providing the usage to which that valuable test data is put is also itself sane and effective.

Failure to stop drug smuggling and lack of encouragement for widespread testing may well be the prison system’s natural compensation for the failure of prison psychiatrists and pharmaceutical advisors to cure addiction.

It therefore follows that an identified drug user should immediately be transferred to a ‘withdrawal wing’ where they can be handled with a 49-year established and proven ‘drug-free’ withdrawal procedure, as a precursor to a fuller sauna and vitamin detoxification course leading to stable recovery.

These procedures have been followed in prisons around the world since 1966, some of which today have their own addiction recovery training courses – run by the prisoners themselves. Readers wanting proof of the above should phone (0044) or (0) 1342 810151 to request a free copy of a DVD shot inside prisons as far apart as the USA and China.

Ken Eckersley, CEO Addiction Recovery Training Services (ART)


James DickinsonJames Dickinson holds a framed picture of A dog’s life (DDN, June, p18), the story of Bert – the unofficial head of treatment at Chandos House. It now has pride of place in their entrance hall.









Naloxone distribution

NaloxoneKeep nagging on naloxone

DDN listened to a lively lunchtime meeting of The Naloxone Action Group (NAG) at the RCGP conference, looking at barriers to naloxone distribution

A show of hands revealed that about half of the audience – many of whom were GPs – believed their area had naloxone, but as Chris Ford pointed out, ‘There are many areas of good practice but many areas where nothing is happening at all.’

‘What’s really making an impact is some brilliant grassroots action by people on the ground,’ said Blenheim chief executive, John Jolly. But Dr Judith Yates told the audience: ‘It’s shocking if people are prescribing methadone and buprenorphine and not naloxone.’ Naloxone distribution was ‘just so easy and we should all be doing it,’ she said.

Release lawyer Kirstie Douse shared the results of Release’s freedom of information requests to all Public Health England directors on whether take-home naloxone was provided in their areas. The findings produced 47 ‘yes’ answers, 80 ‘no’ answers (with ten of these due to be rolled out), with no response from 25 areas. (Some areas had made progress since the survey.)

Release’s website ( offered advice to overcoming barriers, ‘but we need to take it forward at a local level’, said Douse. ‘We’re happy to help with letters and guiding you through it.’

The session also identified a discrepancy between areas that said they had naloxone but were not actually distributing it. This situation could be improved by identifying local champions, said Ford – ‘so if you haven’t found one, get one!’

Kevin Ratcliffe, a consultant pharmacist in Birmingham, said his team knew of at least 40 people who wouldn’t still be walking round the city without naloxone. Alongside improving awareness among prescribers and commissioners, he advised creating simple supply routes with fewer opportunities for patients to drop out – ‘it’s hard for patients to get to different appointments to get it’.

Training should be given to ‘absolutely everybody’ he said, and there were plenty of training packages that were free to download, including the e-learning module at

A targeted approach to distribution could start with prisons and hostels, he said, but should be inclusive, and ‘service-driven at each hub by a naloxone champion’.

Naloxone distribution

Philippe BonnetFast forward on naloxone

Progress on naloxone distribution is still slow and inconsistent throughout the UK. DDN asked naloxone champion Philippe Bonnet for some tips on moving forward

As part of a team committed to distributing naloxone, Philippe Bonnet hears of an overdose being reversed every week in Birmingham. While he credits a very active commissioner and a proactive treatment provider for their role in making naloxone a central part of the area’s drug strategy, he has learned some useful lessons over the past three years. As chair of Birmingham’s naloxone steering group and Reach Out Recovery worker at the sharp end of client care, he has experience worth sharing.

Make champions

‘What is key is to have real champions, who are going to be proactive,’ he says. ‘We identified champions from each service and told them their role was to get to colleagues as well as clients – to get those kits out into the clients’ hands. It’s no good just talking about it.

‘The staff can be trained in two hours, which covers who’s most at risk, myth busting, overdose awareness and how to use the kit,’ he says. ‘They can then train a client in five minutes. It’s so straightforward.’

Create a network

The support of local doctors makes life easier, says Bonnet. ‘We have a number of doctors who are so pragmatic, very switched on. Dr Judith Yates was instrumental from the beginning, not to mention many wonderful prescribing nurses.’

Another important partner is the local ambulance service – and there were some barriers to tackle, he admits. Following an incident where paramedics told a client off for using naloxone, Bonnet contacted the lead of the ambulance service.

‘I couldn’t believe how pragmatic that guy was,’ he says. ‘The next day I had an email saying a memo would be sent out to all the crews, telling them that in Birmingham all drug users were being equipped with naloxone.’

The process had to be repeated with the 999 telephone operators, after one of them told a caller from a hostel not to give naloxone to an overdose victim. Bonnet drew a comparison with anaphylaxis – ‘would you tell them not to use adrenaline?’ – and protocol for telephone operators is changing.

Discussions are still underway with the police to work out how initiatives can be incorporated into protocol, but there has been progress with other local partners, he says. Just weeks ago, HMP Birmingham gave the go-ahead for kits on release.

Making sure hostel owners ‘understand the rationale and legislation around naloxone’ has given many more confidence, knowing that ‘absolutely, categorically, anyone can not only carry, but use, naloxone to save a life.’

Likewise, working with central Birmingham hostels that dealt with countless overdoses led to training for the homeless treatment team of Dr Andrew Thompson at a major hospital. ‘This is a major initiative and it’s early days,’ says Bonnet. ‘The idea would be to give a naloxone kit following discharge from an overdose or other drug-related admission – ideally this would be rolled out for all hospitals in England.

‘What doesn’t work is giving them an appointment and telling them to come back,’ he adds. ‘With some of our clients, you really need to do everything you can with them while you’ve got them.’

Get paperwork in place

The first stage is to get together a prescribing protocol, like PGD or PSD, says Bonnet. ‘That’s easy, just a couple of signatures on a document, really.’

Get kits in place

Then you need to buy naloxone kits and distribute them – ‘all you need is money to buy the kits, so you need to get the commissioner on your side,’ says Bonnet.

‘I remember our previous commissioner, around three years ago, saying he had bought 250 kits to start with. He just told us to get on with it, to go and save lives. The funding keeps coming through to this day. As a result, Birmingham is the leader for naloxone distribution in England. Around 2,500 kits have now gone out. We are now in a position whereby there is real consensus amongst expert organisations, including the Advisory Council on the Misuse of Drugs and the World Health Organization, that this is a medication that should be made more widely available. I hope we see that come to fruition over the coming year.’

CRI, the charity behind the delivery of Reach Out Recovery, actively supported the Naloxone Action Group’s campaign to widen provision of naloxone in England by asking services and stakeholders to write to their MPs to sign a motion which would prioritise its roll-out across the whole of the UK.

Show the economics

‘Our top priority is to save lives, in any way we can,’ says Bonnet. ‘However, it’s important to note that an overdose death costs thousands. Therefore, spending £18 on a kit which has the capability to save a life, as well as precious NHS resources – not to mention the trauma caused to the victim’s loved ones – seems to me like the obvious choice. It’s not rocket science.’

Do you have a naloxone strategy in your area? Let us know your experiences – good or bad – by emailing

Back to life

John’s experience is typical of the naloxone reversals each week in Birmingham. Philippe Bonnet shares his story.

‘John had scored two £10 bags, one for him, one for his girlfriend. He was aware that his girlfriend had diazepam and pregabalin in her system.

They cooked up the gear and within minutes of withdrawing the needle she collapsed in her chair and her head went back. John got up and shouted “babe are you ok,” shaking her shoulders. Her lips went blue straight away.

He panicked, grabbed her, and put her on the floor. He grabbed the phone and called the ambulance, shouting ‘hurry up, hurry up’. He got his naloxone and gave her a dose. Nothing happened.

He gave her a second dose; nothing happened. He gave her a third dose; nothing happened. At this stage I asked him how long he had waited between doses. He said “I don’t remember. She was dying in front of me.”

Then he gave her the last two doses in one, emptying the plunger. The ambulance arrived as she was coming round. He told the ambulance that he had had to give her five doses. As they took her into the ambulance, a member of the crew said, “If it wasn’t for your actions she’d be dead now.”

That happened at about 9am. At 3pm John came back to our service to get another kit. He was shaking, saying “Oh my God, I nearly lost my girl.’ She had been discharged from hospital. She was OK.”’

Naloxone advocacy

NaloxoneLet’s get it out there

The day saw repeated calls for life-saving, and cost-effective, naloxone to be made more widely available. 

‘The case for take-home naloxone is quite clear,’ activist Kevin Jaffray told the morning’s Naloxone – keeping up the campaign session. ‘So why isn’t it in the hands of the people who need it?’

While take-home naloxone programmes in Scotland and Wales had led to a fall in opioid-related fatalities, England saw a 32 per cent rise in deaths in 2013. ‘That’s because we have no national programme,’ said Jaffray. ‘It’s disgraceful. I’m not saying it’s a magic wand, but the fact is we could have saved at least half of these people.’

Naloxone had ‘been around since 1961’ he told the conference, and endorsed by the WHO, NTA and ACMD, among many others. ‘This medicine saves lives,’ he stated. ‘So why are we still having to fight?’ Many of the arguments against naloxone – that it encouraged people to take more drugs, or deterred them from seeking support – were myths, he said.

3The arguments that come up time and time again when we’re campaigning in local areas are comical. Naloxone will bring people into services, not the opposite.’ In fact it had the power to act as a turning point in people’s lives, he stressed. ‘When I OD’d and was brought back by naloxone, I accessed services. Because it scared the shit out of me.’

An overdose situation could add up to £20,000 per person in costs to the emergency services, while an overdose prevented from becoming fatal by naloxone cost around £400. ‘Not only is that a £19,600 saving, you’ve still got a human being breathing and a family kept together,’ he said. ‘We want the Medicines and Healthcare Products Regulatory Agency (MHRA) to publish draft regulations on naloxone now, and we also want Public Health England to be more active in local direction around take-home naloxone programmes.

1‘We have to work with what we’ve got,’ he told the conference, which meant user activism was vital. ‘You’re out there on the frontline. Form naloxone action groups in your local area, get trained and pass the training on in whatever capacity you can. Lobby your local commissioning boards, MPs and health and wellbeing boards. Anywhere you can get this out there, do it.’

Take-home naloxone guidance had just been published by PHE, Rosanna O’Connor told the conference. This would act as a ‘nudge to local authorities and partners’ to promote wider availability in advance of the change to medicines regulations – which currently only allow naloxone to be supplied on a prescription basis – expected in October.

Meanwhile, the lunch break saw an Action on naloxone session chaired by Niamh Eastwood of Release and Mat Southwell of CoAct, looking at what could be done to challenge lack of availability. Delegates were handed a list of local authority areas that were not providing naloxone – a substantial number.

‘How far is it being rolled out?’ asked Niamh Eastwood. ‘It looks like even in a number of areas where they’re saying “yes, we’re providing it” they’re not doing it sufficiently.’ And for those local authority areas that had stated they were not providing it, she said, ‘we need to find out why. Whose decision is this? There’s no reason why it shouldn’t be available. It’s cheap, and it saves lives’.

2Release now intended to challenge non-provision through legal action, she stated. ‘We need to find someone for a test case, and then what we can do is look at taking a judicial review. There’s no guarantee we’ll win, but it’s one of the ways we can push the boundaries on this. There are very strong right-to-life and human rights arguments here. People who use drugs have been stigmatised for years. This approach of taking legal action is one way of giving people a voice again.’

The day also saw naloxone training delivered by outreach worker and activist Philippe Bonnet. ‘The turnout was fantastic,’ he said. ‘I showed how you can train people very quickly, so those people can now go out into their communities and spread the message.

In terms of those areas not providing naloxone, the vital thing remained perseverance, he stressed. ‘Identify champions and knock down doors, and make use of the service user groups and advocacy groups that can do that on your behalf. But absolutely, don’t take no for an answer. One thing’s for sure – it’s not rocket science.’

PHE’s advice for local authorities at

What price life?

NaloxneThe failure to roll out naloxone distribution in England prompted a multidisciplinary group to meet in London to campaign for change. DDN reports

Last year there were 765 deaths related to heroin and morphine in England – a sharp rise of 32 per cent from the 579 deaths in 2012. The reasons for this failure are the subject of much debate, with many in the field suggesting that enforced detox and being encouraged to leave treatment too early are strong contributory factors.

But what is certain for the growing number of service users, treatment workers and medical professionals who have formed themselves into an action group – now called the Naloxone Action Group (NAG) – is that many of these deaths could have been prevented if naloxone had been available to use as an intervention to reverse overdose.

At the Action Summit on Naloxone (from which NAG was formed) held at Bleinheim’s headquarters in London last month, the agenda was split between sharing information and updates on naloxone, looking at examples of good practice from areas of effective distribution, and forming an action plan to challenge every area of the country that was slow or reluctant to roll out distribution and training.

Before arriving at the summit, participants had been asked to complete a questionnaire about the availability of naloxone in their area, the drivers for availability and the barriers to distribution both locally and nationally.

‘From participants’ responses there’s a marked variation,’ said Dr Chris Ford, clinical director of IDHDP, who chaired the meeting. ‘One area had total provision, most areas had nothing…. There is a definite postcode lottery. We’re going back to the bad old days and it stinks.’

The group identified those most at risk, with Professor John Strang referring to evidence that more frequent deaths happened during early stages of methadone treatment and early days of release from prison. One important factor to concentrate on was that many people died in the presence of friends, so the group agreed it was incredibly important – and an obvious move – to involve these potential ‘first responders’ with naloxone distribution and training. Families were also ‘absolutely crucial’ – ‘we want to get away from it being revolutionary to it being normalised,’ he said.

GPs would need to prescribe naloxone to patients and authorise family members to collect it and do the training. Oliver Standing from Adfam said that his experience of running a bereavement project had shown that families were ‘desperate to be involved’, while Jamie Bridge of the International Drug Policy Consortium (IDPC) and the National Needle Exchange Forum (NNEF) said ‘having family voices in this will be invaluable – it will make commissioners care.’ The idea of involving recovery assets such as family also ‘fits beautifully into the recovery framework’, said Fraser Shaw of Compass.

Elsa Browne of SMMGP added that her organisation had launched an e-learning module, written by Dr Kevin Radcliffe, to help with training. Around 100 people a month were doing it, ‘and the evaluation is brilliant’, she said.

John Jolly, Blenheim’s chief executive, brought the discussion back to the critical lack of action in England.

‘What’s happened in politics?’ he asked. ‘In May 2012 the ACMD recommended that naloxone should be more widely available, that the government should ease restrictions on supply, and that people should be better trained to administer it.’ The ACMD also commented on Scotland’s strategy running, Wales’ strategy being about to run, and England having no policy. ‘There are some great areas of good practice in England, but it’s very patchy,’ he added.

A letter from the Department of Health was shown to the group. It was a response to Dr Judith Yates’ letters to public health minister Jane Ellison, in which she pressed for answers on the lack of action. The letter assured Dr Yates that, following the ACMD’s advice, PHE and the Medicines and Healthcare Products Regulatory Agency were ‘working on amending medicines regulations to allow the wider distribution and administration of naloxone’. But new regulations would not come into effect until October 2015, ‘the earliest practicable date’ to avoid the distractions of the general election campaign.

The overwhelming reaction of the group was that this was ‘choosing to do nothing’ as October would not be within this government. ‘We’re not happy with the date that’s been set,’ said service user activist Kevin Jaffray. ‘A date a year from now leaves space for another 32 per cent rise in deaths. There’s been a constant rise since 2009.’

Steve Taylor, programme manager for alcohol and drugs at PHE, was invited to give a response to the situation. ‘We’re not kicking things into the long grass – things will have started to take place by October,’ he said, agreeing that ‘anybody walking out of the door with a methadone script and not naloxone is ludicrous.’

Any changes made in October would not make a huge amount of difference, he added, saying ‘there are things you can be doing’ that didn’t require any change in legislation. It was our responsibility ‘as doctors and clinicians’ to prescribe naloxone to people on methadone treatment, he said, and it could be given to families for the named patient. ‘What is it that’s going to change, that we don’t already do?, he asked.

PHE was looking to produce a briefing by the end of this year, using expertise to advise on what arrangements for wider provision might be. ‘But,’ he advised the group, ‘there is not going to be a national programme in England because of localism.’

Rhian Hills from the Welsh Government and Kirsten Horsburgh from the Scottish Drugs Forum shared their experience of naloxone strategy in each country, both of which had shown a decline in drug-related deaths since the strategies’ implementation. Wales had made a commitment back in 2008 to reduce drug-related harm and deaths, and had set up a national group that included police and paramedics. Demonstration sites had followed, evaluated by the University of South Wales, and the main recommendation to roll out the programme was completed in November 2011.

A decline in deaths of 53 per cent spoke for itself. ‘I don’t think it’s rocket science,’ said Hills. ‘It’s simple, it saves lives. It’s down to commissioners – get your priorities right.’ Involvement of service users – ‘the experts’ – had been really important in making risk logs, and from there, distribution had been increased to carers and their engagement encouraged. ‘Naloxone should be second nature,’ she said.

Kirsten Horsburgh acknowledged there had been ‘challenges and barriers’ in Scotland, starting from having one of the highest rates of drug-related deaths in Europe. But a national naloxone programme, launched at the end of 2010, had responded to common circumstances – that the average age of victims was 40, that they were not in treatment and likely to have had a recent period of abstinence, and that they were likely to die in their own or a friend’s home with witnesses (other drug users) present.

A Patient Group Direction (PGD) had been sent out to nurses and pharmacists in community addiction teams, needle and syringe programmes, harm reduction teams and the Scottish Prison Service, and Lord Advocate’s Guidelines allowed naloxone to be supplied by staff working for services in contact with people at risk of opiate overdose, such as in hostels. Anyone supplied with naloxone had to do training to make sure they were confident.

‘The key messages are prioritise the supply of naloxone to people who use drugs, make it normal in services and ensure people on ORT [opioid replacement therapy] have a supply,’ she said. ‘Make the training brief – just a ten minute chat – and involve peer trainers. All this potentially saves hundreds of lives.’

On 4 November the World Health Organization (WHO) recommended expanding access to naloxone, from just medical professionals to people likely to witness an overdose in their community, including friends, family members, partners of people who use drugs, and social workers. The report emphasised the safety of the drug, the ease of administering it, and its potential to reduce 69,000 deaths a year globally from opioid overdose.

The group around the table in London agreed that action was needed now, and there was no need to wait for PHE’s October 2015 directive to make each area of the country accountable for including naloxone in its localism agenda.

Dr Judith Yates gave the example of Birmingham’s progress – a process driven by doctors, nurses, pharmacists and service users, rather than commissioners.

‘Naloxone kits have become normal – we hear about reversals every month,’ she said. Dr Yates had trained drug workers from local service Swanswell, who were in turn carrying out training. ‘We don’t do risk assessments – we give naloxone to all first responders, we give it to everyone who uses drugs,’ she explained. ‘We have stories of residents in hostels saving each others’ lives.’

‘We’re obsessed with controlled drugs, but this is like giving an asthma inhaler, not methadone,’ added Emily Finch of SLAM. ‘I’ve signed hundreds of naloxone prescriptions.’


At NAG’s second meeting on 21 November, the group prioritised the need to overcome the obstacle presented by localism, which prevented England from having a national naloxone strategy.

‘PHE’s October deadline is disappointing, but it’s less than a year away. Of more concern is that we can’t have a national strategy because of localism,’ NAG chair John Jolly told DDN. ‘We agreed the need to bring this to the attention of politicians as well as clinicians. Naloxone distribution is not a minority sport, it’s day-to-day business. If you’re giving opiate treatment, you should be giving naloxone.’

With thousands of doses administered by ambulances, clear messages on distribution from the ACMD, and the Medicines Act ‘clearly empowering every citizen to use it’, there should be no obstacle to making naloxone available in every part of the country, he said. The recovery agenda was directly relevant: NAG identified that those most at risk were those starting on a journey of recovery, and emphasised the need for training alongside naloxone distribution.

‘We need to be identifying areas that are delivering good practice and naming and shaming areas that aren’t,’ said Jolly.

Through the gate

Sue ReynoldsSue Reynolds, the clinical lead of sub­stance misuse at HMP Littlehey, tells DDN about joining the growing number of prisons to introduce a life-saving take-home naloxone pro­gramme for prisoners upon release

HMP/Young Offender Institute (YOI) Littlehey is a purpose-built category C prison which holds convicted and sentenced adults and young adults. The average number of patients engaged in substance misuse treatment is typically around ten to 15.

The treatment regime for substance misuse was based on a recovery-focused approach and risks at release for these patients were high due to social and economic pressures, including their home situation, family support and employment. The highest risk was that they would have developed a low or zero tolerance to opiates/substances as a result of having been stabilised during custody, and so would be at an increased risk of overdose when released.

The local service provider had initiated a take-home naloxone programme, and so there was already support for these patients as they returned to the community. For these reasons, we wanted to initiate a programme within the prison.

The task was to gain agreement from the governor of HMP/YOI Littlehey and other senior staff for a take-home naloxone programme to be introduced, allowing for patient training to be undertaken and naloxone to be available ‘at the gate’ upon release back into the community.

Initially the idea of implementing the programme was made a reality by free training provided by Nina Bilbie, a Prenoxad representative. The appointment was set up by myself, with the full support of Dr Ruth Bastable, GPwSI prescriber for substance misuse treatment. Follow up meetings between myself, Nina and Ruth were key to identifying and overcoming the barriers to implementation. It turned aspiration into reality.

A needs assessment, which allowed objectives to be clearly defined, and a working plan to ensure that all boxes were ticked, needed to be in place. The Prenoxad protocol was adapted to reflect what HMP/YOI Littlehey would be delivering, and due to the small numbers, it was agreed that a patient group directive (PGD) would not be required and each prescription would be generated to the named patient on an FP10 prescription.

A business plan proposal was put together, using the support and information provided by Prenoxad, and presented at the drugs and therapeutics/medicines management meeting to the governor and other senior staff, including the lead chief pharmacist managing the prison. They were very supportive and due to the small numbers involved, the costs were minimal, which contributed to the positive outcome of the idea.

Training was delivered both to the clinical healthcare staff and non-clinical, psychosocial drug and alcohol recovery team (DART) workers in the prison, and a prison training package for patients was also developed. A DVD and sample syringes, needles, algorithm and instruction packs were supplied by Prenoxad. Training was provided by the substance misuse lead on a one-to-one basis with the prisoner, as well as a training evaluation checklist.

It was important to ensure there was a pathway in place for purchasing and accessing the naloxone. The source supply is as and when required for a prisoner’s release on an FP10 prescription, and the local pharmacist supplies it. The naloxone is given at reception upon release, and signed for by the prisoner and the nurse dispensing it. A letter is also presented at the gate, asking the prisoner to send it in if the naloxone is used and providing information on the circumstances.

The plan has been successful due to the large amount of people offering positive support and having the motivation to take it forward. The key factor was that shared expertise was available and easily accessible. The same commissioners (the DAAT) who provide the Inclusion programme both within the prison and the local community also commission and provide the clinical substance misuse treatment services in the prison. The GPwSI working within the prison also provides for the local community, and all key players involved were in agreement for the plan to be implemented. This was running concurrently with the community service providers who were initiating the same implementation plan.

There were no huge obstacles or barriers to overcome, as the support was there from the head of healthcare, the governor and the chief pharmacist. The materials provided by Prenoxad were excellent and enabled things to happen very quickly, while the protocol was easily adapted to reflect local practice.

The patients thought it was an excellent idea – they were very keen and appreciative that this was available to them and it made them feel empowered and supported. It has been included in the programme delivered on the drug recovery wing as part of the first aid and overdose session, and the prisoners who have had training have felt it has boosted their confidence in being able to manage an opioid overdose situation.

To be able to have naloxone injections available for prisoners being released is a huge breakthrough for drug treatment intervention in the prison setting. It takes away some of the worry of releasing vulnerable people into the community with a high risk of overdose. It has been a fantastic achievement and I was provided with tremendous support from colleagues. I hope this initiative continues to spread nationwide with little resistance – if it is available in the community, it can be made available within secure settings too.