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.’

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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.”’