I recently presented on naloxone at a conference where I was introduced as a ‘poacher turned gamekeeper’. I didn’t take offence – I’ve been called much worse over the course of my recently finished 30-year policing career.
But it did make me question the impact I’d had in relation to drugs over my career, from the overdose deaths that I routinely attended in my early years as an officer in Hull – wholly unaware of the existence of naloxone or how it could have helped me save lives – to arresting for simple possession, and on to my strong advocacy of naloxone with Durham Constabulary, and national policing as a whole, towards the latter end of my career.
Figures from the Office for National Statistics almost perfectly encapsulate the span of my career, and they’re not pleasant reading. Between 1993 and 2023 the age-standardised mortality rates for deaths by any opiate in England and Wales rose from 8.4 deaths per million people to 43.8 – an increase of 421 per cent. To make that real, that’s 2,551 deaths during 2023. We need to do more to prevent the deaths.
The Human Medicines (Amendments Relating to Naloxone) Regulations 2024 (HMR) came into force in December last year. While I used the previous regulations to raise the profile and use of naloxone within policing, these new amendments have the potential to become the most significant moment in the battle against opioid-related deaths in the UK in recent years.
WIDER ACCESS
For years, harm reduction advocates have called for broader access to naloxone. The recent HMR amendments reflect not only these calls, but also the feedback received during recent public consultations on widening the availability of naloxone.
At its simplest, the amendments significantly increase the number of organisations permitted to supply naloxone – in its nasal and intramuscular formats – to others, without the need for a prescription. Previously the regulations had restricted this ability to those employed or engaged by drug treatment service providers. These new changes allow for people working in the following groups to now do the same – police services, prison services, youth justice services, registered midwives, registered nurses, registered paramedics, registered pharmacy professionals and medical services with HM armed forces.
What’s particularly exciting is that these changes provide the opportunity to reach new cohorts of individuals who may not possess naloxone because they either don’t access traditional drug treatment services or regularly see a GP, or they may have previously been offered naloxone but declined. The addition of these new groups represents an opportunity to extend naloxone’s lifesaving potential to more people than ever before.
LOCAL PROVIDERS
While the new groups specified in the regulations are self-explanatory, the regulations also create a new entity, that of ‘local naloxone provider’ (LNP). People working for, or engaged by, an LNP will be able to benefit from the same naloxone exemptions as those groups already mentioned – the ability to provide naloxone without prescription.
So who are, or who will be, the LNPs? Interestingly the legislation doesn’t specify, but it’s not a giant leap to envisage that these would include existing support organisations, peer groups, drop-in centres, outreach workers, and more. By increasing the opportunities to supply naloxone, the regulations create opportunities for LNPs to step up and play a central role in overdose prevention. This ‘on your doorstep’ approach ensures naloxone is available in the settings where local providers know it’s needed and can have the greatest impact.
Operating as networks the LNPs will be run on behalf of the government and the devolved administrations by another new entity, the naloxone supply network coordinators. These coordinators will ensure that the requirements set out in the legislation are complied with, encompassing issues such as training, storage, record keeping and data sharing.
IMPLEMENTATION CONSIDERATIONS
While the legislative amendments are a significant step forward, the real challenge lies not only in their adoption, but also in their implementation. A couple of issues stand out as a priority.
Firstly, training and education: the regulations outline specific requirements that must be adhered to – only by doing so can an LNP retain its status and ability to supply naloxone. Foremost among these are ensuring that those supplying and administering naloxone are appropriately trained to do so. Without a doubt this would include an understanding of how naloxone works, recognising the signs of an opioid overdose, providing aftercare, and confidently administering the medication. Alongside this there are the more administrative elements such as stock control systems, storage conditions related to temperature and security, and recording procedures that would cater for issues such as batch recalls.
Secondly, partnership working: in my experience collaboration is at the heart of successful harm reduction. Working alongside public health teams, commissioned treatment providers, peer providers and community organisations – pushing the police to be in a position where the possession, use, and supply of naloxone was routine – has highlighted that we must all work together to take advantage of this opportunity. Together, alongside existing innovative provision such as ‘click and deliver’ or postal naloxone, we can create seamless distribution networks across our regions, while tailoring them to local needs.
WHAT’S NEXT?
The amendments to the HMR are another stepping stone towards improved harm reduction, but we all need to work together to effectively implement them. Local authorities, public health teams, commissioned services, community organisations, peer groups and naloxone advocates should seize this opportunity to make naloxone a medication so commonplace that its use is well understood, it’s easily available, it’s normalised, and comes without stigma.
By working together you can help translate these amendments into real, measurable outcomes – lives saved, families supported, and communities strengthened. Make the most of this new opportunity, one that many of us in this sector have pushed for. Contact your local public health team, engage with your local drug treatment provider, link in with peer groups, and set the ball rolling on establishing local naloxone providers in your area. Even if you don’t become actively involved in an LNP, there’s going to be a substantial increase in demand for advice and guidance from the numerous organisations that are newly able to supply naloxone, so offer your expertise where you can.
I’m in no doubt that had I possessed naloxone earlier in my career the opportunities for me to save lives would have been greater. I’ve worked towards the position where police officers all over the country now routinely use naloxone, but it’s now over to you to take advantage of this fantastic new opportunity to get naloxone into the hands of those that may benefit from it.