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Naloxone is not enough

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Naloxone

I’m a fan of Take Home Naloxone (THN). I’ve also wondered about how our naloxone programmes might be recovery-focused. Dr Judith Craven wrote a personal piece touching on this a while back. Jason Schwarz picks up on how our expectations might be greater than the impact the drug can actually make. He quotes Andrew Kolodny, from Phoenix House, also a THN supporter:

I’m worried that we may be expecting more from naloxone than it can deliver. As far as public health interventions to address the opioid addiction epidemic go, naloxone distribution is about as downstream as it gets.

He goes on to look at potential impact in the US:

We should never undervalue the importance of saving even one life, but in the grand scheme, I believe naloxone’s impact on our nation’s historically high overdose death rate will be small. 

And the evidence for this view?

Some counties in the U.S. that have done a nice job of making naloxone more available are still seeing overdose rates climb. For example, in Wilkes County, North Carolina, home of Project Lazarus, a naloxone program funded by Purdue Pharma (the maker of OxyContin), overdose deaths are on the rise. Although Wilkes County initially experienced a decline in deaths after the launch of Project Lazarus, from 2011 to 2013, overdose deaths more than doubled in Wilkes County.

This might be because of increasing prevalence of opiate dependence and misuse rather than because of lack of efficacy, and factors such as saturation levels will be important but it’s frustrating and concerning.

Naloxone is not enough on its own

I wonder if it will make an impact here in Scotland where we have a terrible rate of drug related deaths, despite easy and fast access to ORT and high numbers of people in treatment. I’ve met folk whose lives have been saved by THN and others who have administered it (as I have) in overdose situations. Despite this I acknowledge that THN is not going to be the answer – it’s a tool in our toolbox. I don’t think anybody here expects it to be enough on its own. However if it’s used as an opportunity to engage someone in treatment then it’s doing more than saving a life. An overdose can be a window of opportunity for change. Jason Schwarz has his own take:

I also support increasing access to naloxone, especially assuring all first responders carry it. However, I share Kolodny’s concern that advocates are often failing to acknowledge just how incomplete the intervention is. I’ve previously likened it to automatic defibrillators being installed in public spaces. They are great and they save lives. However, no one would feel too satisfied with their dissemination if people just went on their way after having their life saved by the defibrillator. We’d insist that it is followed by an ambulance trip to a hospital where they receive good care.

Let’s increase access to naloxone and make sure that every rescue is followed bythe kind of care an addicted health professional would get.

    2 Responses to "Naloxone is not enough"
    1. Anon says:

      Naloxone is a really valuable intervention but……it only works when the OD is on opiates, there are others present and the others are alert enough to identify and respond. This is a very small proportion of drug related deaths. Naloxone is well worth delivering but set against impact of the ageing opiate using population and of NPS, it isn’t going to reduce the number of DRD, it’s scarcely going to retard the increase.

      • djmac says:

        It will be interesting to see how well distributed TNH becomes and to map that to DRD (Drug Related Deaths), though with the changing demographics and early indications of changing patterns of drug use, it might be hard to get a handle on what the true impact is. Your points are well made.

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