Nalaxone availability will save lives

Last week, the Minister for Health, Leo Varadkar, announced that the drug Naloxone would now be routinely available in Ireland. In our first guest blog on Liversalts.com, a leading drug treatment expert examines the effects that the introduction of the drug will have in Ireland.  Dr Cathal ó Súilliobháin believes it will save the lives of many young people.

Fatalities as a consequence of drug use are a major cause of death in young people. In most European countries the numbers of young people dying as a result of drug use has been decreasing in the last few years.

However, in Ireland, it has been increasing. According to the European Monitoring Centre for Drugs and Drug Addiction, we have the third worst record in Europe, with a death rate of 70 per million compared to a European average of 17.

A significant number of these deaths are caused by overdose, and most of these by opiates.

Many of these deaths are preventable.

A number of interventions have been proven to reduce the number of young people dying in this way.

Supplying Naloxone (a drug which rapidly reverses the effects of opiates) without prescription to opiate users has been shown to reduce the numbers of drug users dying from overdose.

This initiative has recently been endorsed by our new Minster for Health, Leo Varadkar.

Naloxone is now available only in an injectable form in Ireland, and can only be administered by medical personnel.

It is the standard treatment for opiate overdose in an Emergency Department or a pre-hospital emergency setting – administered by Advanced Paramedics.

The drug is safe and has no other use besides reversing opiate overdose. There is no potential for diversion for other purposes by drug users.

A recently developed nasal spray can deliver Naloxone as effectively as by injection. This has the advantage of making it easier for trained and untrained individuals to administer the drug. It also reduces risk to medical personal ,who can be at increased risk from viral diseases (hepatitis, HIV) while injecting drug users with Naloxone.

Another measure shown to reduce drug deaths is to provide supervised injecting sites. This has been successful in a number of European cities and in Canada. It has the added advantage of removing drug use from inner city streets, a problem that has blighted central Dublin in recent years. It can also facilitate entry into treatment programs through contact with medical staff at the injecting site.

Substitution treatment with methadone or buprenorphine has repeatedly been shown to be one of the most effective measures of reducing death from opiate overdose.

In Ireland provision of methadone treatment has been government policy since the early 1990s. It’s puzzling therefore, why Ireland is in the top five European countries with increasing death rates. We are up there with Estonia, Norway, Sweden, and Finland – countries well known for their poor access to methadone treatment.

The answer is that the development of methadone programs in Ireland has been an abject failure. A significant proportion of opiate users in Ireland either will not, or cannot access treatment services.

Methadone treatment is free in Ireland. Doctors are not permitted to charge patients, and must be part of a highly controlled and monitored system.

In 2011, deaths associated with methadone increased from 66 in 2010 to 113. Of those deaths, 68% were people who were not in treatment.

Methadone is a dangerous drug and it needs to be prescribed and dispensed safely.

The question must be asked why drug users who can get methadone free from a clinic or through their GP would pay to buy it on the black market. The answer is that in many parts of the country, there is little or no treatment available.

The roll out of the Methadone Protocol Scheme to General Practice has not worked. There are no community GPs west of the Shannon who can start a patient on methadone treatment, and the situation is little better in most other areas outside Dublin.

Where there are clinics, many drug users will not attend because of the history of punitive treatment practices. While practices are slowly changing to come in line with international norms, a recent external review of the HSE/ICGP Audit program for GPs prescribing methadone described the ICGP treatment guidelines as:

“inappropriate- not currently evidence based, not conforming to practice in most other countries, with practice in other areas, inflexible and in some cases may be restrictive to recovery and person-centred care. They are based on the 2008 guidelines but not consistent with current evidence base.”

Making Naloxone available without prescription to drug users will almost certainly save some lives, but there are other basic issues, such as access to methadone substitution treatment and the nature of the treatment being offered, that need to be urgently reviewed by Minister Varadkar.

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