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Supply of “Take Home” Naloxone to patients and carers in Glasgow

Supply of “Take Home” Naloxone to patients and carers in Glasgow. Duncan Hill Pharmacist Glasgow Addiction Services. Naloxone. Administered by injection to reverse opiate overdose Lasts about 20 minutes – Shorter acting than opiates Doses can be repeated at 2 minute intervals

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Supply of “Take Home” Naloxone to patients and carers in Glasgow

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  1. Supply of “Take Home” Naloxone to patients and carers in Glasgow • Duncan Hill • Pharmacist • Glasgow Addiction Services

  2. Naloxone • Administered by injection to reverse opiate overdose • Lasts about 20 minutes – Shorter acting than opiates • Doses can be repeated at 2 minute intervals • Dose 0.4ml, enough for recovery, not enough to cause withdrawal • NOT a replacement for emergency services • Safe ,effective emergency first aid

  3. Circumstances of DRDs, Scotland 2003 Over half of cases were witnessed by friend, partner or family member 68% occurred in own or friends home 50% several hours elapsed between overdose and death

  4. Background • Legislative changes • Scottish Executive DRD conference (autumn 2005) • Focus on drug related deaths • Exploration of suitability of Take-Home-Naloxone (THN) in Glasgow • Multi agency Support • NHS, City Council, SDF, Police, Prison Service, Family Support Groups

  5. How does the program work?

  6. Structure of the program • Three Stages • 1. Overdose awareness / how to recognise symptoms / risk factors • 2. Practical Basic Life Support Training • 3. Naloxone Supply PGD.

  7. Basic Life Support TrainingStage 2.

  8. 2 x Lead Instructors 85 x Instructors trained Participants Trained X 500 Informal dissemination of information

  9. Participants Program • Shorter version of instructors program • (Approx 1.5 - 2 hours) • Same practical skills • Basic Life Support • Recovery position

  10. Teaching practical skills

  11. PGD(Patient Group Direction) Supply by pharmacist or nurse Undertaken appropriate training relevant to PGD for the supply of medicines Undertaken training appropriate to NHS GG& C Naloxone PGD

  12. PGD Supply This isn’t a clinical trial…… No placebo group No random allocation to treatment Patient / HCP interaction, governed by professional code of ethics.

  13. Evaluation • 2 separate questionnaires for drug users / family & carers • Pre-training and Follow-up • Repeated when requesting replacement naloxone • Questionnaire to trainers

  14. Storage • drug users kept their Naloxone in various places • Bedroom • Fridge • Locked cupboard • High Cupboard • Friends house • Family / Carers were more likely to carry their Naloxone with them. • Handbag • Cupboard in house • House • Car

  15. . “ useful to see the practical side of bringing somebody around and seeing it visually. I’ve seen overdoses in the past and done the wrong things like dumping them outside a hospital.’ • Glasgow Naloxone Pilot, Final Evaluation

  16. “ Very useful. Information was easy to understand……. Gave information in a straightforward manner and I felt comfortable asking questions if I didn’t understand something”. • “ I think as many drug users as possible should get it . Many drug users think they know what to do in an overdose but they don’t” • Glasgow Naloxone Pilot, Final Evaluation.

  17. “Very grateful I took the course. Would never forget how to use it now I’ve used it. I owe them my brother’s life. …..Need to go to the hostels as a main priority …..” • Glasgow Naloxone Pilot , Final Evaluation

  18. Advantages • Very simple messages • Structured and based on previously successful models • Controlled • Multidisciplinary approach

  19. Resupplies and Alternative Training Venues. • “Somewhere local and where there's support and someone to talk to because it can be a harrowing experience and it would be good to have someone to talk to.” • Glasgow Naloxone Pilot, Final Evaluation

  20. Future • Possible Alternative Supply Venues • Local drug projects / health centres – currently expanding to CATs • Pharmacies • Needle exchanges • Police stations • Hostels / hotels for homeless

  21. Results to date (May 2009) • 475 supplies made since April 2007 • 19 reported uses of naloxone in overdose situation, with full use of program - all appropriate • 2 uses of recovery position and ambulance

  22. Developments • “Providing Naloxone in order to save life”…. “ thorough training would have to be in place that covered the use of naloxone and overdose awareness, such as the training programme devised for the Glasgow pilot. Naloxone should not be distributed without such a training programme being in place first”. • Scottish Government Response to the National Forum on Drug-related Deaths Annual Report, 2007.

  23. Contact details • Duncan Hill • Pharmacist • Duncan.Hill@Glasgow.gov.uk • Telephone: 0141 276 6655

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