By Stephen Malloy
As you’ve read on this blog, programs that train drug users to respond to opiate overdose with naloxone are expanding across the globe. An important intervention that’s often overlooked, however, is training family members and “carers” - friends, housemates, and loved ones - of drug users to use naloxone. A program in the UK is doing just that, as Stephen Malloy reports:
In July 2009 the National Treatment Agency (NTA) supported a 16 site pilot project, entitled “overdose prevention and naloxone training for families and carers.” The pilot sites, which were spread across England, recruited and trained family members/carers of people at risk of opiate-related overdose death in overdose prevention; signs and symptoms of overdose; and naloxone administration and basic life support techniques. The family member/carer was also supplied with naloxone IF the person at risk of overdose was available to give written or oral consent for the supply to be made.
A new report shows that 495 family members/carers were trained, and at the time of its writing 20 lives had been saved thanks to naloxone use (18) and basic life support (2). These results demonstrate the need a wider circle of family/carers to be engaged around overdose prevention and crucially, be supplied with naloxone.
The report does however highlight challenges in recruitment of family/carers. It was difficult to recruit parents in particular, sometimes because they said they were not around when their child was using drugs. Partners of drug users, whether they used drugs themselves or not were more easily involved in the program. Other difficulties included recruiting participants post detoxification. Some potential participants reported that they did not want to be involved as this was the end of their drug using. The program also recruited family members and carers of people leaving prison, and the report details some of these challenges.
It’s well recognized that people leaving prison are at significantly elevated risk of overdose death, and are therefore a priority group for overdose prevention and naloxone training/supply. In Scotland we have a national program covering all prisons. Prisoners are trained toward the end of their detention, and are supplied with naloxone upon liberation. Soon, a new study is due to begin in England, also looking specifically at their prison population and providing overdose prevention/naloxone to them.
The full report from the NTA pilot for families and carers, including recommendations for programs starting similar initiatives, is available here: http://www.nta.nhs.uk/news-2011-naloxone-report.aspx.
If links to report don't work, please copy the link below into your search bar. This will take you to NTA publications page, where you will find the report.
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Very very cool. Congratulations on what sounds like a great program. I think it's particularly interesting that you chose to require consent for naloxone to be made available to family members by those who it might be used on. That's a level of ethical consideration too often missing from all kinds of drug services.
ReplyDeleteMatt, the requirement for consent is indeed a good thing, hovwever some families/carers actually see it as a barrier to supply as they've reported that it's sometimes difficult to get the person they care about to agree to give this consent, meaning supply can not be made. This is similar to the current position in Scotland, where many family groups ask for naloxone training and supply, but can only get the training(still a very good thing, but not what all of what is desired by them).
ReplyDeleteExactly, which is to say, it's complicated and to my mind kind of dependent on how the connections are made. In NYC for example, we've trained & given naloxone to a fair number of people who aren't themselves heroin users but people who are around them - family, friends, lovers, squat-mates, etc. Sometimes their connected via users, sometimes not (like, just striking up conversations with people on outreach who decide, oh yeah, this is actually useful for me). Far as I know, no group in NYC has ever had a policy about it, and my inclination is more access to naloxone is always a good thing. But it's very worthwhile to keep this kind of stuff in mind. So at minimum, if you're giving naloxone to non-users, talk through how they have the conversation with people they could use it on; when the contact happens through users, then there's a more direct avenue for talking about consent. Anyway, thanks again, really interesting.
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