November 2013

Examining the effectiveness of Naloxone (take-home; on release) to reduce opiate overdose deaths

Sheila Bird, MRC Biostatistics Unit, Cambridge

Venue: Room A54, Postgraduate Statistics Centre, Lancaster University

Date: 21-11-2013, 4pm


Naloxone, the opiate antidote, is injected by doctors in accident and emergency or by ambulance staff to reverse opiate overdose.

In Scotland, the first quantification was made of the very high risk of drugs-related death in the fortnight following release from prison – 7 times higher than at comparable other times at liberty, with 1 DRD per 200 released adult prisoners with a history of heroin injection. In 2003, Bird and Hutchinson had proposed a randomized controlled trial of Naloxone-on-release. Prisoners' high DRD-risk soon after release is well corroborated: internationally.

In 2005, Naloxone was added to the UK’s exempt list of prescription-only medicines that can be administered by anyone in an emergency to save life. Research by Strang and others had already documented that some-one else is present at about 80% of opiate overdoses, present-others’ willingness to intervene, and that knowledge increased after overdose-training. Community studies of take-home Naloxone set a precedent; and generally reported that the Naloxone administration-rate was about 10%, mainly to someone other than the prescribee.

In 2008, the Medical Research Council approved pilot funding for the N-ALIVE Trial to randomize, equally in two prison jurisdictions, the first 10% of 56,000 prisoners (with a history of heroin injection) needed to determine if those randomized to receive Naloxone-on-release experience 30% fewer DRDs in the first 4 weeks than those randomized to the control group.

As of 2011, however, the N-ALIVE Trial could no longer expect to randomize in Scotland (where prisons have been specifically resourced to provide Naloxone training and prescription) nor in Wales. Take-home Naloxone had become public health policy in both countries.

I shall outline how Scotland’s monitoring of its National Naloxone Programme was designed and modified; summarize recruitment to the pilot N-ALIVE Trial; and give an updated international perspective on take-home Naloxone.