Preven&ng heroin overdose deaths: Cri&cal situa&ons including release from prison

Transcription

1 Preven&ng heroin overdose deaths: Cri&cal situa&ons including release from prison Professor John Strang National Addiction Centre, King s College London, UK

2 Declaration (personal & institutional) DH, NTA, Home Office, NACD, EMCDDA, WHO, UNODC, FDA, NIDA. NHS provider (community & in- padent); also Phoenix House, Lifeline, Clouds House, KCA (Kent Council on AddicDons). Work with pharmaceudcal companies re actual or potendal development of new medicines for use in the addicdon treatment field (incl re naloxone products), including (past 3 years) MarDndale, ReckiU- Benkiser/Indivior, UCB, MundiPharma, Lundbeck, Alkermes, Teva, Rusan/iGen and also discussions with Lightlake, Lanacher, Fidelity InternaDonal and Titan. UKDPC (UK Drug Policy Commission), SSA (Society for the Study of AddicDon); and two Masters degrees (taught MSc and IPAS) and an AddicDons MOOC. Work also with several charides (and received support) including AcDon on AddicDon, and also with J Paul GeUy Charitable Trust (JPGT) and Pilgrim Trust. The university (King s College London) has registering intellectual property on a novel naloxone product, and JS has been named in a patent registradon by a Pharma company as inventor of another naloxone product.

3 Thanks PaDents and advocates and their families Immediate and internadonal colleagues

4 Why does the take- home naloxone issue ma<er? Overdose is the major cause of death among drug users mainly opiates Most heroin overdoses are witnessed Most witnesses intervene acdvely (even if wrongly) Many family members witness overdose (rarely taught) We now know when and where it is more likely to occur and we know how to prevent fatality

5 Why does the take- home naloxone issue ma<er? Overdose is the major cause of death among drug users mainly opiates Most heroin overdoses are witnessed Most witnesses intervene acdvely (even if wrongly) Many family members witness overdose (rarely taught) We now know when and where it is more likely to occur and we know how to prevent fatality

6 Prison release and naloxone key issues Heroin/opiates as the specific implicated drug Prison release and other times and places of particular concern

7 Drug use prevalence and Drug- related deaths: England &Wales 2011/12 (ONS) Drug Prevalence in general population (use in last year, age 16-59) No. of deaths in 2011 Cannabis 6.9% 7 Cocaine 2.2% 112 Amphetamine 0.8% 62 Ecstasy 1.4% 13 Opiates (inc heroin & methadone) 0.3% 1,082

8 Oxygen saturation: case series

9 Prison release and naloxone key issues Heroin/opiates as the specific implicated drug Prison release and other times and places of particular concern

10 When in particular excess? During methadone early treatment Post-detox/rehab Prison release

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12 Risk of death during and after treatment Cornish et al, BMJ 2010; 341: c5475

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21 When in particular excess? During methadone early treatment Post-detox/rehab Prison release

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30 45 Excess mortality ratio Not drug-related Drug-related deaths 0 Up to 1 1 up to 2 2 up to 4 4 up to 8 8 up to up to up to 52 >=52 Total Time since release (weeks) Singleton et al, 2002

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37 Conclusions: the con&nuing challenge Some easy acdons (doctors treat padents; padents live with their families) Some challenging areas (the deadly gap between prison and community; treatment authorisadon for unknown recipient; difficult to conduct rigidly- designed research trials) Self- applied inerda (societal ambivalence; also inerda within the field as well as external)

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39 All work None perfect

40 First-responder overdose management and emergency naloxone; the challenge New category of preventing deaths (EpiPen; de-fibrillator; etc) Incremental technology transfer (wider workforce) Better understanding of the product and application Institutional inertia ( whilst we dither, overdose victims die )

41 Ongoing issues that create hesitation Route Dose Legal (third party; family; outreach; OTC) Opt-in or maybe opt-out

42 First-responder overdose management and emergency naloxone; necessary next steps The emergency context (pre-preparation; ABC-naloxone; rescue breathing; ambulance) The regulatory context (pre-supply; OTC?; Samaritan; message) Improving the product (dose/effect; IM good but needs to be easier; right dose, pre-filled, stake needle; non-injecting potential?; longer-acting?) Target especially... (individuals at known high risk; settings of known high risk; wider intervention workforce) Tracking the impact (case studies OK; crucial to track population impact)

43 Thank you