Comment: Naloxone could save thousands of lives. So why is the government restricting it?
By Kaya Suleyman
French health minister Marisol Touraine recently announced a landmark new policy involving trial centres in various cities across France, where drug addicts can safely inject their own drugs in the presence of health specialists.
In Britain, recent recommendations from an independent report commissioned by Brighton and Hove city council on the need and efficacy of drug consumption rooms are also drawing the attention of the city's public health leaders, as plans to implement them for the first time in the country are being given serious consideration.
But what are so called "drug-use rooms" and how effective are they?
Brighton has for many decades experienced worrying trends in drug abuse. The incarceration of harmless drug users and drug addicts is slowly sowing the seeds of social discord and marginalisation amongst its many inhabitants. As a city that has experienced up to 104 drug related deaths between the years of 2009 and 2011 alone, drug consumption rooms could be a major step in fighting back against the harms of drugs.
The consensus is growing amongst health officials, police enforcement and politicians across the world that placing an emphasis on the prisons system as a means of dissuading drug use is a progressively diminishing, and harmful, pursuit. Just recently, chief constable Mike Barton warned against the dangers of criminalisation. That is why the priority is being placed increasingly on more effective initiatives that focus on helping individuals manage the harms of drug use and addiction, as a substitute to pursuing politically charged and dogmatic policies aimed at achieving a "drug free world".
The idea behind drug-consumption rooms is to provide a hygienic and controlled environment for injecting drug users (commonly abbreviated as 'IDUs'), in an attempt to slash the spread of HIV/AIDS by providing free, clean and sterilised needles. With the supervision of trained on-site professionals, drug-use rooms have been credited with saving lives and reducing anti-social behaviour, by preventing overdoses as well as discouraging public drug use, including the unsafe disposal of dirty needles.
The evidence for the success of these facilities in helping control public drug consumption and potential health epidemics is compelling in the many countries around the world who piloted such schemes.
For example, Canada, which has only one drug-use room in Vancouver, has seen a sharp decline in public drug use in the area surrounding the facility, reducing incidence rates by up to 50%. A report by the European Monitoring Centre for Drugs and Drug Addiction further demonstrated that all studies clearly indicate "drug users readily accept and prefer the hygienic, safe and stress-free environment of consumption rooms to injecting in public…" where they are free from the threat of prosecution.
And according to a report by the Independent Working Group on Drug Consumption Rooms, these facilities have been used millions of times in the 65 countries across the world that have them – yet only one death has ever been recorded to have taken place in one of these facilities. This is compelling evidence for a country like Britain, which has the highest number of recorded overdoses in Europe.
By offering such facilities, we create the possibility of getting drug dependent users "in touch with agencies that can provide treatment". It is easier than it otherwise would be for what is typically regarded as a "hard to reach" demographic. Those quotes, by the way, are from David Cameron's response to a Joseph Rowntree Foundation report in 2006.
This increases the prospect of more individuals entering rehabilitation programs for long term treatment and could provide authorities with an effective strategy for actually combating addiction altogether.
Naloxone is a highly effective 'opioid inverse antagonist', which in brief means it acts as a drug capable of reversing the effects of an overdose from opiates such as heroin. The administration of this drug allows enough time for medical assistance to arrive at the scene, potentially preventing a death and mitigating any long term damage that could be sustained during an overdose. Its increased availability and use form an integral part of the overall recommendations of the report published by Brighton and Hove city council.
Although the supply of Naloxone remains restricted in the United Kingdom, numerous programs have been launched to test the efficacy of training heroin users as well as family members to identify an overdose and to administer Naloxone safely. As many overdoses happen in the presence of a witness, the potential to prevent unnecessary fatalities using Naloxone are immense.
For example, the 'take home Naloxone rescue scheme', which was launched in Wales in 2009, provided heroin users and those in proximity to them, including employees of the prisons system, with overdose reversal kits and basic training in how to administer the drug. Welsh government figures showed that 684 Naloxone kits have been provided since 2009, with 51 being used to bring an overdose victim back from the brink of death.
A previous scheme in Brighton had provided the same training to hundreds of homeless people living in hostel shelters – almost halving the number of overdoses in comparison to previous years. Mike Pattinson, the head of the drug treatment charity CRI, described it as a "miracle drug".
Examples of the effectiveness of Naloxone as forming part of an important public health strategy can be demonstrated as far afield as the United States of America, which is also home to groups with extensive experience in providing Naloxone training. The Chicago Recovery Alliance outreach project has been providing Naloxone training since 2001 in their local communities, and by 2006 it had helped reverse up to 319 overdoses.
In New York, one study has shown over 1,000 needle exchange participants at a facility had received training in overdose reversal, with 122 of these trainees responsible for administering Naloxone to 82 individuals in need of assistance. Projects that involve training police and fire departments in North America have also shown promising results.
There is little debate as to the usefulness of Naloxone, but restrictions on the supply of this drug remain in place nonetheless – mainly due to fears that its widespread availability could lead to riskier patterns of drug taking. The premise, however, is without merit. Multiple studies have already established that there have not been any discernible changes in patterns of drug abuse in the presence of the availability of Naloxone. Furthermore, a study in England selected by the group 'drug and alcohol findings' states that heroin users complained the administration of Naloxone resulted in the "termination" or "dulling" of heroin's effects. This could even suggest that users may be more inclined to manage their dosage of heroin more effectively so as to avoid a situation whereby intervention could abort an expensive high. It is unlikely that such a thing would lead to the deterrence in the use of Naloxone however, as it is the most effective means of immediate intervention for preventing possible death.
Once again, the United Kingdom lags far behind its European counterparts in providing innovative and effective health treatment for drug addicts. Political influences championing a war-like mentality against drug users from across the pond in the US threaten to derail advances made in controlling health epidemics in this country, as most of our politicians opt instead to maintain the self-defeating yet popular line of 'drugs are bad and drug users are worse'.
Political cowardice of this kind is coming at a huge cost to the public, and the NHS is also struggling to keep up with the surge in drug-related illnesses. It is paramount we begin to start having an honest discussion about drugs, and we can start by looking closer to home for new ideas.
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