Viewpoints on future dissemination of take-home naloxone: opportunities and challenges

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1 Viewpoints on future dissemination of take-home naloxone: opportunities and challenges Dagmar Hedrich & Isabelle Giraudon, EMCDDA Bergen, 1 September 2015 OVERDOSEKONFERANSEN 2015 ThINCBergen2015: The lnternational Naloxone Conference

2 EMCDDA reference point on drugs in Europe Specialised EU agency, established 1993, located in Lisbon 30 member countries, incl. Norway Our mission: Provide a factual overview of European drug problems and a solid evidence base to support the drugs debate. - monitoring drug-related deaths: DRD numbers and trends; - responses to reduce DRD, evidence and best practice; - interface to policy making a translational function. emcdda.europa.eu

3 Overdoses 6000 to 8000 drug-induced deaths per year - Known under-reporting in some countries - Reporting delays - Effect of economic crisis - Stigma and marginalisation Polydrug intoxication is the norm, background of heroin and or other opioids in most cases

4 Profiles and trends Source EMCDDA EDR 2015 There is no clear decline in overall overdose trends.

5 Recent increases in some countries Source EMCDDA 2015 EDR

6 Mortality due to drug-induced deaths among adults (15 64 years). Most recent year reported Countries with highest drug-induced mortality rates are in northern Europe

7 Age pyramids of overdose cases >= < Germany 2012 (n=944) Female Male Number of deaths reported >= <15 Ireland 2011 (n=220) Number of deaths reported Female Male >= <15 Estonia 2012 (n=170) Female Male Number of deaths reported >= <15 Norway 2011 (n=262) Number of deaths reported Femal e

8 Heroin/opioid trends a mixed picture Drug treatment has been scaled up: now >50% of estimated opioid dependent population in opioid substitution treatment; Broader range of interventions in many countries, e.g. DCRs; Less new recruitment into heroin use; Success of harm reduction measures: new HIV infections among people who inject drugs have declined to all time low; But: Synthetic and semi-synthetic opioids play an increasing role; Heroin using populations are ageing and physically vulnerable; DRD show no clear decline since 2008.

9 Take-home naloxone Covered by regular EMCDDA monitoring: THN projects operate in DE, DK, EE, ES, IT, NO, UK and are planned in several other countries; Review of evidence (EMCDDA, 2015) Expert meeting Oct 2014

10 Main challenge: to achieve sufficient coverage of at-risk populations so that substantial reductions in opioid overdose deaths can be attained. Legal/regulatory barriers prescription-only use limited to medically trained personnel handling & storage restricted Technological barrier: Naloxone formulation Injectable (IV, IM, SC) use of syringe an obstacle off-label IN use (by paramedics, in pilot projects) Nasal spray and applicator under development

11 Information exchange and training: Providing information to policy makers about effectiveness, feasibility and relevance of the intervention Supporting exchange of best practice Promote awareness raising & training Drug users, family and peers Doctors who prescribe OST Low-threshold and treatment staff Prison staff and police

12 Conclusion Since EMCDDA started monitoring drug-related deaths, overdose deaths were reported in Europe; There is evidence that education and training combined with take-home naloxone decreases overdose mortality; Empowering bystanders to deliver a potentially life-saving intervention is an important step in a harm reduction oriented European response to drug use.

13 Take-home naloxone EMCDDA Insights publication written by John Strang, Rebecca McDonald and colleagues to be launched in for your free copy:

Thank you for your attention Dagmar Hedrich dagmar.hedrich@emcdda.europa.eu emcdda.europa.eu twitter.

14 Thank you for your attention Dagmar Hedrich emcdda.europa.eu twitter.com/emcdda facebook.com/emcdda youtube.com/emcddatube flickr.com/photos/emcdda

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