8.0 Take Home Naloxone

Transcription

1 8.0 Take Home Naloxone 8.1 Population characteristics For the financial year (FY) 2016/17, 721 take home naloxone (THN) kits were issued in the City of Edinburgh. Of the 323 individuals who received naloxone where age and gender were known, 203 (63%) were male with a mean age of 38 (range 16 to 66) and 120 (37%) were female with a mean age of 39 (range 17 to 66). The distribution of residence of people issued with THN is similar to the distribution for injecting equipment provision and drug related deaths (Figure 8.2). 8.2 Service delivery THN is mainly supplied by NHS and third sector colleagues working in Tier 2 and Tier 3 services but work is ongoing to provide THN across all tiers of harm reduction services (Table 8.1). In Edinburgh, there has been a steady increase in naloxone issued in the community from 303 kits in FY 2012/13 to 721 kits in FY The Needle Exchange Surveillance Initiative (NESI) found that of 475 respondents, 242 (51%) had ever been prescribed naloxone. Table 8.1: Take home naloxone supply Tier Providers Tier 1- Health and social services that interface with drug and alcohol care Tier 2 Low threshold open access services Tier 3 Structured communitybased services Tier 4 Specialist residential services Police custody suite (St Leonard s) Scottish Ambulance Service (under development) Regional Infectious Diseases Unit, Western General Hospital Social work at Bonnington Rd. (under development) Recovery hubs in individual localities Harm Reduction Team (Spittal St Centre) Needle Exchange Outreach Network (NEON) bus Women s clinic at Turning Point Leith Edinburgh Access Practice (EAP) for homeless people Harm Reduction Team (Spittal St Centre) Recovery hubs in individual localities Low threshold medication programme (LTMP) Edinburgh Access Practice (EAP) for homeless people Drug Treatment and Testing Order (DTTO) team. Drug Misuse National Enhanced Service (NES) HMP Edinburgh addictions services Ritson Clinic, Royal Edinburgh Hospital LEAP, Toxicology, Royal Infirmary of Edinburgh In FY 2016/17, as with previous years, most naloxone was issued to the user (592, 82%). Kits are also issued to support workers (97, 13%) and family and friends (32, 4%). The 2015 legislative changes that have allowed third sector supply have enabled more family members to access naloxone (Table 8.2).

2 Of the 721 kits issues in Edinburgh, 328 (45%) are recorded as first supply with 336 (47%) as repeat supply and of these, lost kit is the main reason for issue (146, 20%), with 14% damaged or expired. Use for overdose across Lothian as a whole has increased from 35 instances in 2012/13 to 147 instances in 2016/17. However for the city of Edinburgh there has been a decrease from 118 instances in 2015/16 to 83 instances in 2016/17. Data from the last 2 years indicates a seasonal trend with more kits used for overdose in the summer months. Table 8.2: Naloxone supplied by reason for issue, City of Edinburgh FY 2016/17 Reason for issue Kits supplied First supply 328 Spare supply 57 Not known 0 Repeat supply 336 Lost kit 146 Used for overdose 83 Expired 78 Damaged 24 Confiscated 3 Not known 2 There is variation in the number of kits supplied at different sites: the Harm Reduction Team at Spittal Street Centre provided 23% (163) of all kits, NE Hub provided 14% (104), NW Hub provided 13% (97), Drug Treatment & Testing Order (DTTO) provided 10% (71), the Edinburgh Access Practice provided 9% (62) and the Regional Infectious Disease Unit/blood borne virus team provided 19 kits in 2016/17. In HMP Edinburgh, flyers are distributed to highlight THN training and if they complete the training a THN kit will be placed in their property by the addictions team on liberation. The number of kits issued from HMP Edinburgh has increased from 54 in FY 2012/13 to 142 in FY 2015/16. Of the 70 people surveyed in NESI who had been in prison in the previous six months, 37 (52%) had been provided with THN and of these, 19 (51%) had received THN from the prison. There is also variation by patient address (Table 8.3). Data for 2016/17 suggest that individuals resident in the North West locality are in receipt of one THN kit per person at risk, whereas for people resident in the South East locality the ratio is 0.2 kits per injector.

3 Table 8.3: Take home naloxone issued City of Edinburgh locality Locality Number of people injecting drugs (from NEO 2016 regular attendees ) THN issued to people in locality postcodes (% of total Lothian issues) North West (16%) 1 North East (21%) 0.4 South East (25%) 0.2 South West (14%) 0.4 THN issued per injector A major gap in delivery is primary care. In Edinburgh, up to 80% of opioid substitution therapy (OST) is delivered by GPs through the drug misuse National Enhanced Service (NES) and patients collect prescriptions from community pharmacies. However, currently there is very little THN prescribed in either of these locations, in contrast to other locations in Scotland, such as Glasgow where THN training and kits are delivered primarily by community pharmacists. General practices are beginning to prescribe THN (Figure 8.1) but numbers of kits provided are still very low. Figure 8.1: Monthly prescribing of naloxone for Lothian GP practices in the drug misuse National Enhanced Service (NES) from January 2016 to February 2017 (excluding stock orders) Number of Practices/ Prescriptions Practices prescribing Naloxone Number Prescribed 5 0 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Date

4 Recent discharge from hospital with an overdose is a risk factor for DRD [47,48]. However, provision of THN in hospital settings such as A&E departments and inpatient wards remains a challenge. Likewise, although Tier 1 services such as police custody are already providing THN, and the Scottish Ambulance Service is developing plans to do so, other services such as housing/homelessness and social work distribute very low numbers at this time. 8.3 Naloxone use by the Scottish Ambulance Service Based on national data provided by the Scottish Ambulance Service (SAS), between 2008 and 2015, the number of attendances for suspected overdose ranged from 185 to 242 per year. Naloxone was administered on average at 53% of these attendances. Data gathered locally by SAS in Lothian is significantly higher at 431 attendances in This is likely to be due to different reporting and coding practices for SAS locally and nationally. 8.4 Key findings: Take home naloxone Take home naloxone is available through a wide range of outlets across Edinburgh, the number of kits issued and services issuing kits is increasing, and THN use for reversal of suspected opioid overdose is also increasing. There is variation in distribution between settings and localities: settings that need to be developed for THN supply include A&E departments, hospital inpatients, SAS, general practice and community pharmacy; the SE, NE, and SW localities have significantly lower rates of kit/injector than NW and an improvement approach is needed to ensure equitable access across the city.

5 Figure 8.2: Map of patients who received naloxone between April 2014 and September 2016 based on postcode district