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
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
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
Profiles and trends Source EMCDDA EDR 2015 There is no clear decline in overall overdose trends.
Recent increases in some countries Source EMCDDA 2015 EDR
Mortality due to drug-induced deaths among adults (15 64 years). Most recent year reported 140 120 100 80 60 40 20 0 Countries with highest drug-induced mortality rates are in northern Europe
Age pyramids of overdose cases >=65 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 <15 60-64 Germany 2012 (n=944) Female Male -35 15 65 115 Number of deaths reported >=65 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 <15 Ireland 2011 (n=220) -10-5 0 5 10 15 20 25 30 35 40 Number of deaths reported Female Male 45-49 35-39 30-34 25-29 20-24 >=65 60-64 55-59 50-54 40-44 15-19 <15 Estonia 2012 (n=170) Female Male -10 0 10 20 30 40 50 Number of deaths reported >=65 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 <15 Norway 2011 (n=262) -15-5 5 15 25 35 Number of deaths reported Femal e
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.
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
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
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
Conclusion Since EMCDDA started monitoring drug-related deaths, 140.000 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.
Take-home naloxone EMCDDA Insights publication written by John Strang, Rebecca McDonald and colleagues to be launched in 2015. Email for your free copy: publications@emcdda.europa.eu
Thank you for your attention Dagmar Hedrich dagmar.hedrich@emcdda.europa.eu emcdda.europa.eu twitter.com/emcdda facebook.com/emcdda youtube.com/emcddatube flickr.com/photos/emcdda