Each year 58 million people use opioids and approximately 120,000 people die around the world from an opioid overdose.
To put this in perspective, annual opioid deaths in the UK now exceed deaths from road traffic accidents. Research has shown that times of particular concentration of overdose death are also points of transition, such as moving from street drug use into treatment, in the weeks following the end of treatment and rehabilitation, and the weeks following release from prison.
These transition points are often in community settings where medical staff are absent, so it is important to place effective medicine into the hands of people who can immediately treat the user at time of overdose, while waiting for an ambulance.
Over the last 10 years, King’s researchers have developed and adapted an innovative approach (‘Take-Home Naloxone’) which mobilises the general public, including drug users themselves and families as an emergency intervention workforce, to do just that. This research has led to increased distribution of Take-Home Naloxone across the world so that opioid users, carers and families have it ready if or when they need it, to save lives.
We must challenge the stigma around tackling overdose and addictions which often stand in the way of reachable progress, and it will be through better science, accompanied by more effective advocacy and clinical leadership that we harness our ability to have a real effective impact on deaths from opioid overdose– Professor Sir John Strang
Naloxone is a well-established emergency medicine which blocks receptors in the brain to rapidly reverse overdose. It is the antidote which ambulance and A&E staff routinely administer. Although a potentially life-saving treatment, the problem is that overdoses of heroin/opioids usually happen in settings where medical staff are absent.
King’s researchers overcame this challenge by pioneering the concept of pre-providing naloxone to the general public, known as Take-Home Naloxone (THN) so that, whenever and wherever overdose occurs, it can be rapidly reversed, and the life saved.
This approach itself came with its own inherent challenge in terms of complex and value-laden barriers to using naloxone and giving it to people with opioid addictions. Building on this, King’s researchers have worked constantly to ensure THN is both distributed and used successfully, creating training approaches to implement THN and providing evidence and advice to policy-makers to increase awareness of recommendations on THN.
Just knowing and saving someone’s life, it’s better than any drug in the world, you know, any drug in the world– Participant, Red Cross Community Based First Aid Training
Naloxone without the needle
A real obstacle was that naloxone itself was an injection which created regulatory barriers and generated public concern. Injectable THN kits then started being used with an improvised nasal spray adapter in community and medical settings and King’s researchers demonstrated that this practice risked administering a sub-therapeutic naloxone dose that was potentially insufficient to reverse the effects of an overdose. Together with findings about response to injectable THN, these findings made a strong case for rigorous testing of a new, safer, purpose-made and more acceptable nasal spray delivery method. We now have countries (e.g. Sweden) who, since arrival of naloxone in non-injectable form, are now introducing Take-Home Naloxone.
King’s collaborated with the international company Mundipharma to develop a concentrated nasal naloxone spray suitable for general public use and manufactured for this specific purpose. This involved testing the speed of movement into, through, and out of the body of three formulations of nasal spray doses for which King’s contributed to the design of trials and collaborative research that formed the evidence base for the regulatory approval of the resulting product, Nyxoid, across Europe and Australia.
UK Government approval for THN was confirmed in 2015, with nasal naloxone added in 2019.
Establishing evidence-based training approaches
King’s research established that training people who use opioids (PWUO) in overdose management and naloxone administration improved knowledge and confidence to administer naloxone and those who were trained were later able to mobilise skills, knowledge and competency to administer naloxone.
This evidence of the role training can play in the effective administration of THN has enabled the development of training schemes nationally and internationally. The British Red Cross then developed a training video to support delivery of such training to PWUO, their friends and families.
Influencing policy and increasing dissemination
King’s research and the expertise of our academics have been influential in shaping policy at a local, national and international level to enable the distribution and use of THN. Across England, 95% of local authorities now provide THN.
Based on King’s research, pilot schemes were launched in 2020 to train police officers to administer naloxone in North Wales, Durham and West Midlands.
King’s researchers have also been influential in the development of US policy to address this widespread problem. Naloxone was included in the 2010 US Drug Strategy, which paved the way for a host of subsequent policies widening the availability of THN. Nasal and injectable THN kits are now provided to PWUO in the US, and co-prescribed with opioids for medical treatment. Naloxone prescriptions more than doubled from 270,000 to 576,000 from 2017 to 2018 and in 2019, 94% of Syringe Service Programs in the US implemented overdose education and naloxone distribution compared to 55% in 2013.