Scottish government adviser: naloxone ‘didn’t make a difference’

Computer science was a pioneering intervention once hailed as a potential game-changer in reducing opioid overdose deaths.

But in the more than 10 years since Scotland became the first country in the world to fund take-home naloxone kits as public health policy, deaths from drug abuse – mainly involving heroin, morphine and methadone – took a direction: upwards.

So what happened?

In 2011, Scotland’s then Community Safety Minister Fergus Ewing oversaw the introduction of the naloxone release scheme.

Prisoners were initially targeted with naloxone when Scotland began funding the drug for public health purposes in 2011

The drug had been used for decades in clinical settings, but the goal was to reduce the number of deaths among inmates with a history of heroin use in the high-risk period immediately after release from prison.

“The problem then was sudden deaths after police custody,” said Roy Robertson, professor of addiction medicine at the University of Edinburgh, who was chair of the Scottish National Forum on Drug-Related Deaths at the time. where the naloxone initiative has been implemented.

“People were coming out of jail and dying within days because they had lost their tolerance – they walked out, took their usual dose and died.”

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Used in time, naloxone can reverse the effects of a life-threatening opioid overdose by stimulating the addict’s breathing until emergency services arrive.

Between 2011 and 2013, approximately 12,000 naloxone kits were distributed to inmates on release.

Researchers compare before and after results found that it reduced the proportion of opioid-related deaths by about 36% in the four weeks after detention, saving about 42 lives.

“It was a real success story for naloxone, but as always with these things it was seen as a panacea,” Prof Robertson said.

Since then, naloxone has been piloted by police and ambulance services, and increasingly made available by pharmacies, GPs, mobile clinics and shelters for those at risk of overdose, as well as their friends and family.

HeraldScotland: THN = take home naloxone (Source: Public Health Scotland)THN = take-home naloxone (Source: Public Health Scotland)

Between April 2011 and March 2021, over 94,000 publicly funded kits were provided in Scotland, steadily increasing from around 2,500 in 2011/12 to over 22,000 in 2020/21.

As of February 2019, naloxone is also available as a nasal spray (where previously it had to be injected), making it much easier to use.

And yet deaths from drug abuse have risen from 527 in 2013 to 1,330 in 2021.

Nevertheless, the development of an even larger naloxone network was among the main recommendations of the Scottish Drug Deaths Taskforce report published last week.

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Professor Robertson, who now chairs the Scottish Government’s Drug Harm Advisory Group, is skeptical.

“We had high hopes for naloxone, but I don’t think we can assume the more you put in the better.

“The evidence is that it didn’t make a difference. Deaths went up.

“The current program where naloxone appears everywhere – on TV, on buses, basically telling people ‘we could all save a life’ – is a poor use of resources.

“You put a lot of naloxone for very little result.

“Most of it is wasted and eventually remains obsolete, it gets lost and not used at all.

“To fix this major problem, this is not the answer.”

HeraldScotland: The difference in drug-related death rates between the most and least deprived Scots has risen from four times in 2001 to five times in 2013 and 15 times by 2021The difference in drug-related death rates between the most and least deprived Scots has risen from four times in 2001 to five times in 2013 and 15 times by 2021

A drug addict in Glasgow was reportedly resuscitated nine times last year by homeless charity volunteers equipped with naloxone, raising fears the drug could become as much a “sticky bandage” as a lifeline.

It can also leave users feeling “stretched and rotten”, prompting them to seek a new solution, while doing nothing to address the poverty, hopelessness and trauma that underlies so much drug addiction.

The real figure that stands out is not the 1% drop in deaths; it is the widening chasm of inequality in deaths from drug abuse over the past decade.

In 2013, the poorest Scots were 12 times more likely to suffer a fatal overdose than the wealthiest. In 2019, the difference was almost 20 times greater.