Home Affairs Committee - Drugs: Breaking the CycleWritten evidence submitted by Reckitt Benckiser (DP 074)

1.1 Reckitt Benckiser Pharmaceuticals is a UK company with a long-standing heritage in the research, development and distribution of safe and effective medicines and support programmes for the treatment of patients with opioid dependency.

1.2 We welcome this inquiry into an area of public policy that absolutely must be founded on up-to-date and robust evidence, research and careful bipartisan consideration. We shall limit our evidence in this submission to a specific issue relating to opioid overdose.

1.3 Drug-related deaths mainly result from injecting drug use. Treatment, regulation, education, and research must all play a role in preventing overdose. However, even once a dangerous dose of opioids is consumed, death can still be prevented.

1.4 Opioid overdoses typically take an extended amount of time to become fatal and are often witnessed by others, with evidence suggesting that overdoses occur in the presence of others in 60–70% of cases. Emergency medical help is frequently not sought (for fear of police involvement), or called when it is too late.

1.5 Naloxone, which is the first line treatment used by paramedics and A&E departments, is a highly effective reversal agent for opioid overdose. Since naloxone can be administered intra-muscularly, it is a simple intervention for non-medically trained individuals to use. It has no abuse potential and its only contraindication is allergic reaction, which is rare. Timely injection of naloxone rapidly reverses the respiratory suppression caused by the heroin overdose by blocking the victim’s receptors.

1.6 There is a growing level of support for wider distribution of naloxone packs targeted to help reduce the number of fatalities from opioid overdose. There are also a number of programmes in the UK and worldwide to increase access to “take-home” naloxone.

1.7 Naloxone packs contain a solution of naloxone of varying strengths in the form of pre-filled syringes, Mini-jets, or a Uniject device. These are often referred to as Narcan kits and usually contain 0.4 mg of naloxone. These kits contain a syringe and vial and can be injected anywhere on the body.

1.8 A number of naloxone distribution initiatives are in place across the United Kingdom. The Scottish government rolled out a National Naloxone Programme in October 2010, setting aside £500,000 over the course of two years to fund it.

1.9 The Welsh Assembly supported the introduction of the use of naloxone in Wales. In 2009 demonstration sites were developed across Wales to deliver this initiative. By March 2011, 684 naloxone kits had been distributed with 51 being used to reverse opiate overdose. A total of £55,000 had been set aside to ensure that naloxone training and kits were available across Wales by December 2011.

1.10 In 2009 the NTA initiated and funded 16 pilot programmes at drug treatment services across England,1 in a scheme that ended in 2010. The NTA report in August 2011 concluded that the project “helped save lives”.2 Since the end of the pilots, many local services have been able to continue providing naloxone3 through Patient Group Directions.4

1.11 In the US in 2008, there were 52 peer naloxone programs operating legally in 17 US states.

1.12 In the UK, the N-Alive5 project has received approval from the UK Medical Research Council for a randomised pilot trial in UK prisons. Randomly selected individuals with a history of injecting heroin will be issued with naloxone packs on release from prison. The aim of the study is to establish the number of lives that may be saved with this intervention.

1.13 We understand that the MHRA is actively and sympathetically considering the granting of a license for the use Narcan kits, to be provided on prescription to a greater number of at-risk individuals.

1.14 Changing the prescribing status of naloxone from POM to P would make it, and therefore the naloxone packs, more freely available in the UK. This is a decision that would be made by the MHRA in consultation with the Home Office and with advice from leading experts in this field. Political support for such a decision would clearly also be a pre-requisite.

January 2012

1 http://www.nta.nhs.uk/uploads/25_6_09_life_saving_kits_to_beg_scheme.pdf

2 http://www.nta.nhs.uk/uploads/25_6_09_life_saving_kits_to_beg_scheme.pdf

3 http://www.take-homenaloxone.com/proformaBirmingham.htm

4 http://www.dh.gov.uk/en/Managingyourorganisation/Emergencyplanning/Patientgroupdirec tions/index.htm

5 http://www.iop.kcl.ac.uk/departments/?locator=1114&context=1452 DP 074

Prepared 8th December 2012