Prison-based Naloxone-on-release RCT to reduce drugs-related deaths

Opiate overdose has become one of the main causes of death for young people and early adults. More than three-quarters of overdoses are accidental (associated with errors in the calculation of the dose, or lack of tolerance to the drug effect after a period of abstinence), and are not associated with suicidal intent. Most overdoses occur the user s own, or a friend?s home in the company of friends and peers, and involve heroin or other opiates. Consequently, many deaths could potentially be prevented by appropriate management of overdose by peers or family, who could administer a life saving emergency intramuscular injection of Naloxone whilst awaiting the arrival of emergency medical services. Naloxone is a total antidote to opiate overdose. Most opiate overdoses take place away from healthcare settings, especially in private dwellings or among the homeless. This makes fast and effective treatment somewhat problematic. The overdose must be identified, an ambulance must be called, the ambulance must find the location, and only then will the patient be treated with naloxone. Furthermore, the location of the overdose victim may be hard to find or difficult to access. Ambulance crews may also be reluctant to enter some of these areas without police support. These and other factors can contribute to further delay in the provision of vital treatment. Delay in emergency treatment contributes to the high mortality of opiate addicts due to accidental overdose. Antidote injection of Naloxone is now routinely carried in ambulances. The proposed trial involves the next step in the transfer of this technology: placement of emergency Naloxone in the hands of the potential drug user so that if they do overdose there is an opportunity for friends or family to prevent their death between when an ambulance is called and its arrival.

Heroin-related deaths account for around 8% of all UK deaths in individuals aged 15 to 44. For UK prisoners, the risk of a drugs-related death is 7.5 times higher in the first fortnight after their release than at comparable other times at liberty.

More than three-quarters of overdoses are accidental (associated with errors in the calculation of the dose, or lack of tolerance to the drug effect, or binge use, after a period of abstinence), and are not associated with suicidal intent. Most overdoses occur in domestic situations (their own, or a friend?s, home), in the company of family, friends and peers, and involve injection of heroin or other opiates. Consequently, many deaths could potentially be prevented by prompt, competent management of overdose by peers or family, who could administer a life saving emergency intramuscular injection of the opiate antagonist Naloxone (the rapid-acting complete antidote to the effects of heroin and other opiates) whilst awaiting the arrival of emergency medical services. Users? and carers? willingness to intervene has been amply demonstrated.

Following the inadvertent injection of a heroin overdose, quick access to treatment is vital if death is to be avoided. However, this presents a problem. Most opiate overdoses take place away from healthcare settings, especially in private dwellings or among the homeless. The overdose must be identified, an ambulance called, the ambulance must find the location, and only then will the victim be treated and receive Naloxone. Furthermore, the location of the overdose victim may be hard to find or difficult to access. Delay in emergency treatment contributes to the high mortality of opiate addicts due to accidental overdose.

Antidote injection of Naloxone is now routinely carried in ambulances. This proposal involves the next step in the transfer of this familiar technology: placement of emergency Naloxone in the hands of the heroin user so that if they do overdose there is an opportunity for friends or family to prevent their death between when an ambulance is called and its arrival. We propose a randomised pilot trial. The N-ALIVE pilot will provide information on: (i) what happens to the Naloxone and the ex-prisoner once they leave prison; (ii) whether all the important practical arrangements for the trial will work, and (iii) whether the prisons and prisoners will come on board, and in the numbers needed.