Naloxone options and potential impact: Survey of target populations and their attitudes and likely use of nasal versus injectable formulations (Preliminary findings)

First published: 18/06/2019 | Last updated: June 18th, 2019

Ms Sibella Hare Breidahl

I am an Australian medical student from The University of Adelaide, taking a break between my fifth and sixth years of medical school to pursue a Bachelor of Medical Science. I am undertaking the research component of the course at King’s College London, under the supervision of Professor Sir John Strang and Dr Rebecca McDonald. The Naloxone Propensity to Use study will form the major part of my assessment. I am interested in addiction, public health, health communication and in particular the way medicine is represented in the media.

Aims: In 2010, a new UK Drug Strategy ‘Building Recovery: Supporting People to Live a Drug Free Life’ marked a policy shift towards recovery-oriented treatment of opiate dependence after two decades of harm reduction prescribing. We examine trends in opioid substitution treatment (OST) and opioid-related deaths England 2005-2016.

Methods: We used Prescription Cost Analysis (PCA) data on methadone and buprenorphine dispensed nationally in the treatment of substance dependence to estimate total milligrams (mg) per year; and Office for National Statistics (ONS) annual data on drug poisoning deaths registered in England where any opiates/opioids were mentioned in the death certificate. We calculated an index of the number of opioid-related deaths per million defined daily doses (DDD) of OST per year (DDD 60mg for methadone and 8mg for buprenorphine ±naloxone). A lower index score indicates fewer deaths relative to OST DDDs.

Results:  OST prescribing (DDDs) plateaued initially post-shift (4%, 2008-2010 to 2011-2013) and decreased in the second epoch post shift ( -19%, 2011-2013 to 2014-2016). Opioid-related deaths decreased initially post shift ( -9% in 2008-2010 to 2011-2013) and then increased in the second epoch post shift (37%, 2011-2013 to 2014-2016). Opioid-related deaths per million OST DDDs plateaued initially post-shift (-6%, 2008-2010 to 2011-2013) and increased substantively from the first to second epoch post-shift (63%, 2011-2013 to 2013-2016).

Conclusions: Post-policy shift changes to drug treatment commissioning practices and provision are likely to have contributed to reductions in OST coverage and quality of prescribing, and increased mortality risk in the opioid-using population in England.

Co-Authors

Dr Jo Kimber PhD National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience (IoPPN) King ‘s College London Addictions Sciences Building 4 Windsor Walk, London SE5 8BB


Conflicts of interest:

John Strang (JS) is a clinician and researcher and has worked extensively with agencies in the addiction treatment fields and addiction-related charities and with government departments and has contributed to clinical guidelines on treatment types and provision. JS’s employer (King’s College London) has received, connected to his work, project grant support and/or honoraria and/or consultancy payments from Department of Health, NTA (National Treatment Agency), PHE (Public Health England), Home Office, NICE (National Institute for Health and Clinical Excellence), and EMCDDA (European Monitoring Centre for Drugs and Drug Addiction) as well as research grants from (last 3 years) NIHR (National Institute on Health Research), MRC (Medical Research Council) and Pilgrim Trust. He has also worked with WHO (World Health Organization), UNODC (United Nations Office on Drugs and Crime), EMCDDA, FDA (US Food and Drug Administration) and NIDA (US National Institute on Drug Abuse) and also other international government agencies. JS’s employer (King’s College London) has also received, connected to his work, research grant support and/or payment of honoraria, consultancy payments and expenses from pharmaceutical companies (including, past 3 years, Martindale, Indivior, MundiPharma, Braeburn/Camurus) and trial medication supply from iGen and Braeburn. JS’s employer (King’s College London) has registered intellectual property on an innovative buccal naloxone with which JS is involved, and JS has been named in a patent registration by a Pharma company as inventor of a potential concentrated naloxone nasal spray. For updated information see: http://www.kcl.ac.uk/ioppn/depts/addictions/people/hod.aspx.

This survey was conducted with funding support from Mundipharma International.

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Ms Sibella Hare Breidahl