Pre-provision of emergency naloxone: Major achievements but substantial challenges remain

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Professor Sir John Strang

Professor of Addictions & Head of Department

Professor John Strang is a medic and an academic. He is Director of the National Addiction Centre (NAC) and Head of the Addictions Department at King’s College London from where diverse research studies are conducted and educational activity provided. He is Leader of the Addictions Clinical Academic Group of Kings Health Partners AHSC (Academic Health Science Centre). He has also been an addictions psychiatrist for over 30 years, and has led the group at the Maudsley/Institute for many years. Professor Strang has published over 400 scientific papers in the addiction field and has contributed to national and international policy including the chairing of policy-informing committees and expert groups for Department of Health, NICE and Public Health England. He has worked with, and received project grant support and/or honoraria and/or consultancy payments and/or travelling and/or accommodation and/or conference expenses from, a range of governmental and non-governmental organisations and from various pharmaceutical companies concerning identification and study of medicinal products potentially applicable in the treatment of addictions and related problems and has argued for the development of improved formulations. His employer (the university) has registered intellectual property on a novel buccal naloxone formulation with which JS is involved, and JS has been named in a patent registration by a Pharma company as inventor of a concentrated nasal naloxone formulation. For updated information see John Strang’s info on Departmental website at www.kcl.ac.uk/ioppn/depts/addictions/people/hod.aspx


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Nearly 20 years ago, it was first proposed that take-home naloxone should be provided to heroin/opioid users themselves, to their family members and to other carers. In the intervening years, the field has been progressively explored. Influential studies and local early adoption have shaped the development of this initiative, but the full life-saving potential of the approach has not been properly harnessed. In recent years, key milestones there have been pioneering initiatives of large-scale naloxone provision. Recent research studies have strengthened the evidence base, and influential guidance from United Nations, World Health Organisation and for national governments have paved the way for major implementation. However obstacles still exist, such as the reliance on injectable formulations, slowness of the industry to develop non-injectable naloxone, and nervousness and ambivalence from commissioners about this additional harm reduction intervention. Future developments that require serious consideration include proper study of potential non-injectable naloxone (such as potential nasal spray), widespread pre-provision as a public health strategy, and adoption of a policy of presumption of universal provision to relevant patent population.


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