Wed, Oct 30, 2024
Read in 10 minutes
Neasa discussing combating the risk of injury and death due to opioid drug use; with particular reference to Naloxone, a prescription medication used to temporarily reverse the effects of opioid drugs for example heroin, morphine, codeine, methadone and synthetic opioids.
Transcript:
Deputy Neasa Hourigan: I know from our work on the health committee with the Minister of State, Deputy Burke, that he is well aware of the urgent crisis we have with drug deaths in this country. We have very high levels of injury due to the use of illicit drugs.
One of the tools in combating risk of death and injury is to use drugs such as naloxone to stabilise someone during a usage crisis or an overdose. Ireland currently regulates naloxone in a way that makes it practically very difficult for users, service providers and clinical staff to access. Other countries have started to look at the regulation of naloxone. Given that Ireland has some of the highest levels of drug deaths in the European Union, we should very much be leading the way here.
Naloxone is a medicine which rapidly reverses an opioid overdose. It is an opioid antagonist, which means it attaches itself to opioid receptors and reverses and blocks the effects of other opioids. That essentially means it has no opioid effect in and of itself. Somebody who has not taken an opioid could pick it up off the ground, find it and take it, and it would have absolutely no effect on them. For a person in addiction who is experiencing overdose, naloxone can quickly restore normal breathing if their breathing has slowed or stopped because of that overdose. Again, naloxone has no effect on someone who does not have opioids in their system. It is not a treatment for opioid use disorder and has no street value, but it can be used in overdose crises including heroin, fentanyl, oxycontin, hydrocodone, codeine and morphine. Naloxone can be given to any person who shows a sign of an opioid overdose, or even when an overdose is suspected. In Ireland, it is often given as a nasal spray. In cases of nitazenes, which are the new danger and the things we all fear, it increasingly seems that we need three to four doses of naloxone to combat an overdose. One can therefore understand how strong nitazenes are in that case. Often, people simply cannot access the drug in time.
At the Committee on Drugs Use in September, the huge importance of naloxone was discussed with the Irish Pharmacy Union and the Irish College of General Practitioners, ICGP. Both organisations were clear in their support for reviewing access to naloxone. I want to be careful not to miscategorise anything they say on the issue so I will quote what they said. The ICGP said:
At the ICGP, we fully recognise the excellent safety profile of naloxone, so we would be very supportive of removing prescription requirements.
When I asked a representative of the Irish Pharmacy Union if access to naloxone was an issue, he replied:
Correct, and that is where we would have to go back to our Irish Medicines Board, IMB, laws with regard to making the drug no longer require a prescription.
When I put it to him that we have undertaken to install defibrillators across the country - one can access them with a code on the street - he engaged with the suggestion as the kind of level of access we want.
Prior to the UK’s departure from the EU and while it was still within the European Union, England introduced a measure whereby people could walk into any pharmacy and get the drug without a prescription. Anyone could access it that way. Ideally, that is the way the product would be accessed. One would not require a prescription. Any family member, friend of somebody who is living in addiction or person working in drug services could access naloxone. I am aware that this is not just a domestic issue with regard to legislation but is also an EU issue. We would very much like to see Ireland leading the way here.
Yesterday, the Committee on Drugs Use published its interim report and it was very strong on the issue of naloxone. The Minister of State knows that the report is very much based upon the personal experience of drugs from the actual user’s viewpoint. This is absolutely about saving lives. The change in the law is very small here but I would very much urge the Minister of State and the Department to act now, if possible.
Minister of State, Colm Burke: I thank the Deputy and welcome the opportunity to inform the House on the current position relating to naloxone. A strategic priority in the national drugs strategy is to develop integrated care pathways and harm reduction responses for high-risk drug users, including people who are homeless, offenders, stimulant users, and injecting drug-users, in order to achieve better health outcomes and to reduce drug-induced deaths. The Health Research Board recently reported that 354 drug-induced deaths were recorded in 2021, which was 85 fewer deaths than in 2020 and represented a reduction of 19%. The reason the figures relate to 2021 is that inquests, etc., lead to a two-year delay in getting the figures. Opioids were responsible for seven in ten of these deaths in 2021 and continue to play a major role in drug poisoning deaths. I believe that these tragic deaths could have been prevented.
Reducing the risk of drug overdose requires robust public health responses, such as safer injecting facilities, more treatment services, greater access to naloxone, and better awareness about the risks and consequences of drug use. Getting more people with problematic drug use into treatment is a key step in reducing the risk of drug overdose. We are hoping to have a supervised injecting facility opened by mid-December in Merchants Quay Ireland in Dublin. The Department of Health is providing over €160 million per annum on measures to treat problematic drug use. A major component of this funding is to enhance access to and delivery of drug services in the community, through HSE addiction services, drug and alcohol task forces and community-based service providers. As a result of this additional investment, the number of cases entering drug treatment has greatly increased in recent years. In 2023, there were 13,104 cases in treatment, a 50% increase from 2017.
Naloxone is a prescription-only medication that is used as an antidote to temporarily reverse the effects of opioid drugs like heroin, morphine, methadone and synthetic opioids if someone overdoses. The Department of Health works closely with the HSE National Naloxone Oversight Quality Assurance Group to increase awareness and accessibility of naloxone. It is important that naloxone is accessible to support workers, peers and family members. I acknowledge the group’s work and assure it of my continued support. The introduction of the Medicinal Products (Prescription and Control of Supply) (Amendment) (No. 3) Regulation, SI 238 of 2023, in May 2023 allowed the HSE to approve courses for persons who may supply and administer naloxone in an emergency. In 2023, over 2,000 people participated in overdose awareness and naloxone administration training. Over 6,500 units of naloxone were supplied by the HSE to services in 2023 and already over 4,000 units had been supplied by the end of July this year. Pharmacists who have undertaken appropriate training can already administer naloxone for opioid overdoses. The HSE and the pharmacy regulator have recently taken steps to make the training more accessible for pharmacists. I am committed to expanding the naloxone programme to further mitigate the risk of drug overdose deaths linked with opioid use.
I will conclude by making a point about the figures the Deputy is referring to at European level. The figures we should very much be comparing with are in Scotland because it has the same system for accumulating and gathering the information. In Germany, for example, not all of the information is gathered and there is a view that only about one third of the cases are actually reported.
Deputy Neasa Hourigan: I thank the Minister of State for some of those facts and figures. I recognise that there has been a move by the Department to increase the access to naloxone. I would like to give the Minister of State an example of what it is like for service workers on the ground at the moment and how bizarre the current situation actually is. We have made naloxone available to workers. If I work in the drugs sector as a youth worker or in Merchants Quay Ireland, and if I know somebody who I think might go into overdose imminently and who is at a level of addiction where I believe that they have gone into overdose or will do so, I need to go to a GP and get a prescription for that person. If I then meet someone else who is in the middle of an overdose on the street in my work as a drug service worker, and decide to save their life by giving them naloxone, I must go back to the GP get a prescription for that, and get a new prescription for the other person who was to be the recipient of the original prescription.
Family members cannot get access to it at all. A person living with someone who is in addiction is desperately trying to keep their loved one alive but they cannot really access it. They can sign something to say that they - the family member - take drugs and therefore should get naloxone but they cannot access it on behalf of somebody else. This system does not lend itself to emergencies. Considering that it is a drug which has no impact on individuals who have not taken opioids, who might take it for no reason, and has effectively no street value, and all of the medical experts in the area and the service workers are telling us that they need freer access to naloxone, it should be prescription free. It seems like we should be the ones moving, as a Government, towards making that a reality. Approximately 70% of drug-related deaths are due to opioids. That is where naloxone is most effective. In general, research tells us that only four out of ten people who are experiencing overdose, die alone. That means that for six out of ten people somebody was there who could have saved their lives. We should be doing everything we can to stop drug deaths and naloxone is part of that.
Minister of State, Colm Burke: More than 2,000 people participated in overdose awareness and naloxone administration training in 2023. The work is ongoing in relation to having more people trained in its administration. Regarding availability, more than 6,000 units were given out last year, with 4,000 units distributed by July of this year. It is available where we believe there is a need for it. The international overdose awareness day on 30 August provided an opportunity to remember those who have died of drug overdoses and raise awareness of stigma and preventative measures. I acknowledge the grief felt by families on the death of a loved one due to drug poisoning and I welcome the reduction in the number of drug-induced deaths. I acknowledge the contribution of drugs' services to this outcome.
To reduce harm and prevent overdoses we need to encourage people to get medical help if they feel unwell or suicidal after using drugs and not to hesitate or delay because of stigma and fear. It is also important that services are available locally when needed. I am pleased that more than €4.2 million in additional funding has been secured in budget 2025 for new drug initiatives. This includes €4 million for harm reduction initiatives, including a rapid response to the threat of synthetic opioids, a waste water drugs' surveillance programme and extended opening hours for the supervised injecting facility in Dublin city centre. In order to continue to reduce deaths from overdoses, I am committed to ensuring that naloxone is accessible to services, families, emergency services and An Garda Síochána. It is important to understand that the Department and the HSE want to do everything possible to make naloxone available where there is a likelihood of a person overdosing. The Deputy raised the issue of the number of people who have died alone. The number is still extremely high, where no one can get access to them and this is something we need to work on, to ensure that people can get access to services in a timely manner.