The Use of Naloxone

Neasa at the Committee on Drug Use with the Irish Pharmacy Union and the Irish College of General Practitioners discussing 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 will focus on naloxone and access to that. I appreciate that it has been touched on but I want to do a deep dive. We have high levels of injury and death due to the use of drugs in this country, and other countries have started to look at the regulation of naloxone. If I have not taken any drugs and I take a shot of naloxone, what will happen to me?

Dr. Denis O’Driscoll: Essentially nothing. It is an extremely safe compound. There are two types of products, injectable and nasal. The nasal product is reimbursed by the primary care reimbursement scheme, PCRS, on the opioid substitution prescription, so it can be got in that way—–

Deputy Neasa Hourigan: If I picked up the drug off the ground, did not know what it was and snorted it, would nothing happen?

Dr. Des Crowley: A good way to explain it is that there are opioid agonists and opioid antagonists. An agonist does something active, such as heroin—–

Deputy Neasa Hourigan: What about suboxone?

Dr. Des Crowley: Suboxone is a partial agonist but it has an effect on the user in that it is a psychoactive substance. Naloxone is an antagonist, that is, it does nothing, except in the place where you have taken it. It takes that area off the receptor in the brain and the effect of the agonist is totally gone, while the antagonist remains on the receptor in the brain.

Dr. Denis O’Driscoll: Temporarily.

Deputy Neasa Hourigan: Is it fair to say access to that type of treatment is very important when there has been an overdose or the consuming of drugs whose effects you want to cease?

Dr. Denis O’Driscoll: I should declare that I am the independent chair of the naloxone advisory group for the HSE. From my perspective, the answer is “Yes”. Availability has increased significantly in recent times with regard to some of the changes we have brought in regarding how people are trained and access training and how community groups can now register with the Health Products Regulatory Authority, HPRA—–

Deputy Neasa Hourigan: I apologise for interrupting, but my understanding from having spoken recently to a GP is that if I work in the drugs sector as, say, a youth worker, or if I know somebody who I think might go into overdose, I need to go to a GP and get a prescription for that person. If I then meet someone who is in the middle of an overdose and give him or her naloxone, I then have to go back to the GP to explain myself and get another prescription. That does not lend itself to emergencies, considering that it is a drug that has no impact on somebody who takes it for no reason.

Dr. Denis O’Driscoll: 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.

Deputy Neasa Hourigan: Where are we with that?

Dr. Denis O’Driscoll: I understand that one of the companies is going through a process within the EU to see whether it can remove it from prescription status such persons will be able to access the product themselves without needing a prescription.

Deputy Neasa Hourigan: Is it Dr. O’Driscoll’s position that the hold-up is because of the EU complication?

Dr. Denis O’Driscoll: No, the hold-up relates to drug legislation, that is, medicines legislation, both domestic and EU.

Deputy Neasa Hourigan: Other countries, such as France, have started to be more lax—–

Dr. Denis O’Driscoll: Correct. In England, for example, prior to the UK’s departure from the EU, it introduced a measure whereby persons could walk into a pharmacy and get the drug without a prescription. Anyone could access it that way. Ideally, that is the way the product would be able to be accessed, but there is a stepwise process. This is beyond my scope but it is within the territory of the Irish Medicines Board, the HPRA and the organisations that have the product licence on the market because they have to go through a stepwise certain process to have that happen.

Deputy Neasa Hourigan: All the witnesses will have seen the roll-out of defibrillators in this country over the past five years. It is totally new, and my partner is somebody who might need a defibrillator. It has been very interesting to see the roll-out of this expensive technology, which is now accessible on the roadside. Why are we not pursuing a defibrillator-style approach to naloxone? I represent Dublin 1 and we need it there.

Dr. Denis O’Driscoll: I will counter that by saying that that, definitively, is the way I would want it, as independent chair of the naloxone advisory group—–

Deputy Neasa Hourigan: People should be able to walk up to a machine in the street and access it.

Dr. Denis O’Driscoll: Yes.

Dr. Des Crowley: In the context of Dublin 1, there is the peer group UISCE, which works alongside our HSE clinics, where it trains patients and distributes naloxone to them, so they get some for themselves. A really—-

Deputy Neasa Hourigan: If I am a patient’s family member, however, I need to sign something saying I am a drug user and I cannot have the drug in my back pocket to give to them. Is that correct?

Dr. Des Crowley: That is the next point. The professional would need to look at the risk to his or her patients to see in which context they are using and in which context he or she would need to provide the training, most likely to a family member, because the drug-related deaths are telling here. Approximately 70% of drug-related deaths are opioid based, which is where naloxone is very effective, and only four out of ten die alone, so there tends to be somebody present in the house or wherever.

Deputy Neasa Hourigan: That person will probably try to save them.

Dr. Des Crowley: For the other 60%, that is potentially the case.

Deputy Neasa Hourigan: It seems to be a lot of jiggery-pokery and running around the place, whereas if we just deregulated it, it would take away a lot of that.

Dr. Bernard Kenny: At the ICGP, we fully recognise the excellent safety profile of naloxone, so we would be very supportive of any—–

Deputy Neasa Hourigan: Deregulation?

Dr. Bernard Kenny: No, removing prescription requirements. We see it as a very safe medication, much safer than many medicines that are available to buy in a pharmacy, for example, so we would see removing the prescription requirements for naloxone as a good thing, and promoting the dispersion and availability of naloxone would be a priority for us.

Deputy Neasa Hourigan: I am under the impression that in the case of nitazenes now, for example, they are so strong that not just one nasal spray but three or four are needed to save somebody’s life. Are the representative groups putting pressure on the Department of Health to deregulate naloxone or make it prescription free?

Dr. Bernard Kenny: As part of my role in the ICGP, I liaise with the HSE naloxone leads. We would push for that but I guess—–

Deputy Neasa Hourigan: To me, and I do not mean this in a pejorative way, that is upholding a system that is incorrect. From an outside point of view, is there engagement to say working around a bad law is fine for now but that the law should be changed? From an outside point of view, is their engagement indicating that working around a bad law is fine for now but the law should be changed?

Dr. Denis O’Driscoll: Speaking as the chair of the naloxone advisory group, I can say pressure is being put on the Department of Health to consider changing that legislation to allow this product to be available without prescription.