Moderator: Daniel Wolfe (OSF)

Annette Verster (WHO): We know that of the mortality related to drug use, which is very much linked to opioid use, over a half is related to overdose. It is preventable and reversible. 10% of people dependent on opioid, globally, have access to treatment. In terms of its reversibility, you might have heard of the SOS Initiative, to provide naloxone for close family, friends, relatives, etc. as well as first response authorities. The opioid epidemic is also linked to over-prescription. In general, a treatment provided for acute cancer pain, but in some countries it has been prescribed for chronic pain (ex. back pain). Another initiative is the 90-90-90: 90% of people experiencing dependence have received training on risk and emergency management (ex. CPR). 90% of the trainees should’ve been given naloxone. And 90% of them should carry naloxone. There are different presentations/ROA for naloxone: injected, intranasal; and it doesn’t suppose negative effects.

Katie Stone (HRI): The Global State of Harm Reduction is a biennial publication and the only report of its kind. It tracks antiretroviral therapy, policy & civil society developments, information on harm reduction, MMT/OST coverage. Overdose continues to be a major cause of death among people who inject drugs. Most people who use drugs do not have access to naloxone. Guidelines on naloxone, access and training. Endorsement by the UNGASS Outcome Document. Across the world, both administrative and political hindrances. For instance, limited to health practitioners. Although peer distribution is widely recognised as a valuable channel, it continues to be disregarded in many jurisdictions. 144 fatal overdose deaths every day. Explosion in prescription opioids (North Americans use 80% of the world’s consumption). Parallel development – fentanyl. Worth noting inconsistent reporting. It is believed there’s systematic under-reporting of overdose. Only 6 countries provide naloxone in prison. (…)

Natalie Joannard (France): In 2004, harm reduction policies were officially incorporated in the law with a clear definition of its aims (prevention of transmission of infections related to drug injection, social and psychological damage and negative effects). Our recent law, defines harm reduction as a wide range of actions, including medication delivery, addressing all forms of illicit drug use; and it notably allows for the implementation of safer consumption sites. We have low-threshold services, where syringes are available (as they are in hospitals and pharmacies). There’s a civil society organisation piloting postal delivery of injection kits; an outreach opportunity. Problem drug users (EMCDDA definition) 280thousand in France. 170thousand people receiving OST. WE do not suffer from an epidemic related to opioid use. In fact, France is well below the EU average; although it is probably under-estimated and under-reported. The most recent survey on the matter shows 85% of overdoses are related to opioids. Guidelines from EMCDDA have facilitated put naloxone in the agenda in France. In 2015, it was available in injectable form, for hospital and emergency care settings. It could only be delivered with prescription. The intranasal presentation was introduced in 2016. Health professionals are allowed to deliver it in centres and hospitals, after training. Initial stats suggest 87 health professionals had registered, 10 were active, 51 patients were included and 22 kits were delivered. We aim for naloxone to be available in low-threshold centres.

Judith Yates (IDHDP): Glad to see a public health perspective narrative to start to permeate CND. Naloxone is the only medication in the pharmacopoeia that can save a life in 2 minutes. It has no significant side effects. It will do no harm. We must have champions and advocates inside organisations. Things move slowly but surely in England. What’s the situation in the UK? I became a GP in 1980 just before heroin arrived in Birmingham. I’ve accompanied a whole cohort of opioid users and want to make sure they have naloxone. The incorporation of harm reduction interventions to public health under Thatcher, with the support of policy champions, curbed drug-related deaths. In 2012, we have had a continuous increase of drug-related deaths. Most of these are heroin-related deaths. We do not have as much of an issue with prescription opioids. Public Health England is trying to come to grips with this. Why is this happening? Ageing cohort (co-morbities), economic cuts. In 2005, naloxone was allowed to be used by anybody. England is the only country in the UK that doesn’t have a national programme. 4,000 kits out. 2015, kits can be distributed by trained peers. Everyone leaving prison is given naloxone now. We expect intranasal to be licensed soon.

Jasmine Tyler (OSF): Almost 50,000 deaths in 2013. 137% increase in fatal overdose since 2000. When 7 years ago overdoses increased beyond the deaths related to traffic accidents, we thought we faced a crisis…now it’s even worse. There’s a glaring lack of meaningful attention to this issue.  Overdose death rates surpassed death rates related to AIDS in 1995. The immediate response to prescription opioids crisis was a law enforcement response: clamping down on doctors, re-enforcing regulatory mechanisms. This is a consequence of drug policy. We have known about harm reduction and naloxone for years, and only now we see an increase in funding…and sometimes even that is a political battle. Black and brown communities are disproportionately affected. There’s an overwhelming consensus around the need to act from a public health perspective, which is welcome; but there’s a clear hypocrisy inasmuch as drug-related problems have been responded with a law enforcement strategy until the epidemic emerged into the public opinion as a problem of white communities. We are also particularly concerned about states limiting naloxone distribution to law enforcement authorities, who would imprison victims after resuscitation, waiving Good Samaritan laws. Concerns also about the repeal of the Affordable Care Act, because it facilitated access to treatment. We need take home naloxone for people in the community, expanded MAT (and take HAT seriously), safer consumption spaces, cost fix for naloxone, decriminalise low-lefel offences, expansive Good Samaritan laws, science-based drug eucation.