Rein Oidekevi, Estonia. Serious topic, require strong action, PWID experience most severe health risks, high risk of OD and premature death, lack of action can lead to unacceptable loss of life, important to review drug policy to place stronger emphasis on human rights, naloxone programs can immediately reverse the effect of opioid overdose, national program on OD prevention, substantial decrease from opioid related deaths, drug overdoses are preventable
Aldo Lalo Demoz, UNODC. From UNODC welcome the attention to the issue of opioid overdose, effective prevention and management, OD challenge to health, security, associated with poverty, violence, social exclusion. Prevention and treatment essential from a drug demand strategy, essential to improve public health. CND resolution on preventing drug overdose, develop public health response, naloxone essential. SOS initiative worldwide initiative to prevent opioid OD,
Gilberto Gerra, UNODC. Beginning of an initiative, mobilisation, cannot accept to lose so many lives for opioid overdose, continue with WHO study, country local level mobilisation to provide naloxone, drug response system a reward system not entirely true, scenario of self-destruction, pleasure from risk, 17% of OD were intentional OD (IOD) (Heale et al. 2003), solution is naloxone everywhere available to everyone, open the door to treatment, receiving social support, establishing interpersonal relationships, diagnose and treated for depression.
Vladimir Poznyak, WHO. WHO co-organiser of side-event, thank Estonia for bringing this to the CND, not anymore about heroin overdose, include prescription synthetic opioids, opioid OD change mortality trends in some countries, require public health responses, from neurobiology and neuroscience we effectively understand mechanism of addition, naloxone widely available relatively cheap can effectively resolve OD, one condition, timely administration, guidelines published for naloxone administration, promoting implementation of these guidelines, launching SOS initiative, naloxone is an extremely effective but not a magic bullet, straightforward intervention that should be available everywhere, need to not forget that to address these complex issues need complex responses.
John Strang, King’s College London. Burden of opioid overdose and ability to respond: across the world, in many countries, extremely high prevalence of opioid use, not local or regional issue, more than 80% of OD deaths are related to opiates, USA OD deaths overtaken motor vehicle deaths, 2 different epidemic, long time course epidemic in prescription opioid OD, alongside, more recent in heroin overdose death, 2 overlapping epidemics, heroin dampens respiratory drive, death happens from lack of stimulus, we have the response, naloxone displaces the opiate off the receptor, breathing stimulus returns and breathing is restored, hand out naloxone has to be in context of a wider training in administering naloxone, key steps Ambulance-Breathing-ReCovery position-Naloxone, nasal sprays latest development. UNODC/WHO overdose management: multisite study on opioid OD, 3 countries in central Asia, identify 2 cities and stagger introduction across cities, challenge is to acquire reliable evidence, step wedged analysis, look at whether reduction in OD change as a result of changes in naloxone rather than changes in market, link OD deaths to prison releases,
Maria Skirk, USA. USA in the midst of a prescription and synthetic opioid overdose crisis, driven by heroin and fentanyl, very proud supporters and funders of UNODC/WHO project, support other demand reduction programs, evidence-based prevention based and recovery, using another mapping program, implement training with international organisations (WHO, UNODC, AU), credentialing, demand reduction field is new, credential gives legitimacy and evidence based knowledge, support professional association driven to bring together the worlds demand reduction professionals.
Paul Griffiths, EMCDDA. Overview of harm reduction in Europe, concern about NPS and stimulants, must not forget opioid OD, opioid deaths are increasing, particularly in north of Europe, risk factors are known, synthetic opioids are NPS, effective responses have impact, need to reduce risk behaviour, increase retention treatment, awareness take-home naloxone programmes in 120 countries, range of online resources.
Sigrid Vorobjov, Estonia. Role of fentanyl in drug-related deaths and naloxone program experience, main drug injected are illegally produced fentanyl and amphetamines, most users report non-fatal overdoses, non-fatal OD related to duration of injection, frequency, main drug injected, sharing and problem alcohol use, high number of drug related death needed action, 2013 naloxone program was implemented, there could be some relation to reduction in deaths, but still very preliminary data, 11% of OD witness administered naloxone (2016 data), several misconceptions about OD.
Thomas Clausen, Norway. Norwegian program, part of national overdose program, part of national campaign launched by department of health, you can quit drugs but first you need to survive, have overall aim of treatment, but also provide life saving interventions, part of northern European with high risk situations, OD groups are a diverse group, need diverse response, not one simple solution to this, people in treatment, some outside treatment, some injecting in treatment, some benzo in treatment, some imprisoned, some in residential treatment, heterogeneous group demands a range of interventions, aim at reducing numbers of deaths annually, long term 0-vision of overdoses (not realistic but ideal aim), project is in a range of interventions (Prevention – Treatment – Harm reduction), provide naloxone with training, one-to -one with users but also in groups, call ambulance, check breathing and administer naloxone, empowering interaction for staff and users, hundreds of reported naloxone saves, concerns over risk of re-overdosing, not calling ambulance, refusing further treatment, success factors: integrated as part of a national strategy, started by learning from others, relying on local communities, important government support, funding for users, funding of an ongoing evaluation of the program
Ruth Birgin, INPUD, VNGOC/NYNGOC. Support wholeheartedly, PWUD will avail themselves with these tools, emergency administration of naloxone by users vindicated by evidence, barriers related to price preparation route of administration or scheduling administration must be eliminated, PWUD are the key first responders in OD scenarios, question is why is that it hasn’t happened before, lack of response, working with a stigmatised community is reason for lateness, need to lift our game, INPUD stands ready in advising and to assist.
Harm Reduction Coalition. Forefront of naloxone distribution in the US, overwhelming evidence naloxone works, prescription restrictions, price increase by 600%
- Solutions will be different in different countries, imperative is that naloxone is available at the moment of need, way to do that will vary from country to country, some prices are indeed offensive
- there is a formulation which is very cheap, will prescribe the usage of cheap option, need to negotiate with companies
- Intranasal development interesting, medication needs to be available affordable and a third one.
Question. Usage of naloxone for alcohol overdose?
John Strang. Many variations, opiates are the leading cause of OD deaths, even when taken with other drugs opiates are the main cause, since we started introducing this approach, do not want to wait any longer. Knowledge about emergency intervention, any coma in young should be treated with glucose and naloxone, main causes are hypoglycaemia and opioid overdose. Three target groups, should receive training, those trained will have received emergency naloxone supply, should carry the naloxone with them.