Broadening the reach

We need to prioritise naloxone supply in high-risk settings if we’re going to properly tackle drug-related deaths, says Mohammed Fessal.

Read it in DDN Magazine

Mohammed Fessal is chief pharmacist at Change Grow Live

The continued increase in the rate of drug-related deaths in England, Wales and Scotland is a tragedy, not only for those individuals and families directly affected, but for the UK as a whole. Proactive responses are vital, and naloxone supply must be a crucial priority in efforts to reduce the death rate. At Change Grow Live, a key focus in our harm reduction work over the last five years has been increasing the availability of naloxone to those within structured treatment, as well as their family, friends, and wider network.

Naloxone penetration has accelerated since the onset of the pandemic – between 19 March and 21 July 2020, we reached an additional 7,418 service users, meaning 70 per cent of our opioid caseload was in possession of a naloxone kit and efforts to expand our reach are ongoing. Our priorities for national naloxone supply are set out in our new Naloxone strategy for 2021, and a key focus is reaching people who are not in structured treatment and are therefore at most risk.

The strategy identifies the need to prioritise naloxone supply and awareness in hospitals, prisons, homeless hostels/shelters, as well as within ambulance services and across regional police forces. Homeless hostels and pharmacies remain key allies in ensuring naloxone penetration within communities, and pharmacies also play a central role. Since 2015, 19 per cent of the 3,768 kits that Change Grow Live has supplied to pharmacies have been used in an overdose situation, compared with 4 per cent of kits supplied to services and wider settings.

As part of efforts to reach high-risk groups, Change Grow Live has been running the first ever naloxone project within approved premises (APs). Formerly known as bail or probation premises, APs house high-risk individuals who have left prison. There are 101 APs in the UK, providing over 2,000 bed spaces, and more than half of deaths in APs are drug-related.

This project has resulted in the successful distribution of naloxone across over 40 per cent of the national network of APs and gives us confidence that, with the support of the relevant stakeholders, current gaps in provision can be rectified rapidly. Change Grow Live has worked closely with the National Probation Service to develop a comprehensive online training module, and this has now been rolled out across the 42 APs where we provide substance misuse services.

This training module provides clear, evidence-based guidance, empowering staff to know when to use naloxone and to have the confidence to act fast. Feedback from staff shows beyond doubt that effective training, not just supply, is an essential component of successful implementation – staff want to help keep people safe, but the idea of administering a drug in a crisis situation raises multiple questions and concerns.

Since the project started naloxone has already been administered to reverse two potentially fatal overdose cases and the National Probation Service is now planning the roll-out of training and naloxone supply to the remainder of the AP estate. We are supporting this roll-out wherever possible, through the sharing of training resources and best practice, and the training module and approach to distribution is also informing ongoing projects with regional police forces in the West Midlands and Cambridgeshire and a planned national roll-out in settings managed by the Salvation Army.

My hope is that our new naloxone strategy provides a useful guide to where the gaps currently are, but also demonstrates to wider stakeholders working in high-risk settings that naloxone supply is not just possible, but essential. Navigating multiple systems and achieving buy-in from the gatekeepers of those systems is essential, but ultimately our strategy is calling for a joined-up approach founded upon a shared commitment to save lives wherever possible. The more that our sector can demonstrate the immediate benefits of naloxone provision in new settings, the quicker we will be able to fill the current gaps in provision.

Change Grow Live’s 2022 Naloxone strategy is at


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