Supply and demand

Naloxone supply can still be something of a postcode lottery, particularly outside of urban centres. Elli-Jay McNally describes how Lincolnshire Recovery Partnership has teamed-up with Co-op pharmacies to boost local access.

Dee is a harm reduction peer champion at Lincolnshire Recovery Partnership. Not long ago, however, her life looked quite different. ‘I wouldn’t be sat here today if it wasn’t for naloxone,’ says Dee. ‘I was using heroin on a regular basis. Someone came round with some stuff and said it was really strong. Me being me, I thought I was clever and could handle the dose but as soon as I took it, I was on the floor. It was so quick. Next thing I knew, my friend was on top of me administering naloxone.’

Dee lost her brother to a heroin overdose prior to this. For these reasons, being an advocate for naloxone carriage is really important to Dee and her family. ‘Unfortunately, naloxone wasn’t about as much back then, so we didn’t know much about it,’ she says. ‘I know naloxone saves lives, and it needs to be shouted about from the rooftops.

People should carry it all the time. It’s so important that people are educated on it. You’ll be surprised how many people don’t know about it – it doesn’t matter if you don’t know someone personally who uses drugs, you could see anyone on the street who might need it at any time, and you could save their life.’

In England, anyone can carry a naloxone kit and use it in an emergency to save a life. It’s available from drug treatment providers and from some pharmacies, but accessing these locations is not always possible or easy, especially in rural areas such as Lincolnshire.

Lincolnshire Recovery Partnership, which is delivered on behalf of Turning Point in partnership with Double Impact and Framework, has been working to increase access to naloxone across the county. Their latest initiative has seen them partner up with, and supply, 36 Co-op pharmacies in Lincolnshire with naloxone kits that will be available for free to local residents. 

In a real collaborative effort, colleagues from Lincolnshire Recovery Partnership trained Co-op pharmacy staff how to administer naloxone through a combination of online and in-person sessions at Lincolnshire Co-op’s headquarters and Co-op funeral homes across the county. The training sessions were based on research from the University of Bristol, conducted in partnership with colleagues and service users from Turning Point Somerset. 

The original project saw a co-designed naloxone campaign and pharmacy training interventions to encourage people to carry naloxone. The sessions covered what naloxone is, how it works, signs of – and risk factors for – opioid overdose, how to use a kit to save a life, and how to effectively supply a naloxone kit in the community.

Between January and April, more than 100 colleagues at Lincolnshire Co-op were trained on how to supply naloxone in the community and how to use it in an emergency to save a life.

The pharmacy teams were passionate about supplying naloxone in their stores, with many reflecting that they see people who use drugs every day and are able to form trusting relationships with them and their families – making it easier for them to supply naloxone.

Each pharmacy has been provided with a poster to advise that they now provide naloxone and education around overdose awareness, alongside window stickers so people know they can get naloxone from their local store.

The harm reduction lead at Lincolnshire Recovery Partnership will be checking in with the pharmacies regularly to offer training, support and encouragement around naloxone supply. Lincolnshire Co-op also have plans to provide naloxone in their remaining pharmacies at a later date with the support of Lincolnshire Recovery Partnership.

‘By introducing this service, we’re making a potentially life-saving intervention more accessible to people at risk of opiate-related overdoses, as well as their families, friends and carers,’ says Josh Pinder, Lincolnshire Co-op’s healthcare development manager. ‘Our friendly colleagues have close relationships with patients and are able to give them the support they need without fear of judgement.

Pharmacies are uniquely positioned to provide timely support, advice and access to naloxone, helping to reduce preventable deaths and strengthen our commitment to improving health and wellbeing in our local communities.’

The need for increased availability of naloxone comes at a crucial time, with the Home Office saying it expects an increase in drug-related deaths in the coming years because of synthetic opioids like nitazenes.

A King’s College London report from earlier this year estimated that the number of deaths related to nitazenes have ‘likely been underestimated by up to a third’, as they are highly unstable and can degrade rapidly in post-mortem blood samples.

Alongside efforts to increase access to naloxone and reduce drug-related deaths in the county, Lincolnshire Recovery Partnership has trained almost a quarter of all Lincolnshire police officers on how to administer naloxone to help tackle the rise in synthetic opioids. However, in a government consultation on accessing naloxone, some respondents cited the stigma of carrying and using naloxone as a barrier to it being used.

Nathan is a criminal justice recovery Worker at Lincolnshire Recovery Partnership who supports the service to train other agencies on how to use naloxone – he’s also a part of the integrated offender management team based at Lincoln police station, working as drug and alcohol recovery worker. He’s passionate about tackling the stigma of carrying naloxone, having experienced first-hand the lifesaving impact of the medication. 

‘In my first week of being on the integrated offender management team, a colleague and I were in the city centre when we came across a person who was unresponsive,’ he says. ‘My colleague immediately jumped on his police radio to request an ambulance. My naloxone training kicked in and having checked it was safe to do so, I gave the unresponsive person one shot of naloxone into his left thigh.

After checking his pulse and seeing no reaction to the naloxone, I then administered a second shot, and this time he responded straight away. My heart was beating so fast as the adrenaline rushed through my body, but I was so glad it had worked and I’d done everything I could to help him. The ambulance arrived and the person thanked me for my actions. By this time the adrenaline was wearing off, and it hit me that I’d just saved someone’s life.’

He’s administered naloxone six times over the last six years, he continues. ‘I’m very proud to carry it. The importance of carrying naloxone is simple; you never know when you’re going to need it, and it’s so easy to use and you can save a life.’

With the rise in synthetic opioids and drug-related deaths, it’s vital that the government expands the number of places providing naloxone to include venues such as hostels, day centres and outreach services.

 The increase in accessibility locally has led to more people carrying naloxone and potentiality saving lives, with Lincolnshire Recovery Partnership already delivering 48 supplies of naloxone to Co-op pharmacies.

Naloxone works. Dee is still here today, educating others about overdose awareness, because someone used naloxone to save her life. Pharmacy teams are trusted, accessible, and well placed to put this life-saving intervention into the hands of people at risk of overdose, their families, friends, and communities. 

 By embracing naloxone supply, pharmacies can become a crucial part of the UK’s overdose prevention response. If your local pharmacies are not yet supplying naloxone, now is the time to explore how you can support overdose prevention in your community. A simple conversation and a naloxone kit could save a life.

Elli-Jay McNally is national harm reduction lead at Turning Point