Making sure naloxone is in the hands of everyone who needs it, whenever they need it, requires far more than simply handing it out from drug treatment services. DDN reports. Read it in DDN Magazine Despite all the good work that\u2019s been done over the last couple of decades to fight the battle for naloxone and tackle the associated stigma, one key fact remains. As Judith Yates told DDN last month, \u2018You need to have it with you\u2019 (DDN, June, page 15). A commuter reads a copy of a newspaper while waiting on the subway, a pharmacy carries posters in its window, Spanish language adverts on buses. In 2017 New York's Department of Health conducted an advertising campaign urging people to carry Naloxone. Photos: Richard B Levine \/ Alamy Release\u2019s landmark Finding a needle in a haystack report made headlines when it revealed that while all but three of the local authorities who responded to the charity\u2019s FoI request were supplying naloxone, they were doing it in such small quantities that the impact was negligible (DDN, March 2019, page 4). \u2018This life-saving medication is not reaching those who most need it\u2019, Release stated, with the document stressing the need for naloxone to be made easily available to people not in contact with mainstream treatment services, for example via pharmacies or peer networks. In many areas, take-home naloxone was only available \u2018through the main drug treatment provider\u2019, the report found, with a quarter of councils failing to provide kits to people in contact with outreach services for homeless populations, for example. If there was ever any doubt over the need for this, a St Mungos report from last year stated that in 2018 around 12,000 rough sleepers had gone without drug or alcohol treatment \u2013 the same year that recorded a 55 per cent increase in drug deaths among people sleeping rough. It also found that the number of rough sleepers with a drug problem had increased from 50 per cent to 60 per cent in just four years. It's about Harm Reduction \u2018Getting out as much naloxone as possible to people who don\u2019t necessarily engage with standard services is really important,\u2019 says Megan Nash, team leader for WDP\u2019s Redbridge outreach service, where all workers have carried it since the service\u2019s inception. \u2018That\u2019s both because it\u2019s getting a life-saving drug to the people most at risk of drug-related deaths, but it\u2019s also starting a conversation about harm reduction. It allows you to have a short conversation about how to use it and about risk of overdose \u2013 what to look out for and how to prevent it.\u2019 Crucially, it\u2019s also about \u2018giving someone something\u2019, she points out. \u2018I think that can be a really nice engagement tool. It just feels friendlier to give someone a little present, and people can then spread the word.\u2019 This kind of harm reduction approach can be transformative when dealing with people with very complex needs, such as the Redbridge team\u2019s clients. \u2018It\u2019s a way of showing you care about people, and a way of getting them in contact with services, which they may have struggled to engage with in the past as they\u2019re expected to turn up at a specific time, and not intoxicated. I absolutely appreciate that it can be difficult for a lot of mainstream services to manage these kinds of clients, but just having that positive engagement and being told \u201cwe care about you\u201d, that someone genuinely is worried about your safety and whether you live or die, is crucial for us.\u2019 None of her team have ever had to administer naloxone themselves, she says, an illustration of how important it is to \u2018get it distributed \u2013 because a lot of people will be using in hidden places. Often our service users tend to use in groups \u2013 in temporary accommodation and squats and things like that. It\u2019s not as easy to see as an outreach worker, and you can\u2019t be there all the time, so it\u2019s really important that it gets out through people who will be in that situation.\u2019 This kind of peer-to-peer distribution model is vital agrees her colleague Dave Targett, WDP\u2019s operations manager. \u2018We had a massive squat in the city centre in Chester a year or so ago and we kept giving it to people to take in there to give to others \u2013 targeting those high-population areas is really important.\u2019 Inadequate supply Another alarming finding from the Release document was that only half of prisons and one in five young offender institutions were actually providing naloxone to those leaving custody \u2013 this despite the up-to-eightfold increase in risk of a drug-related death the first two weeks after release, as a result of reduced tolerance levels. The amount of take-home naloxone being given out to people on release in 2017-18 was \u2018wholly inadequate\u2019, it said, with kits and training provided to just 12 per cent of opiate clients as they left custody. The report also called for take-home naloxone programmes to be extended to immigration removal centres and policy custody suites. A pioneer when it comes to the latter has been Durham Constabulary, where more than 200 police officers and civilian staff have so far received naloxone training (DDN, May, page 13). Temporary Chief Inspector Jason Meecham The force began having naloxone onsite at its custody suites after a spate of opiate-related overdoses in 2018-19, and it\u2019s now offered on release to anyone over the age of 18 who has a problematic drug issue, has had one in the past, or lives with someone who has one. \u2018It\u2019s no strings attached,\u2019 temporary chief inspector Jason Meecham tells DDN. \u2018They\u2019re offered an opportunity to watch a video on how to assemble a kit but they don\u2019t have to, and we run through a quick checklist of basic first aid stuff. We also provide them with details of local treatment services, but there\u2019s no catch.\u2019 So does everyone who\u2019s offered it accept? \u2018No, they don\u2019t,\u2019 he says, and while the force is looking at ways to drive up acceptance levels they\u2019re also not expecting to be \u2018giving away dozens\u2019 every week. \u2018Some people don\u2019t want one. They\u2019ve either already got a kit \u2013 and we\u2019re more than happy for them to have another \u2013 or it\u2019s not what they want, so we\u2019re working with the county council to try to drive that up. The majority of people we\u2019re in contact with are also in contact with local treatment services, which are very good, so they\u2019ve probably already got access to it. There\u2019s only a limited number of individuals we see in custody who don\u2019t deal with GPs or drug treatment services.\u2019 These, however, are precisely the people who need naloxone the most, and overall provision has \u2018gone fantastically well, as you\u2019d expect from a drug that\u2019s simple, proven and effective,\u2019 he says. \u2018We now have a stock of it in all of our custody suites throughout the county\u2019. If we\u2019re going to create a widespread culture of supplying naloxone in custody suites a key element is effective communication between forces to get it out there, he says. \u2018I\u2019ve got a phone call later this week with another force who are looking to introduce it, and what we also need is more widespread understanding over the legality of it, the guidance, the litigation issues, safety.\u2019 While the force\u2019s frontline staff could see the need for naloxone on the streets and had been asking for it, with some custody staff there had been \u2018a bit of a lack of understanding, which is to be expected. We just had to provide that clarity over the safety, the integrity of it, the efficacy of it, just going over those worries people had about something unknown. But overwhelmingly it was, \u201cWe want this and can we as an organisation make it happen?\u201d For the staff, it\u2019s been overwhelmingly positive.\u2019 One important factor for any other force looking to introduce it is Durham Constabulary\u2019s close working with the public health team at the county council, he says. \u2018Other forces could look at how that relationship is managed. We took a partnership approach and really worked hand-in-hand, and we really learned a lot because they were very familiar with naloxone. At the moment it\u2019s about trying to ensure a continuous supply from the county council, and trying to ensure that when cops see someone in the street possessing it it\u2019s not grounds for a stop-and-search. We have to make sure they know what it is even if they don\u2019t carry it themselves \u2013 raising that level of awareness and confidence.\u2019 But if we\u2019re going to be successful in making sure naloxone is in the hands of everyone who needs it \u2013 whenever they need it \u2013 then people working in the sector need to be the standard bearers, Dave Targett believes. \u2018Ultimately, it starts with us. I was at a drug-related deaths conference a couple of years ago and when someone asked how many people were carrying naloxone only half a dozen or so put their hands up. Those are professionals in the sector who weren\u2019t carrying it. We are the carriers of the message in the first instance, and I think we have to act how we want others to act. You can\u2019t use it if you haven\u2019t got it, and I think the best way to get people to carry it is for us to lead the charge.\u2019 This article has been produced with support from Ethypharm, which has not influenced the content in any way.