Naloxone has not yet become a household name. Here in Ireland, we are only beginning to learn about this potentially life-saving medication, which can easily be administered to someone suffering from a suspected opioid overdose.
It is baffling that this incredible drug is not more widely available, and that awareness of it is not widespread. Could our society’s prejudice against drug users be costing lives?
There is an opioid problem in this country. And the more we understand about these drugs, the better we are placed to help those who are addicted to them. Opioids are chemicals that interact with opioid receptors in the body and brain and reduce feelings of pain by sedating the central nervous system.
Some of the opioids available in Ireland include natural drugs such as codeine and morphine, semi-synthetic drugs such as heroin and synthetic opioids such as fentanyl, methadone and nitazenes. These synthetic opioids can be sold as heroin and described as new or stronger. They are often more potent and can be toxic at minimal doses which can make it easier to overdose accidentally.
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Naloxone works by displacing opioid molecules from receptors in the brain. When an overdose happens, the opioid molecules fit into the brain’s receptors, blocking the signals. This leads to breathing slowing and stopping and the person becoming unconscious. Naloxone has a stronger affinity to the brain’s receptors than opioids. It temporarily knocks the opioids out of the brain’s receptors, meaning the brain signals resume, breathing restarts and the person wakes up from the overdose. If administered in time, someone who is not breathing and completely unresponsive due to an overdose can, within moments, be conscious and breathing normally.
Naloxone will not help if the person has overdosed on drugs other than opioids; it only works to reverse an overdose involving them. However, many other street drugs can contain an opioid and Naloxone will remove any opioid element in an overdose. Naloxone has almost no effect on people who have not taken opioids. And it has no psychoactive properties, intoxicating effects or misuse benefits.
In Ireland, naloxone is available as an injection, Prenoxad, or as Nyxaid, an easy-to-use nasal spray. Some may know it by its brand name in the USA, Narcan.
I recently requested a prescription for naloxone from my GP. Keeping in mind that it has no effect on those who have not taken opioids, I thought it might be a good idea to carry a dose. As a person who is sometimes in environments where recreational drug use occurs (as many people are), I thought it would be a responsible thing to do. As I am not an opioid user, I was refused access to naloxone because I am not at risk of an overdose.
Since that day, several months ago, I have encountered two people in the street who were unresponsive after a suspected overdose. I can’t say with certainty that early access to naloxone by a passerby would improve their chances of survival before the ambulance arrived, but as evidenced by the very nature of the drug, what is the harm in trying?
In Ireland, naloxone is available by prescription but can only be prescribed if a doctor believes the person requesting it is at risk of overdosing on opioids. The person who receives the prescription may ask their doctor for multiple doses and give them to someone who may be nearby while using.
The fear of judgment and stigma surrounding drug use is likely to be a potential barrier which may prevent a drug user from requesting this from their healthcare provider. This taboo could also mean the person at risk is uncomfortable providing those close to them with the medication. Many opioid users do so in private or secretly.
The strict rules around the distribution of naloxone in Ireland are damaging and endanger these individuals. The law states there should be no exclusions from administering naloxone where the risk of opioid overdose is suspected, as failure to administer naloxone may result in the death of an individual. Legislation is in place which allows intervention in an emergency situation for those who have received training. Ideally, I believe this training should be provided nationwide, with naloxone readily available for those who know how to administer it.
The World Health Organisation states that about 45 per cent of drug users experience a non-fatal overdose and about 70 per cent witness a drug overdose (including fatal) during their lifetime. This is something happening all the time – it not only surrounds us, but it is within all of our lives, whether we choose to recognise it or not.
According to the Health Research Board, in 2021, 354 drug poisoning deaths were recorded in Ireland. This equates to seven deaths per 100,000 of the population in that year – 68.9 per cent of these deaths from overdose involved opioids. One in 10 occurred in homeless accommodation, and 7.9 per cent of poisonings occurred in a public place. The median age of the deceased was just 42½ years. About half of the deceased had a recorded history of mental health problems.
Only two in five of the people who died from opioid overdose were alone at the time of the incident leading to death. Most overdoses are witnessed by a friend, family member, partner or staff.
Death from overdose is preventable with basic life support and the timely administration of naloxone. Between 2018 and 2020, it was reported that naloxone was administered to 569 people. Of these, 98 per cent survived the overdose, with nine deaths. Last year, while on a trip to Los Angeles, a city amid an appalling opioid crisis, I was surprised and encouraged to see how widespread the availability of Narcan was there.
In trendy hipster cafes there were boxes beside the tills, with handwritten signs; “FREE Narcan” and drug-test strips along with booklets on harm reduction. Dublin is also a city suffering from an opioid problem. Why do we continue to turn a blind eye?
An amendment to the legislation surrounding Medical Products (Prescription and Control of Supply) Regulations was made by then Fianna Fáil minister for health Stephen Donnelly in 2023. It states that the purpose of these regulations is to provide for the approval of courses by the Health Service Executive for people who may supply and administer naloxone in an emergency. These Regulations also provide for the HSE to prepare and publish clinical-practice guidelines for the supply and administration of naloxone. While it is indeed a great step forward that frontline healthcare workers who are trained in CPR are able to attend training on administering Naloxone, this alone does not go far enough. Why should this training not be available to everyone? Why is naloxone not available over the counter and distributed among communities?
In researching this topic, I haven’t been able to find a satisfactory answer for these questions. Is it simply a matter of the State lagging behind the times? Or is it something worse? We must face the fact that we are far behind where we need to be in terms of harm reduction, and it’s time we addressed the reasons why.
It’s beyond time, as a society, to make real moves towards ending the shame surrounding drug addiction.
A change in mindset could genuinely lead to the saving of lives.
