emergency services arrive. People who overdose, and their friends and family, could be given supplies of naloxone to keep at home and could be trained to give lifesaving interim care. w2 w3Naloxone is already approved for reversing opiate overdoses. About 10% of user distributed naloxone is used for resuscitation-an informal project in Chicago reports 440 "reversals" from 6000 doses distributed (D Bigg, personal communication, 2006), and no fatalities or adverse reactions have yet been reported. The novelty is in the different settings and people giving naxolone. Doctors are the primary group able to prescribe and administer naloxone. But many people who take overdoses die before the doctor arrives. Naloxone is already approved for use by ambulance services, similar to giving thrombolysis and defibrillation for suspected myocardial infarction. Some nurses and pharmacists can now give naloxone, under new "patient group directions" in the UK.w4 Doctors can instruct patients in self administration, as well as instructing family or other carers in emergency care or drug rehabilitation houses. Naloxone can be prescribed to named patients for self administration (this is an orthodox doctor-patient relationship, analogous to prescribing antivenin or emergency adrenaline). However, most opiate misusers are incapacitated by the time they realise they are overdosing. Named patients, with named carer, relative, or friend trained in its administration, can be prescribed naloxone (as with emergency adrenaline for anaphylaxis or glucagon for hypoglycaemia). Prescription to named patients, who themselves train another in assessing overdose and giving naloxone, is also possible, making naloxone more widely available but less controllable for clinicians. All these approaches are already being used within different clinical services in different localities.Within our own clinical services, we currently target two groups, both with a high incidence of overdose: detoxified opiate misusers being discharged back into the community, w5 and patients in the first few weeks of methadone substitution therapy. w6 We also plan to provide naloxone to former opiate misusers being released from prisons, in view of their recognised excess mortality. Three proposals should be considered to increase the availability of naloxone. Firstly, further training should be provided in emergency administration of naloxone by non-healthcare staff. Non-healthcare staff in police stations, prisons, rehabilitation hostels, or remote communities could be trained in recognising and managing overdoses (as aircrew are trained in managing in-flight emergencies) and could even receive instruction by mobile phone.Secondly, patients or carers could administer naloxone to others who have a heroin overdose. If a patient or carer, trained in use of naloxone, is called to a life threatening heroin overdose, then they could potentially save a life by administering naloxone while waiting for emergency services to arrive. Although we do not currently recommend this, as it ...
