Overview
Opioid drugs are widely consumed globally – as prescribed medications, in abuse patterns using pharmaceutical opioids, and also in non-medical abuse of heroin and other opioids. Opioids are associated not only with dependence but also with high risk of overdose death. Globally, more than 150,000 people die annually from opioid overdose, a figure rising sharply in recent years, particularly in North America where mortality rate now exceeds 100,000 annually.
Three aspects of clinical practice and public policy need re-consideration:
Firstly, the importance of treatment and times of particular importance: Annual mortality rates of those abusing opioids is of the order of 1-2% annually. Treatment with medications such as methadone or buprenorphine is protective against risk of overdose death, reducing it to at least a quarter of the previous level. However we must be alert to the transient return of increased risk of overdose death immediately after cessation of these treatments. Furthermore, risk of overdose death is not evenly distributed – there are times of major concentration, notably following release from prison or discharge from hospital or moving back to community from protected residential rehabilitation. For former prisoners with a history of heroin use, one in 200 is dead within a fortnight of release. Whatever interventions or policies we consider, we must examine how they impact these dark periods, and how we might alter he danger of these periods of predictable risk.
Secondly, new technologies (apps and wearables): We should by now be able to detect overdose through apps in the wearable devices on which we all increasingly rely. If my smart-watch can detect that I have had a fall, or that I have an unexpected cardiac irregularity, then should we not also use the technological capability to detect that I have had an overdose? The algorithm would be very similar – an initial alert to the wearer (to check it was not a false alarm), then an emergency message to a pre-nominated close family member or friend, and, if no response from these earlier levels, then a transmission of geo-location to emergency services. We are currently exploring this capability and will present findings on ability to detect opioid overdose.
Thirdly, the need to develop better, more easy-to-use emergency interventions: If an overdose emergency is identified, then what action should be taken? Over the last decade, many countries have introduced training for drug users themselves, as well as for family members and care workers, to manage the overdose crisis while awaiting the arrival of the ambulance, including training in how to administer emergency naloxone to reverse the opioid-induced respiratory depression. An overview of the development of new concentrated naloxone nasal sprays will be presented, and also new work currently under way to explore the feasibility of a novel lyophilised buccal naloxone wafer/tablet to combine equivalent speed of onset with ultra-portable format to ensure constant carriage.
Speakers
Chair: Professor Fiona Gaughran, Institute of Psychiatry, Psychology and Neuroscience, South London and Maudsley NHS Foundation Trust, London
Professor Sir John Strang, King’s College London
