HSE Naloxone Drug Insights Report

Naloxone Administration by Addiction & Homeless Service Providers in Ireland: 2018-2020 Drug Insight Report 2

The National Social Inclusion Office (NSIO) has launched the second instalment of their Drug Insights Report Series – ‘Naloxone Administration by Addiction & Homeless Service Providers in Ireland: 2018-2020.’

The aim of the new report is to provide an assessment on the impact of the provision of naloxone, and training to addiction and homeless services. The study reviewed data collected by service providers for each incident where naloxone was administered during the period of 2018-2020, and uses cost benefit analysis calculations to demonstrate the return on the investment as a result of the Naloxone Programme over the last number of years.

The Naloxone Programme has become an important element in the Health Service Executive’s (HSE) implementation of a harm reduction approach, which is advocated by the National Drug and Alcohol Strategy ‘Reducing Harm, Supporting Recovery: A health-led response to drug and alcohol use in Ireland'.The increased provision and development of naloxone in Ireland is centralised around minimizing, ‘the harms caused by the use and misuse of substances and promote rehabilitation and recovery,’ in line with Strategic Action 2.2.30, to ‘continue to target a reduction in drug-related deaths and non-fatal overdoses.’

The increased provision and development of naloxone use in Ireland is centralised around minimizing, ‘the harms caused by the use and misuse of substances and promote rehabilitation and recovery,’ in line with Strategic Action 2.2.30, to ‘continue to target a reduction in drug-related deaths and non-fatal overdoses.’

You can access the report here

You can access the high level infographic here

As recommended in the report, the development of the Naloxone Programme will be focussed on ensuring that all those individuals who have been administered naloxone are signposted to relevant treatment services to ensure that their ongoing health needs are addressed. This aligns with Strategic Implementation Group 3 (announced by the Department of Health in 2022), and its’ goal to, ‘develop integrated care pathways for high risk drug users to achieve better health outcomes’.

This report aligns with recommendations proposed in the first NSIO Drug Insights Report, launched last year 'Drug-related Deaths in Ireland: Key Patterns and Trends 2008-2017' which recognises that; ‘naloxone availability for opioid users should be prioritised and its impact monitored on an ongoing basis.’

Overall Findings

Between 2018-2020, the supply of naloxone units by the National Social Inclusion Office has increased by 149% (8881 units over the 3 years)
569 people were administered naloxonE
It is estimated that the Naloxone Programme saved the lives of at least 22 people from 2018-2020.
51% of those that had received naloxone were reported to have taken more than one substance, with 35% taking two substances
In terms of gained productivity savings, the 22 estimated lives saved equates to €968,550 from 2018-2020. This results in an estimated productivity saving of €670,736 over three years, when supply and administration costs are deducted.
For every €1 spent on the programme there was a return of €2.36 in terms of gained productivity due to death prevention.
Almost three quarters of cases where naloxone was administered were from County Dublin (400 overdoses).
Other people were reported to have been present for 64% of overdoses. The average number of people present was 2.7.

Key Recommendations

The Naloxone Programme should continue to be resourced and expanded to achieve a stronger geographical spread given the demonstrated lifesaving benefits.
The need for gender specific initiatives in terms of overdose prevention and treatment needs further recognition and wider implementation.
Ensure that all those individuals who have been administered naloxone are ‘signposted’ to relevant treatment services to ensure that their ongoing health needs are addressed.
Reimbursement of intramuscular naloxone by the PCRS, in line with the National Centre for Pharmacoeconomics, Ireland (NCPE) would merit consideration.
Ambulance services should be called in all instances where naloxone is administered. This should be a target set for all service providers and should be reviewed annually and this recommendation should be incorporated into training.
The training programme should be reviewed yearly to ensure that the course content is up to date with developments in drug trends, in particular any emergence of synthetic opioids that may influence naloxone requirements. In addition, a refresher training programme should be developed to facilitate skill retention. This should contain practical examples and utilise both face-to-face and remote options to expand the provision of training.
Naloxone training and distribution to PWUD should include other potential bystanders, such as; family members, close friends and members of An Garda Síochána.
A specific drug education programme for PWUD on overdose risks, in particular polydrug use, should be developed
The process of recording naloxone administrations should be streamlined to facilitate data analysis and to ensure that all naloxone administrations are recorded. Consideration should be given to redesigning the form and developing a secure mobile ‘App’ or online submission system, in line with GDPR.