Naloxone for families and carers demonstration project

1. Naloxone for families and carers demonstration project Naloxone Saves Lives Conference, Swansea 19 May 2011 Michelle Judge

2. Overview • Background and timeline • Why train carers? • Aims & Methodology of the evaluation • Who were the trainees, and what did they learn? • Findings and benefits of training different carer groups • Uses of naloxone • Running your own overdose and naloxone training

3. Background 1

4. Deaths due to drug misuse increasing 1 2009: 1731 deaths

5. Timeline 1

6. The 16 pilot sites 1

7. Why train carers? 2 • “[A] family member is defined as any adult person who is significant in the life of the drug user, irrespective of his or her biological, social or legal status. A carer is defined as anyone who cares for or offers support on a regular and personal basis to an individual, whether or not he or she has formal carer responsibilities and status.” • NTA, 2008

8. Aims and methodology 3 • 1) To show the benefits of training carers to respond to overdoses and administer naloxone • 2) To provide a set of practice recommendations for any local area wanting to run its own training programme. • Quantitative components – questionnaire data • Qualitative components – interviews and focus groups

9. Who were the trainees? 4 • 495 people trained across 16 pilot sites – 1094 target • Just over half (52%) of carers male • Average age of the carers was 40 • Over half (57%) of carers were former or current injecting drug users in a caring capacity for someone at risk of opiate overdose (‘mutual carers’) • Majority previously witnessed an overdose – on average 4x each

10. What did they learn? 4

11. Cardinal naloxone 2mg (2000 micrograms) in 2ml Mini-jet naloxone 400 micrograms in 1ml Types of naloxone 4

12. Structure of the training 4 • Training conducted in pairs or groups • 2 to 3 hours long • Flexibility needed to address sensitive issues and complete questionnaires

13. Findings (1) 5 • But… • Uptake of training lower than expected • Inpatient detox and prison settings difficult to engage with • Still… • Training works within normal service provision • Sites would include training family members in future • Extending training to service users may have greater impact

14. Benefits of training family members 5 • “[Since having the training] it’s been good knowing it’s there on standby. It’s like a comfort blanket” – Parent • Family members can be likely to witness an overdose and respond • Training empowered carers - gave them confidence • Users reduced or even stopped taking drugs • Training encouraged discussions on drug use and overdose

15. Benefits of training ‘mutual’ carers 5 • “Quite chaotic, vulnerable people took the training on board, retained it and used it!” – Trainer • Mutual carers are service users who are partners, close friends, or housemates • Training gave them the confidence to respond to an overdose • Causes of overdose were clarified, and myths about how to respond to an overdose were dispelled • Contact maintained with chaotic users

16. Other carer groups 5

17. Carers’ response to the training 5 • POSITIVE! • “I wish this had been around years ago” • “This gives me a lot of hope” • Better informed and more confident • More willing to intervene in overdose situation • Less concerned about using needles; triggering withdrawal

18. Uses of naloxone 6 17 uses of naloxone 2 uses of resuscitation techniques "I asked my other housemate to call an ambulance and I gave him the shot in his thigh, kept talking to him. It was almost like second nature. The paramedics said I had saved his life. I'm just grateful for going on that course. If I hadn't, a close friend would be dead." – Mutual carer who successfully revived someone using naloxone “When you do it sitting at the table in the training, you’re not shaking and your hands aren’t all sweaty, but you know, I managed it. I had never used a needle before – I’m actually pretty pleased I managed to put it together properly.” – Carer who successfully revived someone using naloxone

19. Uses of naloxone (2) 6 • “I know if there wasn't naloxone, [my partner] wouldn't be here with me today. I know for 100% [certainty] what happened – we used the same amount and all of a sudden he dropped to the floor… • …what helped me keep my composure was out of seven people in that room I was the only person trained to save him. I had the equipment, I knew exactly what to do. Everyone in that room that was really frightened and flapping and running round scared, and I was confident that I would save this man, I knew it was down to me.” • – Mutual carer who successfully revived someone using naloxone

20. 7 • Running your own training: checklist

21. Implementing a carers' training programme 7 • Local stakeholder support • Carers of prisoners – community follow-up • Staff knowledge and training is accurate and current • Qualified trainers available • Capacity within day-to-day service delivery • Project lead or champion • Appropriate prescribing mechanisms – PGD or PSD

22. Supplying naloxone – get it right! 7 • Naloxone is a prescription-only medicine, although it may be 'used by anyone for the purpose of saving a life' in an emergency • Prescribed directly to a patient, or given via a PGD or PSD • Naloxone should only be prescribed and supplied to a known patient who is at risk of opiate overdose, with the patient’s informed consent • Naloxone cannot currently be prescribed (or supplied using a PGD/PSD) to a carer on behalf of a drug user, and cannot be given to a carer without the drug user’s informed consent

23. 7 • Running your own training: what might a training session include?

24. Overdose and naloxone knowledge 7 • Causes of opiate overdose • Recognise overdoses and respiratory arrest • What to do to help someone who has overdosed • Know what naloxone is and how it is used • Dispelling myths and misconceptions about overdose • Practise basic first aid techniques • Confidence in dealing with an overdose improved

25. Managing an overdose 7 • Carers will know what to do if they see an overdose • Carers will be confident in: • - Phoning 999 and asking for an ambulance • - Performing rescue breathing if needed • - Putting someone in the recovery position • - Knowing when to use naloxone

26. Giving naloxone 7 • Know where to keep naloxone • How to prepare a naloxone injection • How and where to give naloxone • How much naloxone to give and when to give • another dose • What to do when the user comes around, and what • to do if they don’t

27. Questions? • Thank you • michelle.judge@nta-nhs.org.uk