Naloxone training in General Practice

Dr Joe Tay

Background

Naloxone, a short acting antagonist which temporarily reverses the effects of an opioid overdose, has been shown in a recent systematic review to decrease drug related deaths (DRD) if provided as part of basic first aid training (so called Naloxone training) (1). Scotland has had a national Naloxone programme since 2010 to address it having one of the highest DRD rates in Europe (2). The programme has been offered through the specialised drug services although GPs of course are likely to have contact with drug users and their families. Matheson and colleagues recently identified that Scottish GPs did not see Naloxone training provision as part of their remit and had minimal awareness of the national programme (3).

We are an 8400 sized practice with 200 patients on our substance use register. The majority of our substance misuse patients do not have routine access to the Naloxone training programme as they do not attend the specialist service. A recent increase in DRDs in our catchment area has prompted a change in our practice.

What we did

As of January 2016, we adopted obligatory Naloxone training as part of our practice policy for all patients being prescribed opiate substitute therapy in the practice.

Step 1: Awareness raising

We initiated an advertising campaign which included posters in all public spaces in the health centre, leaflets for patients, and an insert in the practice newsletter.

Step 2: Staff and GP Education

We organized a health centre wide education event and demonstration for all clinical and non clinical staff and also a further Naloxone training demonstration for all GPs.
I attended a one day Naloxone training for trainers event run by our local substance misuse directorate.

Step 3: Naloxone clinics

Setup

We organized a monthly dedicated Naloxone clinic with 15 minute appointments to allow time for the brief intervention.
The clinic was organized such that it coincided with the next opiate substitution prescription to maximize attendance.
Prior arrangements were made with our local pharmacy to order in the Naloxone kits on a named patient basis. This was done on the GP10 and the kits were delivered beforehand so it could be handed to the patient at the end of the brief intervention.

Materials for the training were obtained from http://www.naloxone.org.uk/, the official website of the Scottish National Naloxone Programme.

Ad hoc Naloxone training is provided out with the clinic when an at risk patient or a family member of an at risk patient is identified.

The intervention

The brief intervention consisted of training the patient in 7 competencies:

1. What the Naloxone Injection is, what it does and what it doesn’t do
2. The signs/symptoms of suspected opioid overdose, and how to assess for consciousness and breathing
3. How to assemble the Naloxone kit
4. How to inject Naloxone alongside basic life support. This included teaching chest compressions, rescue breaths and the recovery position
5. When to call 999
6. Naloxone is short acting (20-30minutes)
7. The importance of staying with the person until help has arrived and to keep them from using drugs if they awaken

Step 4: Audit

The intervention is coded and the intention is to conduct an audit of patients having received the intervention at the 6 month point to see if the kits had been used in this time. Refreshers for the brief intervention are planned annually for those having had the intervention.

The experience so far

Patients have been appreciative of the opportunity to learn a new potentially life saving skill. Barriers have included concerns raised by the patient that we are challenging their stability with regards to treatment. Framing the intervention as a form of positive community action to tackle a significant public health threat however has assuaged this.

References

(1) EMCDDA (2015). Preventing fatal overdoses: a systematic review of the effectiveness of take-home naloxone, Publications Office of the European Union, Luxembourg.

(2) EMCDDA (2010). Annual report on the state of the drugs problem in Europe. Publications Office of the European Union, Luxembourg

(3) Matheson, C., Pflanz-Sinclair, C., Aucott, L., Wilson, P., Watson, R., Malloy, S.,& McAuley, A. (2014). Reducing drug related deaths: a pre-implementation assessment of knowledge, barriers and enablers for naloxone distribution through general practice. BMC family practice, 15(1), 1.