Paramedics to supply take home naloxone



Paramedics are to supply to patients at risk of an opiate overdose take-home naloxone as part of a pilot scheme in Glasgow.


The three-month trial will see those treated by paramedics for a non-fatal overdose who decline to attend hospital, and their friends and family, given a naloxone kit – which temporarily reverses the effect of an opioid overdose.


Training will be given on how to use the medication in the hope that it can be used by in the event of any future overdose witnessed by the individual before the ambulance arrives, reducing the risk of potential death.


The pilot has been funded by Scotland’s Drug Deaths Taskforce.


Public Health Minister, Joe FitzPatrick, said:


“This pilot scheme is one of a range of actions the Drug Deaths Taskforce is taking to address the public health emergency Scotland faces in terms of drug-related deaths.


“We know from the evidence that having naloxone available can and does save lives, but we also know from our database that around half of those whose death was drug-related had also suffered a non-fatal overdose at some point.


“Supplying naloxone kits through our teams of paramedics following a non-fatal overdose is just one more important action we can take to provide support to people at a time of crisis.”


Scottish Ambulance Service medical director, Jim Ward, said:


”We are committed to improving outcomes for all patients and our paramedics and ambulance clinicians often respond to emergencies to treat people who are experiencing an accidental overdose from drug use.


“This is a vital project that has the potential to help save lives – we are pleased that we will be on the front line in efforts to cut the death rate in Scotland from drug overdose, by offering this additional patient safety intervention.”


Scottish Drugs Forum’s Strategy Coordinator for Drug Death Prevention and lead of the Scottish National Naloxone Programme. Kirsten Horsburgh, said:


“This is a welcome development to Scotland’s national naloxone programme. SDF has advocated for ambulance service involvement in distributing kits for some time, due to the elevated risk of a drug-related death following a near-fatal overdose.


“SDF have provided training and guidance for this pilot, which will involve paramedics supplying take-home naloxone kits to people who decline a transfer to hospital and also to those who are present at the scene, such as family members and friends.


“The provision of naloxone is only a small, but essential, part of an effective response to Scotland’s drug deaths crisis where the majority of fatalities involve opiates. Without the availability of naloxone, it is highly likely that the number of people dying from preventable overdoses would be even higher.”


Calls for ‘minimum’ of 15 minutes for GP appointments in Scotland


GP appointments should be extended from ten to at least 15 minutes long, the Royal College of General Practitioners Scotland (RCGP) says.


RCGP Scotland believes this would reduce risk and ensure patients’ needs are met, but would only be possible with an increase in the number of GPs and a reduction in their current workload.


In a recently published report the family doctors’ group warns GPs’ ‘unique and irreplaceable’ role is under pressure as stress and workload challenges mean increasing numbers of doctors are opting to leave the profession. A quarter of Scottish GPs say they are unlikely to be working in general practice in five years’ time.


The Scottish Government says there’s a record number of GPs working in Scotland and numbers per head of population are higher than elsewhere in the UK. Under the new contract, GPs’ roles are changing so they become ‘expert medical generalists’ supported by a broad medical team that will take on some of the tasks traditionally reserved to doctors.


It’s hoped this will free up their time to focus on essential patient needs. Many of the doctors surveyed for today’s report said they were concerned the current appointment length was simply not long enough and could lead to risk and uncertainty.


One GP surveyed said:


“The vast majority of our patients (the ones we actually see) have increasing multi-morbidities and it is simply not sustainable to meet these needs in a 10-minute consultation – yet to give them the time they need means running over time which adds to stress.”


“It is necessary to work very significantly in excess of a manageable working day. Without more doctors to share the workload it seems unlikely to improve,” another reported.


To pay for more family doctors, RCGP Scotland is calling for 11% of the NHS budget to be dedicated to general practice, claiming Scotland ‘lags far behind’ England and Northern Ireland. It’s also suggested the Scottish Government’s commitment to recruit 800 additional GPs could have less impact than hoped for because more GPs are choosing to work part-time.


Using whole time equivalent figures and targets would be a better measurement, the College says.


Elsewhere, the report calls for GP training to be lengthened, pointing out training is still three years long despite other specialities being higher and the ‘increasing complexity of what it means to be a GP.’


RCGP wants at least a four-year competency-based scheme embedded in practice.


Another ‘significant challenge’ is a ‘culture of negativity towards general practice’ in medical schools, with 76% of students surveyed saying they had encountered negativity towards general practice by their fifth year of study.


The Scottish Government says it will consider the issues in the report and work with the college on the next phase of the GP contract.


A spokesperson said:


“Health and equalities are at the core of everything we do and we are committed to addressing the underlying causes that drive health inequalities. Our bold package of measures to help tackle issues such as smoking, obesity, inactivity and alcohol misuse will support people to live longer, healthier lives.


“We are also tackling the wider causes of health inequalities through measures such as investing in affordable housing, providing free school meals and continuing to provide free prescriptions and personal care.


“We now have a record number of GPs working in Scotland with more per 100,000 population in Scotland than the rest of UK and we are increasing the number by a further 800 over the next decade. We are also committed to 11% of funding going into primary care and to investing £250m in direct support of general practice by the end of the current Parliamentary period.”


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What can Scotland learn from British Columbia’s approach to overdose deaths?


Part of the answer to mounting drugs-related deaths in Scotland lies in grassroots charities, community groups and experts with lived experience taking a lead role, a Canadian substance use researcher says.


Professor Bernie Pauly of the Canadian Institute for Substance Use Research was in Scotland last week to speak at a Dundee harm reduction event organised by the Scottish Drugs Forum.


In Vancouver, the setting up of unsanctioned ‘pop up’ overdose prevention sites to save lives in the face of a rising tide of overdose deaths led to the provincial government backing these sites across the province, Professor Pauly, who is also a nurse at the University of Victoria School of Nursing, tells


Her comments come amid an ongoing standoff over a safe consumption room in Glasgow. The Home Office refuses to allow such a facility, which campaigners, local politicians and the Scottish Government say has been proven to “save lives”.


British Columbia is home to just over five million people, compared to just under five and a half million for Scotland.


Like Scotland, it has also struggled with drugs. In 2015, overdoses became the highest cause of unnatural deaths, outstripping suicides and traffic accidents.


Fatalities have remained stubbornly high, with more than 1,500 people losing their lives in 2018 and, for the first time in recent history, life expectancy is falling.


In Scotland, 934 drug-related deaths were recorded in 2017.


Professor Pauly explains how, in light of long processes for federal approval of drug consumption rooms, activists and campaigners moved to provide an “essential health service” themselves.


“There were people, particularly in Vancouver, who started by setting up unsanctioned sites – often called pop-ups, because they were in tents. One of the ones in Vancouver was basically a tent in an alleyway where people could be observed and Naloxone administered immediately in the event of an overdose.


“People knew there were evidence based-interventions that would save lives – so why weren’t we doing that?”


Following the declaration of a public health emergency in 2016, the provincial government sanctioned overdose prevention sites – a move opposition politicians in Scotland have been calling for.


Overdose prevention sites are small-scale, “welcoming and friendly” spaces typically staffed by harm reduction workers, including staff with lived experience of drug use.


As well as expanding access to overdose prevention, they created “a space that was safe, where people felt like they wouldn’t be judged, with opportunities to develop trust and facilitate opportunities to access other services.”


In Canada, larger drug consumption spaces – of the kind proposed for Glasgow – have a broader range of staff, including nurses and counsellors. But while British Columbia is held up as an exemplar when it comes to harm reduction policy, Professor Pauly says a comprehensive response is critical.


Alongside overdose prevention sites, there was rapid scale-up of the provincial Take Home Naloxone Program and Opioid Substitution Therapy – but, she argues, more is needed. While no deaths occurred at supervised consumption or overdose prevention sites, British Columbia still saw 104 suspected overdose deaths in March.


Ultimately, these spaces are still “emergency measures,” Professor Pauly says. The ‘real prevention’ is ensuring a safe supply.


One idea being proposed in Canada’s western-most province is ‘compassion clubs’, in which members would be able to access a safe source of heroin.


It’s hoped this would undermine the illegal market, reduce poisonings and overdose deaths caused by impurities.


Asked what lessons Scotland could draw from the Canadian experience, Professor Pauly says:


“One is engaging people with experience right from the start because so many innovations are driven by them. The establishment of safe consumption sites…were really led by people with expertise and lived experience.”


Ultimately, she returns to the issue of supply, which is “something that should be addressed from the start.”


“You can scale up things like overdose prevention,” Professor Pauly says, “but you really have to address the fact there is an unsafe supply and really focus on changing policy to ensure a safe supply – that’s the real prevention.”


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Early statin treatment may help Fragile X sufferers


University of Edinburgh researchers hopeful cholesterol drug in infancy could prevent learning problems.

Children with an inherited form of intellectual disability and autism could be helped by taking a medicine commonly used to lower cholesterol early in life, according to researchers at the University of Edinburgh’s Patrick Wild Centre and Simons Initiative for the Developing Brain.


The cholesterol drug – called lovastatin – corrected learning and memory problems in rats with a form of Fragile X Syndrome, tests revealed, and researchers are hopeful learning problems in children with Fragile X might be prevented by a similar treatment in early life. One of the most common genetic causes of intellectual disability, Fragile X syndrome is often associated with autism and attention deficit and hyperactivity disorder (ADHD). Many affected individuals also have seizures.


Statins – including lovastatin – are widely prescribed to both children and adults to control high blood cholesterol and to reduce the risk of heart disease. Rats were treated with lovastatin for four weeks during infancy but the benefits persisted for months afterwards.

The condition occurs when a particular gene is disrupted, leading to altered communication between brain cells. Previous studies in mice and rats have shown that this disruption can be treated with drugs, but it was not known how long treatment might be effective for.


“Children with Fragile X Syndrome need special education and, although some will live semi-independently, most require some form of lifelong support,”says Professor Peter Kind, director of the Patrick Wild Centre and Simons Initiative for the Developing Brain at the University of Edinburgh. We have found that early intervention for a limited period during development can lead to persistent beneficial effects, long after treatment ends, in a rat model of Fragile X Syndrome. Our future experiments will focus on whether there is a critical time-window during development when treatment is more effective.”


Researchers at the university studied rats with a genetic alteration similar to that found in people with Fragile X syndrome that have problems completing certain memory tasks when compared with typical rats.


Treatment with lovastatin between five and nine weeks of age – the precise window when they are developing the memory abilities – restored normal development in the rats. The animals were able to complete the memory tasks more than three months after treatment ended, indicating the effects of the drug were long-lasting.


Children with Fragile X Syndrome are usually diagnosed around the age of three, typically because they are late in learning to speak. Genetic tests have enabled earlier diagnosis, which raises the possibility of starting treatments sooner. Current medications help manage specific symptoms – such as hyperactivity and seizures – but there are not yet any treatments that tackle the underlying brain changes leading to Fragile X syndrome.


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