Take-home heroin antidote

The largest ever intervention study within the UK prison population - involving 56,000 people in approx 20 prisons - will investigate whether the large number of heroin overdose deaths that occur soon after release can be prevented by giving prisoners a take-home supply of the heroin antidote naloxone.

Heroin overdose deaths increase more than sevenfold in the first fortnight following release from prison.  Of prisoners with a previous history of heroin injecting, one in 200 will be dead from a heroin overdose within four weeks - approximately 10 times the mortality rate of general prisoners on release and 100 times greater than an age-matched general population. 

The overall aim of the study is to reduce the number of heroin overdose deaths from the population studied by a third.

Naloxone injections are routinely used by paramedics and clinicians to counteract the effects of heroin overdose.  Research shows that the majority of heroin overdoses are usually witnessed by family members, carers and drug users (a quarter of parents at family support groups have witnessed the overdose of their child), and that there is also a recognised and extensive willingness among these groups to intervene.  These interventions however tend to be inefficient and/or incorrect.

The study is being carried out by the Medical Research Council's Biostatistics Unit and Clinical Trials Unit, and by the National Addictions Centre.  

Professor John Strang, Director, National Addictions Centre, said: "This study will rigorously test whether this method can reduce the post-prison-release carnage.  The issue does not need more public debate; it needs good science."

The initial pilot stage of the study, involving 5000 prisoners, will test whether a supply of take-home emergency naloxone, accompanied by explanatory leaflets and instructions for themselves and their families is effective in saving lives.  The training also emphasises the importance of calling an ambulance following overdose.

The study seeks to generate a solid evidence-base on the effectiveness of this harm reduction approach by using the extraordinary concentration of heroin users in the prison population.  Less than 1% uses the drug in the general public, but this figure is transformed into approximately 40% in the prison population. 

Small scale schemes using take-home naloxone have taken place in the UK, but these have involved anecdotal reports and employed no systematic follow-up.

The research project is funded by the Medical Research Council and has been made possible with the assistance of the English prison health care services. 

Of the approximate 1500 drug deaths in UK each year, around 80% are opiate related - usually caused by the respiratory depression characteristic of the drug. 

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Notes to editor

The National Addictions Centre (NAC) seeks to improve understanding of addiction to drugs, alcohol and tobacco, and to develop effective preventative and treatment interventions. It is collaboration between researchers at the Institute of Psychiatry (IoP), King's College London and clinicians at South London and Maudsley NHS Foundation Trust (SLaM).