Naloxone is a drug that can quickly reverse an opioid overdose, so family members, friends, emergency services and first responders can save a person's life by carrying it. Unfortunately, many overdoses occur when a person is alone, making naloxone administration impossible.
There are high levels of loneliness and isolation within the drug-using community, and a lack of connectedness and breakdown of relationships means many live on their own.
There is compelling evidence that community-wide distribution of naloxone reduces fatalities from opiate-related overdoses (McDonald and Strang, 2016). Without the rollout of naloxone, it’s likely that deaths both locally and nationally would have seen a greater increase.
This highlights an important criterion of naloxone's efficacy which is that it requires the presence and availability of another person to deliver it in the event of an overdose. Without someone on hand to administer naloxone, it can often be too late to save a person who has overdosed alone.
Sadly it is the side effect of stigma and isolation which means we continue to see an increase in drug-related deaths despite a life-saving drug being available in communities.
Overdose and isolation
According to a Dundee Courier article from January 2021, 60% of drug-related deaths in Dundee were in people who were alone (Malik, 2021). Furthermore, a 2017 experimental study of 115 drug-related deaths by Public Health England found that people who died commonly lived alone (Office for National Statistics, 2018).
It has also been found that service users are unlikely to change the practice of using alone due to convenience and not wanting to share drugs. Furthermore, naloxone is rarely in place even when others are in a position to respond, suggesting that any overdose-reduction strategy must address the evidence that points to people using alone and being unable to access emergency treatment.
The statistics, while saddening, are unsurprising when you consider the frequent stigma and judgement imposed onto people who experience addiction. They are often abandoned by family and friends, shunned by their communities, and even turned away from treatment facilities. Many individuals are "told to sort their drug use out” before they can access counselling for mental illness, and being told to “sort their mental health out” before detoxing, a Catch 22 that Working With Everyone highlighted in a recent report commissioned by the NHS APA. The report is based on findings from people with addiction about their experience of stigma.
Naloxone is undoubtedly a life-saving drug, but its effectiveness will remain limited as long as the high levels of loneliness and isolation within the drug-using community remain, with stigma playing a significant role. Jon Shorrock, previous Chair of the NHS Inpatient Network, suggested that a positive start would be, firstly, “for local authorities to routinely collect the relevant data'', and secondly for “more national and international strategies and research to be reviewed in relation to mitigation of risk for people using opiates alone.”
As an alliance of NHS trusts, we are working towards a future without stigma, by listening to the voices of those who have lived experience and advocating for change. We expect that by working to remove stigma, we will begin to see a greater understanding and compassion for those who suffer from drug addiction in society as a whole, and we hope that this will be reflected in commissioning, policy and treatment including naloxone administration.
If you think you might know someone who is at risk of having an overdose, read our blog on ‘what to do if you think someone is having an overdose.’