April 2017 | Aibreán 2017

High Level of GP Support for Naloxone Programme

Sat, 22 April 17 17:06

There is strong support among General Practitioners for the roll out of a national naloxone programme to prevent opiate overdose deaths according to Professor Gerry Bury, UCD Professor of General Practice and Director, UCD Centre for Emergency Medical Science.

Naloxone is poorly absorbed when taken by mouth, so it is commonly combined with oral opioid preparations such so that when these are taken orally, just the opioid has an effect.  If misused by injecting, the naloxone blocks the effect of the opioid, hence the combination can be used to prevent opiod abuse. Also, naloxone is rapidly acting when injected intravenously or intramuscularly to reject the effects of opiate overdose.

Three-quarters of Irish GPs care for patients with an opiate use disorder and a third had a patient who has experienced an opiate overdose.  Although used internationally, naloxone is currently not available under the general medical services (GMS) scheme.

Prof Bury and his UCD Primary Care colleagues undertook a survey of 448 qualified and trainee GPs from across the country assessing awareness of, and support for a national naloxone programme.  Despite a high level of contact with opiate users, just a quarter of those surveyed reported that their practice prescribed opiate substitution treatment, although a third had completed training in this area.

The survey, published in the British Journal of General Practice, highlighted a high level of support for naloxone distribution in the community, with two-thirds of GPs in favour of a planned initiative to increase the availability of the treatment by allowing access to trained lay bystanders. Almost a third stated that they would consider taking part in such a project.

The vast majority (81.7%) said they would prefer the use of intranasal naloxone compared to just 12.8 per cent who cited injectable single dose naloxone as their first preference, with 3.3 per cent preferring an injectable multi-dose delivery system. However, the study also pointed out that to date, there was no licensed preparation of intranasal naloxone available in Ireland.

The survey also found that GPs who prescribed methadone as an opiate substitution treatment were “more likely to work in urban areas, have patients using illicit opiates and be willing to take part in a naloxone distribution project”.

Interestingly, the study revealed that while both qualified and trainee GPs reported experience of naloxone use, significantly more trainees had used naloxone to treat opiate overdose; however, this was more frequently in the hospital setting. GP trainees were also more willing to take part in a naloxone distribution programme in general practice.

“This study suggests that GPs commonly provide healthcare for patients with opiate use disorder and support naloxone distribution within the community,”

noted the authors.

“A structured overdose prevention and naloxone distribution programme within general practice should be considered in an effort to reduce overdose-related deaths.”

Speaking to the Irish Medical Times, Prof Bury said:

“GPs are very supportive of the idea that some form of rescue medication should be made available and on a flexible basis. Clearly those feelings are highest and support is strongest where doctors practise in areas where opiate dependency is a problem.”

Commenting on the fact that naloxone was not currently available under the GMS and practically impossible for GPs to access, Prof Bury added:

“The situation we are in at the moment is characterised by 200-plus deaths among this population each year.  Now it is unfair to suggest that many of those deaths might be prevented by the availability of naloxone, but some probably could, and I think that separate to the physical effect of the drug, the sense that the care system cared enough to put in place some safety net might itself have some signal of support for the families and the carers and the individual drug users themselves.”

More than 200 opiate overdose deaths occur annually in Ireland. Overdose prevention and management, including naloxone prescription, should be a priority for healthcare services. Naloxone is an effective overdose treatment and is now being considered for wider lay use.

Adapted from an original article by June Shannon, Irish Medical Times

The survey was published in the British Journal of General Practice (Br J Gen Pract 2017; DOI: https://doi.org/10.3399/bjgp17X689857)