This Is How England Could Stop Its Heroin Users Dying from Overdoses
Naloxone is a miracle drug that can bring people back from the brink of an overdose. Problem is, a mixture of fear and austerity is keeping local English councils from getting their hands on the stuff.
Earlier this month, six Nottinghamshire residents died in the space of 36 hours after injecting what's suspected to be a super-strong batch of heroin. Chris Kenny, the county's director of public health, was quick to dub this a "public health emergency".
Of course, this was bullshit. Tragic though the deaths were, a dodgy batch of heroin is no public health emergency, as it presents no risk to the general public; it's not as if some evil bastard dropped a tub of liquid norovirus into the water supply. Nottinghamshire's overblown reaction is a classic case of shutting the stable doors after the horse has bolted. It also has the whiff of a hysterical, guilt-ridden PR exercise.
Sadly, the real story behind the deaths two weeks ago in Mansfield, Bassetlaw and Newark is not about rogue batches of heroin – because they will always come and go. It's about missed opportunities, money and fear.
While the exact circumstances around the deaths are yet to emerge, it's fair to suggest that if the six had happened to live in Nottingham city rather than in the surrounding Nottinghamshire county, they might still be alive. This is because, in Nottingham city, heroin users at risk of overdose are handed this amazing, injectable re-animating fluid called naloxone, a magic medicine that when injected can bring overdose victims back from the brink of death. Drug users keep these heroin overdose reversal kits – consisting of a syringe with four doses of naloxone – in their pockets so that if they "go over", a friend, relative or medic can jab them and reverse the overdose. Even the Daily Mail, traditionally not big fans of opiate users, has marvelled at a video of someone being revived after being given a naloxone injection.
But in the surrounding county, apart from the odd kit handed to released prisoners and people in detox, naloxone is not given to heroin users; the provision of naloxone is threadbare. So the emergency that Nottinghamshire should be talking about is not that, for some unspecified reason, school kids and pensioners might now be at risk from this super-strength smack; it's that we urgently need to speed up the national distribution of naloxone.
In the last three months in Nottingham, 12 lives have potentially been saved after heroin overdoses were reversed with naloxone injections. In Birmingham, where around 2,500 of the £18 kits have now gone out, an overdose is reversed every week. In Wales and Scotland, where there are national programmes of naloxone supply, heroin overdose deaths have fallen.
The use of naloxone kits in the USA, which have become increasingly available in the country as heroin use has risen, has resulted in almost 27,000 drug overdose reversals between 1996 and 2014, according to a new government study.
In 2012, the government's own drug advisory body, the Advisory Council on the Misuse of Drugs, told the Home Secretary that naloxone saves lives and that it should be made more widely available. Thousands of heroin overdoses later, and as part of its parochial "localism" policy, the government is happy to let local authorities mess about deciding if handing out naloxone is a good idea or not. Public Health England have been far too weak in pushing local areas to adopt naloxone.
Sadly, Nottinghamshire's wafer-thin naloxone policy is the norm, despite a big rise in deaths from heroin in England. A Freedom of Information request by drug charity Release last year found that only a third of local authorities in the UK confirmed they were handing out naloxone in some shape or form.
Some areas have pulled back out of fear: they think they will be kicked out of the town hall by local voters who may disapprove of limited resources being spent on undeserving junkies. Other areas are worried they may be seen as encouraging heroin use by handing out naloxone.
As more local authorities like Nottingham (which was stung into action when four heroin users from the same homeless hostel died last September) set up comprehensive naloxone distribution and training programmes, the drug is needed now more than ever. In the UK right now, the conditions are ripe for heroin overdoses. The 2010 UK heroin drought, where purity dropped to below 10 percent, is well and truly over, and rogue batches of highly pure heroin are popping up across the country. Like in Nottingham.
The day before the deaths, in Mansfield, Bassetlaw and Newark, police had seized bags of street heroin of import purity – between 54 and 67 percent – being sold in Nottingham city centre. Similarly high purity heroin was seized in April.
Heroin users dose the drug according to how pure it usually is, which in the UK is between 15 and 35 percent. Unfortunately – unlike alcohol, for example – bags of heroin don't come with potency levels. So when a double strength batch hits the streets, drug users, blind to the danger, can easily overdose and die. And Britain's ageing group of around 150,000 heroin users is more likely to succumb to overdose because they have become increasingly frail and sick.
READ ON MOTHERBOARD: Meet the 'Fake Heroin' Behind the Next Overdose Epidemic
What's more, help for heroin users is becoming increasingly patchy. Like all public services, drug treatment has been seriously squeezed during austerity. As a result, scores of drug services around the country have been either downsized or shut down. The number of outreach workers – those trained to go into the streets to look after drug users – has fallen dramatically. This means there's less care for people with addictions (even for those officially in drug treatment), a factor that heightens the chance of people dying of overdoses.
An emergency summit of drug experts who met in January to look at the rise in heroin-related deaths – up a third from 2012 to 2013, to 765 – concluded that heroin users were far less likely to die of an overdose if they were regularly in touch with a treatment service and if they had naloxone.
The government's policy of getting people who have been prescribed methadone to become drug-free is laudable, but if heroin users are given too little doses or weaned off too quickly, they can end up overdosing on street heroin. Because their tolerance is lowered, those most at risk of heroin overdoses are those trying to quit.
The Naloxone Action Group, a campaign set up by drug experts from around the UK, is rightly calling on the government to stop fucking about – to override localism and develop a national plan in order to make sure that where someone happens to live becomes less of a factor in whether they survive a heroin overdose or not.
Lee Collingham, a former heroin user who campaigned to have naloxone in Nottingham, told me: "Naloxone kits cost £18 per kit. A coroner's report costs £20,000, and of course someone has died. On a moral level, a naloxone kit is a small price to pay. On a financial level, it's a huge saving."
There is a bit of hope for getting more naloxone into circulation. At the moment it's a prescription-only medicine, so only drug users themselves can be handed naloxone. In October, the government will change the law to ensure that drug treatment services will be allowed to provide Naloxone to anyone who might be present at the scene of an overdose, even though they personally are not at risk of OD. Training on how to use naloxone on an overdosed person only takes 15 minutes. But don't hold your breath – there is no guarantee that local authorities will opt to pay for the kits.
Last year, a nurse manager in Birmingham came out of the ballet with his wife and found someone overdosing in the car park near his car. He carried his kit everywhere, so called 999 and administered the naloxone while waiting for paramedics. He was later told the heroin user wouldn't have been found until the morning otherwise, and would have died.
It is rare thing when a heroin overdose makes the national news. Compared to deaths from ecstasy or legal highs, people "going over" are usually ignored by the media – unless they're famous. Maybe this is because heroin overdoses occur with a predictable regularity. Despite their more widespread use, deaths from ecstasy and legal highs are relatively rare. Sadly, death-by-heroin is seen by newspaper editors as being less of a tragedy – and less photogenic – than a fun-loving university kid from a good family dying after taking pills.
As we await to hear from toxicologists what the exact cause of the six deaths in Nottinghamshire was, Crime Reduction Initiatives – the charity that runs Nottinghamshire's drug services and many others around England – declared it would push to get naloxone distributed as widely as possible in all areas. It said naloxone would be available in Nottinghamshire "imminently".
But it's a scandal that drug users have to die like flies before authorities come up with the motivation and the cash to provide one of the few medicines that's pretty much guaranteed to save their lives. Perhaps it's because these people are viewed as junkies, living on a lower plane of existence than regular citizens. So what's the rush?