New EMCDDA review studies effectiveness of overdose antidote, naloxone

Cited from Drugnet Europe No 89

January–March 2015

Can naloxone provided in the community help reduce the thousands of drug-induced deaths recorded in Europe every year? This is the question explored in a new EMCDDA Paper released in January: Preventing fatal overdoses: a systematic review of the effectiveness of take-home naloxone (1).

Naloxone — a pharmaceutical drug used to reverse the effects of opioid overdose — has been used in emergency medicine (e.g. by ambulance crews, hospital emergency-room teams) for over 40 years. But as many overdoses occur in the presence of drug users’ family members or peers, empowering bystanders to act effectively, before emergency services arrive at the scene, can save lives (2).

Following pilot initiatives in the 1990s, measures to scale up naloxone availability to those likely to witness an overdose have emerged in the last decade. This has been driven partly by the epidemic of opioid-related deaths (heroin and non-heroin) in the USA (3).

Analysing 21 studies conducted in four countries — Canada, Germany, UK and the USA — the new review examines the latest evidence on the role of take-home naloxone (THN) in reducing opioid overdose fatalities. It concludes that THN provision, delivered with educational and training interventions, can be effective in reducing overdose-related deaths and improving knowledge on the signs of overdose and the correct management of patients.

Listed by the World Health Organization (WHO) as an ‘essential medicine’, naloxone is available in injectable form, with non-injecting administration under investigation. Programmes and trials with THN distribution are currently run in seven European countries: Denmark, Germany, Estonia, Spain, Italy, UK and Norway (see Annex 3 of review). Since September 2013, Estonia has offered a naloxone programme to tackle the sharp rise in deaths caused by illicit use of the synthetic opioid fentanyl. In 2014, Norway began a pilot of a nasal spray naloxone programme.

The report shows how evidence supports THN provision as part of a comprehensive harm reduction response. WHO guidelines on community-based naloxone provision were launched in November 2014 and a number of European countries have now developed national guidelines (4). Knowledge exchange on THN is important to allow potential implementers to take informed decisions (5).

Drug use is one of the major causes of mortality among young people in Europe. Overall, some 6 100 overdose deaths were reported in Europe in 2013. Substances associated with the risk of overdose include: opioids (non-medical or prescribed); benzodiazepines and synthetic opioids (e.g. fentanyls).

Marica Ferri and Lucas Wiessing

(1) www.emcdda.europa.eu/publications/emcdda-papers/naloxone-effectiveness

(2) www.emcdda.europa.eu/topics/pods/preventing-overdose-deaths (EMCDDA Perspectives on drugs).

(3) www.whitehouse.gov/ondcp/national-drug-control-strategy

(4) www.emcdda.europa.eu/best-practice/guidelines

(5) The role of take-home naloxone (THN) in reducing opioid-related fatalities was the focus of an EMCDDA meeting held in Lisbon on 14 October 2014. www.emcdda.europa.eu/events/2014/meetings/naloxone See video at www.youtube.com/user/emcddatube

Dangerous drug PMMA makes a comeback

Cited from Drugnet Europe No 89

January–March 2015

Over the last three months, PMMA — a stimulant-type drug of the phenethylamine group — has been seen to be making a comeback on the European illicit drug market in ecstasy tablets bearing a Superman logo. Since the end of December 2014, these tablets have been associated with the deaths of at least six individuals in Europe.

PMMA (para-methoxymethamphetamine) underwent a formal EMCDDA risk assessment in 2001 and, following a Council Decision in February 2002, was subjected to control measures and criminal penalties across the EU Member States (1)(2)(3).

PMMA is considered to elicit entactogenic effects in users — similar to those provoked by MDMA. However, the substance has weaker stimulant effects, is slower-acting and more toxic than MDMA, particularly when combined with other substances. Users believing tablets to be MDMA, and experiencing the weak stimulant effects and delayed onset of action, may believe that they have consumed ‘weak ecstasy’. As a result, they may be tempted to re-dose, increasing the risk of adverse effects and possible overdose.

From 1993 to 2013, the EMCDDA is aware of approximately 47 deaths in 10 European countries associated with the use of PMMA, with a notable cluster in Norway in late 2010.

Rachel Christie, Andrew Cunningham and Roumen Sedefov

(1) Risk assessment report at www.emcdda. europa.eu/publications/risk-assessments/pmma

(2) www.emcdda.europa.eu/news/2002

(3) www.emcdda.europa.eu/news/2012/10

Mortality among drug users in Europe

Cited from Drugnet Europe No 89

January–March 2015

Drug use is one of the major causes of mortality among young people in Europe, both directly through overdose (drug-induced deaths) and indirectly through drug-related diseases, accidents, violence and suicide. Every year, over 6 000 drug users die of overdose in the EU, most of these deaths involving opioids and occurring among problem drug users. To gain a clearer picture of the overall number of lives lost due to drug use in Europe, this new EMCDDA paper builds on the results of earlier work investigating ‘all-cause’ mortality among problem drug users. By linking data on entrants to drug treatment programmes with information from death registries, mortality cohort studies can determine death rates from all causes within the study population.

Available in English at: www.emcdda.europa.eu/publications/emcdda-papers