Senator Lynn Ruane: I acknowledge that the Minister of State, Deputy Naughton, contacted me yesterday to say she would not be available today for which I thank her and she has agreed to engage further on the matter. I thank the Minister of State, Deputy Carroll MacNeill, for being here today to take this Commencement matter. Over the past few months, we have seen a very high rate of overdose due to heroin containing synthetic opioids. We often do not think of how the globe is so connected in this sense. When we look at the Taliban reducing poppy cultivation by 95%, most people will see that as a great thing because it is reducing the amount of opioids coming out of a country and going around the world. However, it then leaves a hole because people will create synthetic drugs to which we are probably not ready to respond or catch up with so everything has a consequence. 

Unfortunately, in the past few months, we have seen what this consequence is. The fact that there have been over 40 deaths does not mean that there are not more deaths that have not been captured adequately. This is on top of the fact that already, one person per day dies from an overdose. They are not all opioid overdoses but the ones that are opioid overdoses are preventable with naloxone. 

Naloxone is available on prescription in Ireland. There is no need for it to be on prescription. It is not a drug that can be abused. 

The only risk with having complete access to naloxone is if somebody thinks that someone is in an overdose and brings them around and that person goes into withdrawal. When you measure the small risk of being overly cautious with the use of naloxone, given that the alternative is death, we should have free access to naloxone in chemists. Currently, pharmacists do not seem to understand how it is prescribed. There is now a box tick for doctors who can prescribe naloxone but lots of doctors who prescribe it are getting calls from pharmacies about this new aspect of the prescription so maybe there needs to be a campaign to help pharmacies understand this new box on the prescription in regard to naloxone. 

My fear is that if we do not make naloxone accessible we will just continue to watch people die unnecessarily. We should be able to have naloxone in our homes. The HSE did a very good job of getting the message out in recent months. I protect people that I love very much and ask them not to buy heroin because there is a bad batch. When somebody is in that situation they will often still take the risk because they are experiencing such bad withdrawal, they have no other options, or they have no way of knowing. So many families do not know, first of all, that there is access to naloxone. The individual who is using heroin is the one who gets prescribed naloxone but that does not seem to make sense when they are not going to be the ones who respond to their own overdose. We should be able to go into a chemist, get naloxone and have it in our homes and community organisations. Outside of Dublin we not only have barriers to naloxone but we also have waiting lists for opioid substitute replacement of up to 12 months in some counties, which will also bring down overdoses over time if people are moving from heroin to a more managed maintenance programme. 

One more point I wish to raise relates to the prison system. Reports are coming to me from the prison system is that some of the lads are trained in overdose prevention but they do not have access to naloxone. Even in the likes of the John F. Kennedy Presidential Library and Museum in Boston there is a little glass box, like in a fire alarm system, that can be shattered with a hammer to get naloxone out. Some of the men in the prison system are sometimes afraid to alert the prison authorities that there is a potential overdose because they feel it could result in punishment or raids on cells, so they may wait too long before they alert someone. We have the Red Cross in there training people as listeners and on overdose prevention and they could also be tasked to have peer-to-peer access to naloxone if something does happen on a landing, which could be in a glass box like in the JFK museum and other places in America.

An Leas-Chathaoirleach: Before I bring in the Minister of State, I welcome to the Visitors Gallery St. Anne's Secondary School from Tipperary. It is the unwritten rule of Seanad Éireann that there will be no homework, hopefully until 2024, if that is agreeable to the House. 

Minister of State at the Department of Finance (Deputy Jennifer Carroll MacNeill): I thank Senator Ruane. I am glad that the Minister of State, Deputy Hildegarde Naughton, had the opportunity to speak directly with her. I will update Senators more broadly on the position but I know the Minister of State will do further work in that regard. 

As Senator Ruane said, naloxone is a prescription-only drug at the moment and measures have been put in place to ensure that as many people as possible have access to naloxone administration courses. 

The Department of Health and the HSE are acutely aware of the dangers of all drugs, especially synthetic opioids. They are working in collaboration with European partners to prepare responses to new opioids or other drugs that may emerge. 

The emergence of synthetic opioids is monitored closely by the EU Drugs Agency. Ireland supports that mechanism through the early warning and emerging trends network, EWET, which has representatives from the Department of Health, the Department of Justice, An Garda Síochána, the Irish Prison Service, the Health Research Board, the HSE, several national laboratories, and civil society representatives. 

Naloxone is used as an antidote to reverse the effects of opioid drugs like heroin, morphine and methadone if someone overdoses. As Senator Ruane has said, it is a lifesaver drug. More than 1,900 people have been trained in overdose awareness and naloxone administration by the HSE and partner services. Some 6,488 units of naloxone have been supplied by the HSE to services. It can be used in emergency situations without a prescription but the barrier is that the person administering the product must have been issued with a certificate stating that he or she has satisfactorily completed a course of training. As the Senator has pointed out, there are many situations where that happens but where access to the drug is more restricted. 

We know that during the recent spike in overdose cases, in Dublin and Cork in particular, naloxone has saved lives. In many cases it was administered before emergency services arrived on the scene. The Minister of State, Deputy Naughton, is keen to ensure that it is more readily available. The question is what is the pathway for that and how will it be done. I understand from the Minister of State that work is under way by her officials to ensure that gardaí, for example, are trained to use naloxone and that they would carry it while on the beat. Separately, she is also keen that it is more readily available to people helping those in addiction, including support workers, peers, and family members. She is exploring ways in which to make it entirely prescription free and to see how that might work and what the practicalities of that are. I might allow Senator Ruane to respond if she has any questions. 

Senator Lynn Ruane: It is good to hear that the Minister of State is exploring how to make naloxone prescription free. I understand that training is necessary but in an emergency situation it is much like the use of an EpiPen. Nasal naloxone, which is applied in a shot straight up the nose, is obviously a much easier option. There are loads of options. 

We must also empower community leaders. Communities are trained in suicide prevention and how to respond. If naloxone could be freely accessed in a chemist, some minimal training could be provided to individual chemists or doctors who could give insight to family members on what is expected of them in an emergency if a trained person is not around. Training is important, but other than bringing someone around this is not a drug that is going to cause any harm. I am glad to hear that the authorities are looking at ways to make naloxone prescription free. 

I hope the Minister of State can also communicate with the prisons to see how we can make naloxone more accessible within the prison system. When you walk into Mountjoy at the moment there is a big sign promoting naloxone. When you leave prison you are more susceptible to overdose anyway in those first few weeks because you have not had the same access to an opioid yet you cannot access naloxone in prison. I might follow up with the Minister of State specifically on the point about prisons. The Department of Justice might also need to comment on that as well. 

Deputy Jennifer Carroll MacNeill: The Prison Service has been working with HSE addiction services on this for some time. It is a hugely beneficial project that benefits both people in prison and their families. 

There is significant ongoing training for pharmacists on naloxone administration. There is a body of work on this as the Government recognises that it is a lifesaving drug. It is clear the response it can have on a person's life and their well-being. Notwithstanding that it is currently a prescription drug and that there are restrictions on it, it is the express intention to try to make it as broadly available as possible in order to save lives.