Finding a needle in a haystack. Take-home naloxone in England 2017/18

One of the most important and pressing challenges in UK drug policy today is preventing drug-related death. Drug-related deaths have increased significantly in recent years and the United Kingdom now has one of the highest rates of drug-related deaths in Europe (70 per million). Many of these deaths are due to fatal opioid overdose - more than half (1,829) of the drug poisoning deaths registered in 2017 across England (3,482) involved an opiate, such as heroin. It is therefore crucial that efforts to prevent drug-related deaths in the UK include specific interventions aimed at preventing fatal opioid overdoses, such as Take-Home Naloxone (THN) programmes.
Naloxone is an essential life-saving medication that counteracts the effect of opioids and is used to reverse opioid overdose. THN programmes make naloxone available for people to take home, typically without a prescription, and include training on overdose management and naloxone administration. THN programmes are widely endorsed, as evidence has shown that THN programmes reduce fatal opioid overdose and are cost-effective. THN programmes can operate in both community and custodial settings, such as prisons. People released from prison are particularly vulnerable to opioid overdose; the risk of relapse and weakened tolerance levels makes the immediate post-release period fatal. Estimates suggest that there is a "three- to eightfold increased risk of drug-related death in the first 2 weeks after release from prison compared with the subsequent 10 weeks" and "of prisoners with a previous history of heroin injecting who are released from prison, 1 in 200 will die of a heroin overdose within the first 4 weeks".
In October 2015, regulations were introduced permitting naloxone to be supplied without a prescription, with the aim of making naloxone more widely available across the UK. Scotland, Northern Ireland and Wales all have national naloxone programmes and report on THN provision, whereas in England the responsibility to provide THN is devolved to local authorities and there is no requirement to report on THN provision at the national level. This report updates Release's previous reporting on 'Take-home Naloxone in England: 2016/17', which was the first independent analysis of take-home naloxone provision in England since the October 2015 regulations. In addition to updating the findings on THN provision in community settings, novel findings are presented on THN provision in custodial settings, such as in prisons, across England.