Plea for Naloxone
Although the Netherlands has relatively few opioid overdoses in comparison to other countries, in recent years there has been a slight increase in deaths caused by these substances. In 2014, 40 people died from opioid overdoses; in 2019, that number rose to 124; and in 2022, it reached 170. One explanation for this increase is the emergence of other opioids, such as fentanyl and oxycodone, in addition to heroin, methadone, and morphine. And as if that weren’t enough, a new threat is on the horizon: nitazenes, a substance even stronger than fentanyl that belongs to the category of synthetic opioids.
One of the most effective ways to prevent an opioid overdose is through naloxone (also known as Narcan). This medication has been used mainly in emergency medicine since 1970 because it can reverse life-threatening opioid overdoses. It allows a person to breathe again, removes them from acute danger, and gives them time to wait for emergency services.
However, in the Netherlands, the use of naloxone is strictly regulated. It can only be administered by a medically trained person in a medical setting. This means that in situations outside the reach of professional help—such as on the street or in a home—the window of opportunity to save a life can be missed more quickly. There is also limited access to naloxone in places where opioid users frequently gather, such as drop-in centers, user spaces, or at MDHG.
In 16 European countries, including Scotland, France, and Germany, laws and regulations have been adjusted in recent years to allow naloxone to be obtained without a prescription at pharmacies, and provided to users themselves, without the need for medical training. Opioid users and the individuals surrounding them receive training under the names “Peer-to-peer Naloxone” or “Take-home Naloxone” to learn to recognize signs of overdoses and administer naloxone. Multiple studies have shown that this model saves lives without posing a risk of misuse. There is also no evidence of harmful effects from naloxone, other than the possibility of temporarily triggering acute withdrawal.
Naloxone is available in three forms: a pre-filled injection, a nasal spray, and a glass vial from which liquid must be drawn with a needle. The pre-filled syringes and nasal sprays especially facilitate use by non-professionals in emergencies. In countries like Norway, Sweden, Denmark, and Finland, ready-to-use naloxone nasal spray kits are available. In 2022, the Belgian High Health Council also recommended making ready-to-use naloxone kits (preferably in the form of nasal spray) available for free and without a prescription.
MDHG has long advocated for naloxone to be available for users, their relatives, drop-in centers, user spaces, and other care providers. The urgency for this was not strongly felt (even by us) until the emergence of increasingly dangerous opioids. It is now time to take action. More people should have access to naloxone, and we should train them on how to use it.
Perhaps the threat of nitazenes will turn out to be less severe than anticipated; let’s hope so. But it is unwise to wait until things go wrong. By the time nitazenes become a real problem, there will be endless discussions, and for many, it may be too late. We don’t have to reinvent the wheel: other countries have proven that it works. Let’s adjust the legal frameworks for administering naloxone and make it available now so that it is ready when it is needed.
By Leonie Brendel