The National Naloxone Oversight Quality Assurance Group seeks to expand the availability of naloxone, to reduce drug-related harm. In this article, the Group’s Chair, Dr Denis O’Driscoll, explains the role of community pharmacists in supporting this expansion.
The HSE is dedicated to delivering action 2.2.30 b) of the National Drugs Strategy, Reducing Harm, Supporting Recovery 2017-2025, which focuses on expanding the availability of naloxone to people who use drugs, their peers, and family members, to reduce drug-related harm.
Naloxone is a prescription-only medication that is used as an antidote to temporarily reverse the effects of opioid drugs like heroin, morphine, methadone and emerging synthetic opioids for example nitazenes if someone overdoses. Naloxone can help to keep a person alive until an ambulance arrives.
In January 2024 the HSE launched an Opioid Overdose Awareness and Naloxone Administration Training course on HSeLanD, the HSE’s online learning and development portal. This course was developed by the National Social Inclusion Office to provide learners with the skills to recognise, intervene and respond to an opioid overdose, including the administration of naloxone. It is accessible to all HSeLanD users and is designed for both clinical and non-clinical frontline workers, as well as volunteers who might witness an opioid overdose
Organisations which complete the two-module training can notify the Health Products Regulatory Authority (HPRA) of their intention to procure naloxone from a pharmacy or other supplier for supply and administration in an emergency situation.
Jenny Smyth, HSE Naloxone Project Lead, who has co-ordinated the launch of the HSE’s naloxone training course said, “As of late July, 1,462 learners have already completed the Module 1 course in the five months since it launched on HSeLanD. It has been vital to ensure that following this, a Module 2 course is available for learners to enrol on in their local area. We’ve established a network of 26 HSE Module 2 facilitators across Ireland with facilitators in each HSE Health Region including three Community Engagement Officers within the National Ambulance Service. The face-to-face in-person module is essential to provide learners with the practical skills to recognise, intervene and respond to an opioid overdose, including the administration of naloxone.”
Ms Smyth continued, “It creates the opportunity for learners to ask any questions they may have from Module 1, and it is a planned time to practice using the types of naloxone that they will have access to. Participants become familiar with the medicines so they are confident and competent to administer naloxone should they witness an opioid overdose. We always reassure participants that when they call 999 or 112 the emergency call operator will talk them through each step of how to administer the naloxone which may save the person’s life. Based on international literature on survival outcomes, at least 18 lives were saved through the administration of naloxone on 461 occasions in overdose situations last year. It’s very humbling when someone tells you that they have, or they know someone who has responded to an overdose after participating in training and that the person could be alive because they had naloxone and knew how to administer it.”
In the context of the Emergency Medicines Legislation, the PSI sets the standards of training for pharmacists to be competent to administer these medicines in an emergency.
The aim of the naloxone training is to enable pharmacists to diagnose and treat suspected opioid overdose and to supply and administer naloxone in emergency situations competently and safely.
The PSI has reviewed and approved the HSE Opioid Overdose Awareness and Naloxone Administration Training (Module 1) as a critical part of the training requirements for pharmacists, empowering them to supply and administer life-saving medicines or reduce severe distress during emergencies. This is in accordance with Regulation 4B of the Medicinal Products (Prescription and Control of Supply) Regulations.
From June 2024, pharmacists who complete the following listed training, are permitted to administer naloxone in an emergency situation:
While the HSE’s Opioid Overdose Awareness and Naloxone Administration Training (Module 2) face-to-face training is available for pharmacists, it is not mandatory. However, pharmacists may consider undertaking this in-person training to enhance their preparedness and competence.
The PSI website has been updated to reflect the new training requirements for pharmacists wishing to supply and administer naloxone in emergency situations. The relevant page on the PSI website can be accessed at psi.ie > Education and Training > Emergency Medicines Training.
When registering on hseland.ie, community pharmacists should register themselves in Section B, and select ‘Community Pharmacist’ option. You can enrol on the Module 1 course by logging into HSeLanD and using the ‘search a module’ tool with the key word ‘naloxone’.
The two pharmacy naloxone administration record keeping templates (Form 6 and Form 7), are available to download at hse.ie/eng/about/who/primarycare/socialinclusion > National Social Inclusion Office > Addiction Clinical Matters > Naloxone. They should be completed and securely stored in-line with pharmacy practice requirements.
The Irish Institute of Pharmacy (IIOP) issued communications on 9 July 2024, advising pharmacists that the current programme, available through the IIOP website, Diagnosis and Treatment of Suspected Narcotic (i.e. Opioid) Overdose and the Supply and Administration of Naloxone Training Programme, will be retired shortly, in accordance with their policies when a programme comes to the end of its accredited period.
Professor Eamon Keenan, HSE National Clinical Lead, Addiction Services said; “We have seen the lifesaving benefits of naloxone during the emergence of synthetic opioids in Ireland. In many cases it was administered before emergency services arrived on the scene, and this reinforces the need to make it more readily available. The HSE welcomes the approval by the PSI Registrar of the HSE’s Module 1 course as part of the training requirements for pharmacists. This course approval expands pharmacists’ accessibility to training to empower them to be able to administer naloxone if someone experiences an opioid overdose. Pharmacists who opt to complete this training will support the expansion of naloxone availability in pharmacies across Ireland, which can be used in an emergency situation and can save lives.”
Pharmacists can supply a prescription-only medicine, of which naloxone is one, that a Listed Organisation has notified the HPRA for procurement. Pharmacists must check the register of Listed Organisations on the HPRA website to confirm that the organisation, accountable person and medicines requested on the signed order have been notified to the HPRA, and all details are correct.
The PSI has produced guidance for pharmacists on the supply of emergency medicines to listed organisations for use under this legislation, which can be accessed at psi.ie.
I am currently the Independent Chair of the National Naloxone Oversight Quality Assurance Group. While in my role as Chief Pharmacist at HSE Addiction Services, I led and managed the Naloxone Demonstration Project. The Project was established by the HSE in 2015 to test the feasibility of making naloxone available for use by opioid users in order to prevent death from overdose. The Demonstration Project was under Action 40 of the previous National Drugs Strategy (2009-2016).
I am very grateful to the PSI and the panel of experts for the review they conducted of the HSeLanD training programme, ‘Opioid Overdose Awareness and Naloxone Administration Training (Module 1)’, and to the Registrar for her approval for it as part of the training requirements for pharmacists. I look forward to supporting pharmacists to complete the required training, so naloxone is available to improve the health outcomes for people who use drugs. This will commence with my pharmacist colleagues in our LloydsPharmacy and McCabes nationwide.
There are currently two types of naloxone available in Ireland:
Denis O’Driscoll,
Superintendent Pharmacist, LloydsPharmacy Ireland,
part of PHX Ireland; Vice President of the PSI Council; and Chair of the
National Naloxone Oversight Quality Assurance Group
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