Extern News Opioid Overdose in NI – The Bigger Picture Opioid Overdose in NI – The Bigger Picture by Chris Rintoul, Manager of Extern’s Drugs and Alcohol Consultancy Service Heroin use has increased rapidly here, particularly in Belfast. This is reflected in the NIAS figures reported in the Belfast Telegraph (24.05.19), which reveal a doubling of the rate of opioid overdose in the space of two years. It’s a highly concerning development, and one which mirrors what Extern sees on a daily basis. What the NIAS figures do not tell us, however, is the number of times naloxone is administered by non-NIAS personnel. Naloxone is also given out by Extern, and other charities and agencies, to people at risk of overdose, as well as others connected to them, such as those working within homelessness services. We may never know if they needed to use the naloxone. Each week it is also administered numerous times by hostel workers, other drug users, and our own staff. In Extern, we know that there are at least 58 people walking around Belfast today, whose lives were saved because our staff were there to administer naloxone to them during the last year. Ready availabilityThe increase in the availability of heroin here has led to a rise in the number of people using the drug in Belfast city centre. With that we see a range of associated issues, including discarded injecting equipment, and inevitably, an accompanying, rather simplistic portrayal of the issues, often on social media. It is a conversation which suggests that dependent heroin use by someone is a sign of moral failure on their part, rather than a chronic but treatable health condition.A health issueBut if we want to get to really get to grips with this issue, before it escalates further, then we need to be highlighting that such a simplistic portrayal is wrong. A chronic drug dependency is a complex health issue and one linked to education, poverty and more. We need to realise that developing a chronic drug dependency, whether that is to heroin, prescription drugs or alcohol, is something that can impact on any family, at any time. That’s a fact borne out by what we see in Extern every day. As a society it is vital we all realise that we need to invest in services to support people so they can begin to stabilise. This is critical. Drug dependence is chronic, with relapse being an in-built part of stabilisation and recovery. We therefore need to be investing in additional support services – rehabilitation and residential support services, which will enable people to embark on a journey to leave their dependency in the past. At present there are lengthy waiting times here for detoxification or treatments involving a substitute drug like methadone. This needs to be urgently addressed, and treatments made readily accessible across all of our Health Trusts, as lengthy waits put people at further risk and are extremely distressing for their loved ones. In short, there are many parts of this puzzle which need to be considered, including other evidence-based approaches such as Heroin Assisted Treatment and Medically Supervised Injecting Centres. What is crucial, however, is creating compassionate and practical health services, that connect with people who find themselves injecting drugs, and support them in a non-judgemental, person-centred way. Never again should we have to witness such a rise in naloxone administrations.