(4 days, 5 hours ago)
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The Minister for Secondary Care (Karin Smyth)
I beg to move,
That the draft Human Medicines (Amendments Relating to Naloxone and Transfers of Functions) Regulations 2024, which were laid before this House on 29 July, be approved.
I, too, congratulate you on your election, Madam Deputy Speaker; it really is a pleasure to see you in the Chair.
The draft statutory instrument will amend the Human Medicines Regulations 2012 to expand access to naloxone: a lifesaving medication that reverses the effects of an overdose from opioid drugs. In addition, the SI will keep the regulations current by updating references to Public Health England and the Health and Social Care Board, following the dissolution of those bodies.
Hon. Members will no doubt know of the devastating impact of illicit drugs. Drugs destroy lives, tear families apart and make our streets less safe. Almost 3,000 people died of drug misuse in England in 2022—the highest number since records began in 1993. Drug misuse deaths have doubled over the past 10 years, and people die from drug misuse at a tragically young age, often in their 40s. Almost half of drug misuse deaths in 2022 involved opiates such as heroin.
These deaths are avoidable. Dedicated drug treatment services provide the path to recovery, and my Department is continuing to invest in improvements to local treatment services, which have faced significant cutbacks. We also know that over half the people struggling with opiate addiction are not engaged in treatment at all. That means that significant numbers of an incredibly vulnerable population are at increased risk of accidentally overdosing and dying.
People who experience addiction often have multiple complex needs, and we know that there is a strong link between addiction and deprivation. The rate of drug misuse deaths in the most deprived areas of England is almost three times higher than in the least deprived. Nearly a third of people in treatment for drug or alcohol problems reportedly have a disability, around one in six have a housing problem, and around 70% have a mental health treatment need. Tackling this issue supports the Government’s health mission, ensuring that people can live longer, happier lives, as well as our collective efforts to break down barriers to opportunity and create a fairer society.
Naloxone is a highly effective antidote against opiate overdose. It can be administered quickly and safely by anyone in an emergency, but currently exemptions in the human medicines regulations targeted at specific providers enable supply only by drug and alcohol treatment services, which limits the reach of this lifesaving medicine. Widening the statutory framework will mean that more services and professionals are able to supply this medication. That means easier access to it for people at risk and their loved ones. In short, the legislation will save lives. We are already seeing the benefits of professionals outside the health service, such as police officers, being able to administer naloxone. North Yorkshire police have already saved seven lives since April, when naloxone was rolled out across the force.
The draft instrument proposes two key UK-wide changes to existing regulations. First, it will expand the list of services and professionals named in the regulations who are able to give out naloxone without a prescription. In short, that means that professionals such as registered nurses and probation officers will be able to provide take-home supplies of naloxone where appropriate, should they wish to do so. Secondly, we propose to establish national registration services across the whole of the United Kingdom. That will enable all other services and professionals who are unable to be named in the legislation, including housing and homelessness services, to register and procure naloxone, subject to the passage of this statutory instrument. I look forward to working with colleagues across the devolved Governments on this important issue; I thank them for their work to date, and their continued support.
I reassure hon. Members that we are not compromising on safety with these changes. This is an extremely safe and effective measure, even when administered by a layperson with no prior experience. It has an effect only if the person has taken opioids, and is already widely used across the UK and internationally. We are taking steps to mitigate any, very limited, risks associated with wider access. We will provide updated guidance for services in scope, and set out robust requirements for training and safeguarding. The new powers are enabling but not mandatory. The intention is not to create new burdens for services, but to provide an opportunity for provision based on local need. I am confident in the support for the changes across sectors, which was evident in the responses to my Department’s consultation earlier this year, over 90% of which were in support.
I recognise the long-standing calls for these changes among experts in this area. For instance, the Advisory Council on the Misuse of Drugs is an independent expert body that advises the Government on drug-related issues in the UK. In 2022, it published a review of naloxone implementation that called for more work to widen access to the medication. Similarly, Dame Carol Black’s independent review of drugs also highlighted expansion as a vital harm-reduction measure. I pay tribute to Dame Carol for the work that she has done to drive improvements in drug treatment and recovery, and express my gratitude for her continued advice and expertise.
The importance of this work only continues to increase as time goes on. Hon. Members may be aware of the growing threat posed by synthetic opioids. These synthetic drugs, such as nitazenes and fentanyl, are often more potent and more deadly. The Government are taking a range of steps to prevent the rise of these dangerous drugs in the UK, but the availability of naloxone will be vital to our ability to respond and save lives.
Addiction is not a choice. It is often fuelled by wider issues, such as trauma and housing instability. This is a complex public health issue and must be tackled as such. We must change the narrative on addiction to one that is about preventing drug use, reducing harm and enabling recovery. The changes in the legislation are simple and low risk, but have the potential to save countless lives. On that basis, I commend the draft regulations to the House.
Dr Ben Spencer (Runnymede and Weybridge) (Con)
It is not often that one speaks in this place on changes to the law that will have the direct result of saving lives, but once the draft regulations pass, as I hope they will this evening, we expect them to save many peoples’ lives. Today is a very special occasion. I do not say this to disparage people who work in the public health industry, but at its core, public health is not about flash or pizazz; it is about incremental changes that make a real difference to people’s lives, and have an ongoing, cumulative effect. Naloxone reverses the effects of opiate intoxication or overdose. It stops people from dying of accidental or deliberate overdoses of heroin and other opiate drugs, and opiate medications. It is quite literally a life-saving medication. Accordingly, it is one of the World Health Organisation’s essential medications.
Tomorrow is World Suicide Prevention Day, so I am pleased that we are supporting and debating a motion to expand access to and administration of a vital antidote to opiate poisoning. Suicide is the biggest cause of death in men under the age of 50. The stats vary, but while I was looking for the best and most recent data, I read that around three quarters of suicides each year are by men, and that suicide is the biggest killer of under-35s, impacting people from all walks of life. Many people are affected by such deaths. On World Suicide Prevention Day, we remember all those affected by suicide, and the work that we need to do to reduce suicides through public health measures and mental health service provision and treatment.
The use of highly addictive, lethal opiates, perhaps in combination with other substances, is often responsible for death as a consequence of drug misuse. In 2022, opioids were involved in 73% of drug misuse deaths in England, and 82% in Scotland. The last Government worked very hard to make progress on reversing the upward trend in drug poisoning deaths. Our 10-year, cross-departmental drugs strategy, published in 2022, aimed to prevent nearly 1,000 deaths in England by 2025. The naloxone roll-out has been highly effective in reducing drug misuse deaths by treating the effects of opiate overdoses.
There have been several regulatory changes that have expanded access in the last decade. Under the last Government, the Human Medicines Regulations were approved in 2012 to regulate the supply and use of drugs in the UK. That was followed by further amendments in 2015 and 2019, which focused on expanding access to naloxone for emergency use. The last Government then called on Dame Carol Black to lead an independent review of drugs policy. I thank Dame Carol for her work in this space, and indeed everyone working in this area, and those who contributed to our consultation earlier this year.
One of Dame Carol’s key recommendations was that more individuals supporting drug users be able to access and give out naloxone. I am pleased that she welcomed the proposals to expand access to naloxone earlier this year. When we launched a consultation seeking views on improving naloxone access through named services and professionals, as required by the Medicines and Medical Devices Act 2021, there was strong support. There were over 300 responses, of which a third were from organisations and over 200 from individuals and professionals. More than 80% were supportive of improving access through named services and professionals, and of introducing registration with a naloxone supply co-ordinator.
I am pleased that Ministers have followed the direction of the previous Government in legislating to expand access to naloxone to more healthcare professionals and services, as they want and need it. That will build on work across the UK to reduce the scourge of drug-related deaths caused by opioids. On this legislation, the Government will have the support of His Majesty’s loyal Opposition, and I encourage all colleagues from across the House to give it their backing.
Of course, I have a question for the Minister about training, which is critical. During my psychiatric training at medical school, a key thing instilled into my head about the use of naloxone is that it is a wonderful drug for the first 30 minutes, but then it starts to wear off. It has a short half-life—the time that it takes to leave the body—and then the effects of opiate overdose can start to reoccur, especially when we are talking about long-acting opiates, so although it fixes one problem, another problem is coming down the track. The patient must have adequate treatment quickly so that they do not suffer after effects when naloxone wears off. Can the Minister reassure me that for those involved in the administration of naloxone kits and aftercare—she mentioned families, and broader access for homelessness charities—the training component is as secure as possible, so that everything is done to avoid further drug-related deaths?
Madam Deputy Speaker (Judith Cummins)
I call the Liberal Democrat spokesperson.
Bobby Dean (Carshalton and Wallington) (LD)
It is good to a hear consensus building across the House on naloxone because, as we have heard from other Members, it is a lifesaver. Since its roll-out in the UK, that highly effective antidote to opioid intoxication has doubtlessly saved hundreds of lives and prevented many more harmful overdoses, as organisations working in my community have known for some time.
On the day that my local branch of Cranstoun—the harm reduction charity—received its first supply of naloxone, staff members noticed that someone was overdosing in the reception area. They were still unpacking the pallet, but they were able to get access to the medicine, administer it, bring the person back around, and then help them further. Within an hour after that vital medication was received, it potentially saved a life in my borough. The local staff describe naloxone as a game changer. That is why I and the Liberal Democrats welcome this motion to expand access to that vital treatment.
Naloxone is not a difficult drug to administer: just 30 minutes of training can be enough to equip somebody to treat a person in need. Naloxone is also low-risk. The person administering it does not need to know for sure what drug someone is on: if they have taken an opioid, Naloxone will help; if they have taken something else, it will likely do no harm. The combination of it being easy and safe to use, along with its life-saving potential, means that, as long as the correct training is given, it is common sense to get naloxone into as many hands as possible. That is particularly true given the frightening rise of the use of synthetic opioids, such as nitazenes, in our country. Most people are aware of the dangers of one particular opioid—heroin—but the crackdown on supply in Afghanistan means that a new synthetic alternative is rapidly taking its place in the market. Nitazenes are estimated to be anywhere between 30 and 500 times as potent as heroin. That is scary. If we do not act fast, we could be dealing with a national emergency comparable to the fentanyl crisis sweeping across the United States. Although I welcome the measures, this urgency means that I must encourage the Government to think quickly about going further.
The expanded roll-out of naloxone to police, prison, probation and youth justice services is welcome, but I ask the Minister to monitor the success of that expansion closely, to listen to the organisations on the ground, and to keep under review whether it is practical and desirable to expand access even further. For instance, some charities have called for taxi drivers and nightclub door staff to be able to access if they want it. That would have to go alongside the appropriate training, so that they can recognise the effects wearing off in 30 minutes. If that training is in place, we should expand access further still. If we build the evidence base, we can be led by it and ensure that harm reduction measures reach as many people as possible.
Going further also means taking a whole-system approach to drugs policy—from appropriate sentencing to investment in addiction services and other specialist support for users. We have tried the tough talk and the war-on-drugs route in this country, but they have left us with one of Europe’s worst drug-related death rates. If we transferred the departmental lead on drugs policy from the Home Office to the Department of Health and Social Care, it would go a long way towards our recognising that our drugs policy should ultimately be driven by the desire to reduce harm and save lives. The Liberal Democrats support this measure to improve access to naloxone, and I thank the Minister for bringing it forward.
Jim Shannon (Strangford) (DUP)
I thank all those who have made maiden speeches and valuable contributions today. As the Democratic Unionist party’s health spokesperson, it is important that I speak on this issue to provide, as I always do, a Northern Ireland perspective for the Minister, the shadow Minister and all others who have spoken. The experience in Northern Ireland mirrors that in the rest of the United Kingdom. I add my support for what the Minister has brought forward—nobody in the Chamber is unable to see the benefits.
As Members will be aware, naloxone is a life-changer. The DUP has consistently supported the administration of naloxone by the Police Service of Northern Ireland and the ambulance service. The legislation before us will extend that remit to further professions and staff, as well as confirm necessary rules around storage and training. I have talked to colleagues and friends back home about this issue. They were clear that we need to address it, and the provisions are a method of doing just that.
The figures around opioid-related death in Northern Ireland are absolutely heartbreaking: 154 drug-related deaths were registered in 2022. Although that represents a reduction of 59 from the 213 drug-related deaths registered in 2021, I think we can all agree that that is simply too many deaths. We must do whatever we can do reduce that number and the impact on all those families who wish something was available to save lives. Since 2012, deaths from drug-related causes have risen by 98% in Northern Ireland, They have gone from 110 to a peak of 218 in 2020, and to 213 in 2021. The 2022 total of 154 represents a 40% increase on the number of drug deaths registered a decade ago. All those figures show a worrying trend.
My constituency gained new territory from South Down in the boundary changes prior to the last election. Drug-related activity there is incredibly worrying, and I am taking up those issues with community representatives and the PSNI. Of the 154 drug-related deaths registered in Northern Ireland in 2022, over two thirds were of men. If we look at the number of deaths by age, the 25-to-34 and 35-to-44 age groups accounted together for 56% of all drug-related deaths in 2022. Each year, over half of drug-related deaths involve an opioid. In the years from 2020 to 2022, the death certificates for an average of 118 drug-related deaths mentioned an opioid.
The Minister mentioned homelessness. The provincial press back home—I think it was a newsletter that I read before I left this morning—mentions an increase in the number of homeless people in Northern Ireland. We have never before experienced such figures in all these years. The Minister is right to underline that issue, because it is not just happening in London, Birmingham, Manchester, Newcastle, Glasgow or Cardiff; it is happening everywhere. It is happening in Northern Ireland. The numbers of people looking for properties and accommodation in my constituency are at some of the highest levels I have ever seen, in all my years as an elected representative—as a councillor, as a Member of the Northern Ireland Assembly and latterly as a Member of Parliament.
The need for the appropriate use and storage of this medication, which can bring people back from the brink and hopefully give them a chance of a normal life, is all too clear. I also ask the Minister to outline whether, within the legislative process, there is any protection for public health staff. That is very important; I say that respectfully, because I know how important it is for the staff I speak to back home that they receive protection from legal liability for the administration of naloxone. We need to ensure that staff do not fear stepping in and that they fully understand that their intentions to do good in the circumstances will come with a cloak of protection. I ask that for the sake of the people I represent; I know that the hon. Member for South Antrim (Robin Swann) will speak shortly, with his vast knowledge of health issues, and will probably reiterate the same point.
It is a terrible thing to understand, but whenever I speak to medical personnel, they say that there must be no hesitancy about stepping forward for fear of repercussions. Many people wait to see whether someone else will step forward—not because they lack confidence in their ability or because of a mentality that they are off the clock and about to go home, but because of a deep fear that if their help is not successful, they will face repercussions. The situation needs to be clarified for the workers allowed to administer the drug, who must always be protected while administering it.
I very much welcome the Minister’s proposals, and I look forward to the House’s endorsement of the draft regulations. There has been magnanimous support for them from the shadow Minister and the hon. Member for Carshalton and Wallington (Bobby Dean), as I am sure there will be from the hon. Member for South Antrim and from other Members who contribute. This is the right thing to do. Let’s do it. I look forward to the Minister’s response.
Siân Berry (Brighton Pavilion) (Green)
Alongside hon. Members who have spoken on behalf of other parties, I welcome the changes. Naloxone saves lives: it brings people back from one of the most final and, in many cases, fatal mistakes they can make.
This is a really important change to make, but I hope that the regulations will be kept more closely and continuously under review, rather than us just coming back to the topic in two years’ time, as is mandated. Drugs policy must be evidence-led. As we see the benefits, hopefully quickly, of wider access and of more people having naloxone available in their work, it might be a good idea to see whether we can widen access any further.
I have been reading the careful, evidence-based and considered responses from a range of different charities, including Release. It seems that there are quite a few groups of workers who ought to be able to use the first route—the expanded definition of workers who can easily access and use the drug—rather than the second route, under which they access it not directly but via a separately accredited provider of naloxone. As Release says, one of the simpler ways to achieve that might be to make it a pharmacy-available drug rather than a prescription drug, with some exceptions, as we have now.
I do not want to say, “Don’t do this”; I am saying, “Do it, then review it and go further if you can.” Many groups of workers will have the experience of unexpectedly meeting people who are going through overdose more often than others will in their daily work. There are now also more people working with those who will unexpectedly be going through overdose because of the wider prevalence of synthetic opioids and the other routes to becoming a victim of opioid overdose. They include student welfare workers, youth workers who are not necessarily involved in youth justice, local councillors potentially, night-time venue staff, transport workers, who are not currently on the list, street cleaners and park workers. Once we see the benefits of wider groups being able to access naloxone easily, it may become obvious that some of these other groups ought to be trained and given simple access—potentially through pharmacies to anyone who asks.
This is not to quibble. I am obviously restating quite a lot of what was said in the consultation. I hope that we continue to look at the evidence and expand this as quickly as possible. Every life that we could save, we should save. The harm that could be done is minimal in comparison.
Robin Swann (South Antrim) (UUP)
I thank the Minister for bringing this statutory instrument to the House. As I think all hon. Members have said, naloxone has proven itself time and again to be the lifesaving drug that reverses the effect of a devastating opioid overdose. That is especially important because opioid-related deaths now make up the largest proportion of deaths from drug misuse across the UK; in Northern Ireland, as the hon. Member for Strangford (Jim Shannon) said, they represent over 50%.
The purpose of these amendments, which I fully supported when I was Minister of Health in Northern Ireland, is to increase the number of services, professionals and organisations that can supply naloxone without prescription or even a written instruction. In June 2021, when I was in post in my Department, the then Government agreed to a UK-wide public consultation on the proposed changes to the Human Medicines Regulations 2012, which sought views on the viability of proposals to widen access to naloxone by expanding the list of services and individuals who can give it out without a prescription or a written instruction.
I support the contribution from the hon. Member for Brighton Pavilion (Siân Berry). We need to keep the matter continually under review, with additional training to ensure that we can get naloxone into as many people’s hands as possible, so that it can be administered at the right point at the right time.
I thought at the time, and I still think today, that these changes are not just perfectly sensible; they are a small legislative step that will have big, real and life-changing consequences. I am glad to see that they have received support across the House. Thankfully, the consultation indicated strong support for each of the proposals, including from those who responded solely from the Northern Ireland perspective. The evidence is clear: countless lives have been saved as a result of naloxone. I am confident that today’s changes will help to prevent more people who use drugs from sadly losing their lives to that use.
Karin Smyth
This evening, I am standing in for my hon. Friend the public health Minister, who could not be here. I might offer to stand in again, such has been the rare outbreak of unanimity across this House. I know from my own experience in the sector that that is often the case with public health measures, as so much work is done in the background, and there is broad agreement on the need for prevention and the great work that has been done before. I thank Members, particularly the Opposition spokespeople, for their support this evening and their comments, which are testament to the work done by officials and by the previous Administration to get us to this point. The consultation was very well received.
I support the comments of the Opposition spokesperson, the hon. Member for Runnymede and Weybridge (Dr Spencer), about recognising World Suicide Prevention Day. Suicide, particularly among men, is something that has affected most families—most of us, I think—and it has certainly affected many people in this House, so the hon. Member is right to raise those issues. He asked about training, and I can confirm that training and data reporting requirements will be attached to this measure. That training will be required to meet some broad objectives, including the safe administration of naloxone, safe storage, and how to train someone else to handle and administer it safely. Training on its use is already well established in most parts of the country alongside naloxone provision, and each product has its own established training set out by the manufacturer. I have heard the professional points that the hon. Member has raised, and if he has any further requirements, my hon. Friend the public health Minister would be happy to write to him.
Other excellent points were made about keeping this issue under review, which we absolutely will be doing. The hon. Member for Brighton Pavilion (Siân Berry) made her points well, and they are now on the record. The Government will be looking to work on our prevention strategy across all Departments—including the Ministry of Justice, the Home Office, the Ministry of Housing, Communities and Local Government, the Department for Work and Pensions, and the Department for Education—to ensure that we take a preventive, public health-led approach to this issue. I also thank the hon. Member for South Antrim (Robin Swann), who has brought his expertise in Northern Ireland into this House for this debate. I am sure this issue will come back before the House in the future.
Jim Shannon
In my contribution I asked a question—which the hon. Member for South Antrim (Robin Swann) has reminded me of—about ensuring that medical staff who have the expertise to administer naloxone, but do so outside of their job, are covered and that there is no comeback against them. Could the Minister answer that question?
Karin Smyth
I understand that there are some concerns about that issue, and we will make sure that the hon. Member receives a full answer from my hon. Friend the public health Minister.
In short, these changes will widen access to life-saving medicine. I am sure hon. Members will agree that any death from an illicit drug is tragic and preventable, so I am pleased that we are taking this step and that we have the support of the House this evening for reducing drug-related deaths. On that basis, I hope hon. Members will join me in supporting these important regulatory changes, which I commend to the House.
Question put and agreed to.
Resolved,
That the draft Human Medicines (Amendments Relating to Naloxone and Transfers of Functions) Regulations 2024, which were laid before this House on 29 July, be approved.
Gareth Snell (Stoke-on-Trent Central) (Lab/Co-op)
On a point of order, Madam Deputy Speaker. Last Thursday, during questions to the Leader of the House on the statement of business, I asked a question about BTecs in relation to colleges. Although it is registered in the Register of Members’ Financial Interests that I am a governor of two colleges, I failed to draw the House’s attention to that fact before asking my question. The two colleges that I am a governor of are affected by the answer, so I take this opportunity to place that on the record, and offer my unreserved apology to the House accordingly.
Madam Deputy Speaker (Judith Cummins)
I thank the hon. Member for his point of order and his clarification. I am sure the record will stand amended and corrected.
Business of the House (Today)
Ordered,
That at today’s sitting the Speaker shall put the Questions necessary to dispose of proceedings on the Motion in the name of Lucy Powell relating to the Modernisation Committee not later than one hour after the commencement of proceedings on the Motion for this Order; such Questions shall include the Questions on any Amendments selected by the Speaker which may then be moved; proceedings on that Motion may continue, though opposed, after the moment of interruption; and Standing Order No. 41A (Deferred divisions) shall not apply.—(Lucy Powell.)