Summary/Abstract

The country with Western Europe's worst heroin overdose rate to trial Naloxone spray in Oslo and Bergen, its two most populous cities.
Norway is poised to start trials of a nasal spray that reverses the effect of a heroin overdose, in a move that could encourage other countries to follow suit.

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Despite its oil wealth, well-funded drug rehabilitation programs and generous welfare safety net, Norway has western Europe's worst overdose rate. Campaigners have long been urging the government to approve the rollout of the nasal spray, which administers Naloxone to people who have taken an overdose, in effect acting as a kind of liquid defibrillator.

Now, regulatory approval permitting, the Norwegian trials will offer the kit in Norway's two most populous cities, Oslo and Bergen, later this year. Philipp Lobmaier, the doctor leading the trials, said that while Naloxone was no silver bullet, he was confident it would cut down the number of ambulance cases. "I hope we will soon be able to show fewer incidents of paramedics being called out for overdoses," he said.

Britain's Advisory Council on the Misuse of Drugs has been saying since 2012 that it would like Naloxone to be available to UK users without prescription. Addicts in Wales and Scotland are given injecting kits on prescription. The nasal spray is considered superior, however, as it is easier for the uninitiated to use and reduces the likelihood of needle pricks spreading hepatitis C or worse.

Since 2002, about 240 people have died each year in Norway from heroin overdoses, more than have died from traffic accidents.

Naloxone counteracts the effect of opioids on the central nervous system. The kits will be available from non-medical environments where users are more likely to feel safe, such as drop-in centers, hostels and Oslo's safe injecting room. Critically, according to Martin Blindheim, who is drawing up the national overdose strategy for the Norwegian health directorate, friends and families will also be able to obtain kits and be trained to use them. "The most important people will be the mothers," he said.

In Vestby, just south of Oslo, Wivian Koppang, whose 21-year-old daughter Madeleine died from an overdose three years ago, welcomed the Naloxone trial but said the government was still dragging its feet on other solutions. "It must do more to save our children," she said. Calls from treatment centers and hospitals in Bergen to allow doctors to prescribe heroin to the most at-risk cases have been flatly rejected. There is also no appetite at national level to have safe injecting rooms in cities outside Oslo.

Last year, Oslo's injecting center was renovated to allow users to smoke the drug there as well. But since the new Conservative-led government came into office in October the change in regulations to allow the new smoking booths to be used has been kicked into the long grass.

In a still conservative country, harm reduction strategies are seen by many as inevitable steps towards a fully-fledged libertarian drug policy. Like preaching celibacy to tackle teenage pregnancy, abstinence and rehabilitation are regarded as the key. "In the long term we all want rehabilitation," said Blindheim. "But dead people cannot be rehabilitated."