Never use alone, and carry naloxone. Overdose risk is highest after a period of abstinence (release from prison, after detox or hospital) when tolerance has fallen. Naloxone saves lives when given early.
Core services
- Needle and syringe programmes (clean equipment, sharps return)
- Hepatitis B vaccination and blood-borne virus testing (HIV, hepatitis B and C)
- Safer injecting advice and wound care
- Referral to opioid substitution treatment
Overdose prevention
- Take-home naloxone with training for the person and household
- Avoid mixing opioids with benzodiazepines, alcohol or other sedatives
- Beware reduced tolerance after any abstinence
- Awareness of potent contaminants (fentanyl, nitazenes); start low after a break
Prevention / education
- Take-home naloxone
- Avoid mixing with alcohol or benzodiazepines
- Do not use alone
Overdose recognition
- Unresponsive, slow breathing, blue lips
- Call 999, give naloxone
- Recovery position
Active overdose
- Apnoea or arrest
- Repeat naloxone, rescue breaths
- Stay until the ambulance arrives
Engagement
1
1. Non-judgemental
Build trust and keep contact; every encounter is a chance to reduce harm and offer treatment.
Build trust and keep contact; every encounter is a chance to reduce harm and offer treatment.
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2
2. Naloxone
Supply and train the person and those around them; explain re-dosing and that it is short-acting.
Supply and train the person and those around them; explain re-dosing and that it is short-acting.
↓
3
3. Physical health
Treat injection-site infections (cellulitis, abscess, DVT) early; tetanus status; check for endocarditis if febrile.
Treat injection-site infections (cellulitis, abscess, DVT) early; tetanus status; check for endocarditis if febrile.
↓
4
4. Recovery
Offer OST and psychosocial support when the person is ready; address housing and social needs.
Offer OST and psychosocial support when the person is ready; address housing and social needs.
Key messages for users
- Do not use alone; tell someone and keep naloxone nearby
- Tolerance falls fast after a break: use less
- Mixing with alcohol or benzodiazepines is especially dangerous
Pitfalls
- Assuming one naloxone dose is enough (it wears off)
- Not warning about reduced tolerance after abstinence
- Missing endocarditis or DVT in injectors
- Judgemental care that drives people away
MedPrep - www.medprep.uk - Educational revision aid only. Not clinical guidance. Doses are adult examples; check the BNF, current guidelines and local policy, and seek senior advice. Nov 2026