Government Response

The Government responded to this petition on Monday 9th September 2019

Adrenaline pens should be carried at all times. Back-up pens in public places could be a safety net but significant safeguards would be required. The government will look into the feasibility of this.

Adrenaline auto-injectors, commonly known as adrenaline pens, are intended for self-administration by a patient or carer, to treat anaphylaxis at the onset of symptoms. Anaphylaxis can progress rapidly and may result in death before emergency medical help has arrived. The sooner anaphylaxis is treated the more chance a patient has of a successful outcome.

Epipen is one brand of adrenaline pen available in the UK, other brands include Jext and Emerade.

A person at risk of anaphylaxis is recommended to carry two adrenaline pens at all times as sometimes one injection is not enough. Even if a patient responds to their own adrenaline pens, emergency medical help must always be summoned because the patient may deteriorate later on. It is therefore important for them to be supervised in hospital during the recovery period.

The Government recognises there may be situations where back-up adrenaline pens could be life-saving, for example where someone is not carrying adrenaline and is inadvertently exposed to a known allergen, or if they were to react to a previously unknown allergen.

However, any consideration of the benefit of back-up adrenaline pens in public places must be balanced against the risks. Serious harm could arise if adrenaline were to be administered inappropriately to someone who had collapsed for reasons other than anaphylaxis, such as an electrical disturbance of the heart.

In considering provision of adrenaline pens in public places, one must also consider the need for significant safeguards. Adrenaline pens do not offer a way to tell whether a patient has collapsed due to anaphylaxis, nor is it obvious to an untrained person how to administer them safely in an emergency. Therefore, training in the recognition and management of anaphylaxis and the correct administration technique would be needed to ensure the safe and effective use of adrenaline pens by individuals without medical training.
The situation for defibrillators is somewhat different as modern defibrillators can determine, from the electrical activity detected, whether a shock should be delivered to the heart and if so, the defibrillator will deliver it at the appropriate point in the electrical cycle. This removes the responsibility from members of the public to make an appropriate diagnosis.

The adrenaline pens would also need to be stored correctly and securely. Adrenaline breaks down quickly especially at high temperatures and at low temperatures the pens’ release mechanisms may not work as they should. This means that they would need to be kept indoors and away from extremes of temperatures. Expiry dates of pens would also need to be checked on a regular basis so that pens close to expiry were replaced with fresh pens. This is essential to ensure that the pens will be reliable. Security of storage would be another important consideration. For these reasons the Government had previously concluded that it would not be feasible to make adrenaline pens widely available alongside defibrillators.

Adrenaline pens are normally supplied against a prescription for an individual patient. However, in 2017 the UK government changed its medicines legislation to allow schools to obtain back-up adrenaline pens not issued against a prescription, for use in an emergency to treat anaphylaxis. This was accompanied by detailed guidance to provide a framework for training of school personnel in the safe and effective use of the back-up adrenaline pens. The legislation is presently restricted to schools, or educational establishments that would fall into the category of schools as defined in legislation.

The Government recently re-opened its consideration of wider availability to investigate whether the provision for schools to hold back-up adrenaline pens without a prescription could be extended to eating places and other establishments. This will be informed by the experience of wider availability elsewhere, as in Ireland where accredited training courses are linked to legislation on the supply of adrenaline pens without a prescription as a means to ensure that individuals or organisations are suitably qualified to hold and administer adrenaline pens safely and effectively.

In summary, the UK government will undertake a timely and thorough investigation into the possibility of making adrenaline pens available in public eating places and other establishments and in doing so will consult clinical and technical experts for their views. If the outcome is that the benefit of wider availability of adrenaline pens is considered to outweigh the risks, and appropriate safeguards can be put in place, the Government would look to implement further amendments to the medicines legislation in order to enable this.

Department of Health and Social Care