Naloxone

Keep Calm and Carry Naloxone

Saving lives simply

Naloxone is a life-saving medication that can reverse an opiate/opioid overdose by blocking the effects of an opioid drug or medication (such as heroin, methadone, morphine, codeine, etc). Naloxone is safe to use, non-addictive and has no active effect other than to reverse opioid overdose. Administering naloxone can keep a person alive and breathing until the ambulance arrives. Naloxone is a short-acting medication so it is vital to call an ambulance and continue to monitor the overdosed person. It is important to use naloxone in addition to calling an ambulance, not instead of calling an ambulance!

There are a number of circumstances that can be considered risk factors for opioid overdose. These include: not having used opiates/opioids for a while (for example after prison, detox, or drug-free treatment), mixing opioids with other central nervous system depressants such as alcohol or benzodiazepines, using (injecting or smoking) alone or in an unfamiliar environment, and accessing opioids from a new or unfamiliar source (or if a regular source or supply has changed or their product is stronger than usual).

Prior to 2016, naloxone was a PBS schedule-4 medication, which meant that it could only be provided on prescription by a medical practitioner. Anyone who wanted to access naloxone, in order to have it on hand to use in the case of witnessing an overdose, had to ask a GP for a prescription. It took a very brave and very determined person to stand up to the judgement and discrimination of their GP and ask for a naloxone prescription.

In February 2016, naloxone became available over the counter at pharmacies. It was still available from medical practitioners as an S4 medication but it was now also available as an S3 medication that could be supplied by a pharmacist without a prescription. This was great news as it meant that people could purchase naloxone directly from a pharmacy without needing to see a GP. The aim was to make naloxone more accessible. The drawback was that the over-the-counter price of naloxone ranged from $40 to $60.

In December 2019, SA commenced participation in the Australian Government Take Home Naloxone (THN) Pilot. Under the pilot, naloxone became available for free from participating pharmacies. Initially the pilot was to continue until February 2021. The pilot was extended until June 2021 and has now been extended for a further 12 months until June 2022.

The Take Home Naloxone Pilot is a great initiative and is not restricted to people who inject drugs or people who use drugs illicitly. Many deaths involving opiate/ opioid use are a result of accidentally taking too much prescribed opioid medication. Vouchers to exchange for free naloxone can be obtained from hospitals, primary care settings, alcohol and other drug (AOD) services and, most importantly, from Clean Needle Programs (CNPs).

Vouchers are available at all Hepatitis SA fixed and sessional site CNPs and can be presented at any participating pharmacy. Hepatitis SA Peer Educators provide a brief intervention with each voucher to ensure that the person accessing the naloxone has information on preventing and responding to overdose, including how to administer naloxone.

Naloxone is available as ampoules for intramuscular injection and as an intranasal spray. The intranasal spray is a good option for people who are not comfortable or confident using needles and is a quick way to administer naloxone without needing to deal with needles, syringes and ampoules. Only a squirt of the spray up one nostril is required (the plunger must be depressed all the way).

There is no limit to the number of times an individual can access vouchers or exchange vouchers for naloxone. You can’t knock free naloxone but there are still barriers to accessing it through the THN pilot. Pharmacies don’t always have the naloxone in stock, so people may sometimes have to return at another time to collect it. People who use drugs may feel uncomfortable asking the pharmacist for naloxone because of past experiences of discrimination. It would be preferable to provide naloxone through the CNP rather than providing vouchers. There would be more naloxone available in the community, which equates to more lives saved. Some states in Australia are already providing naloxone directly through needle and syringe programs and druguser peer programs. We hope SA will soon join the list of states providing naloxone directly from Alcohol and Other Drug services and NSPs (called Clean Needle Programs or CNPs in SA). For more information on the Take Home Naloxone Pilot go to health.gov.au/initiatives- and-programs/take-home-naloxone-pilot.

Carol Holly