Naloxone Take-Home Pilot

Naloxone Success Story

Evaluating the Take Home Pilot

As we reported in issue 91 (see issuu.com/ hepccsa/docs/hcn91/14), the Australian Government funded a Take Home Naloxone (THN) Pilot as part of the Pharmaceutical Benefits Scheme (PBS), allowing people at risk of experiencing or likely to witness an opioid overdose to access naloxone without a prescription, at no cost to themselves, and from a range of pharmacies and other approved sites in NSW, SA and WA.

In September 2019, the Institute for Social Science Research at the University of Queensland began an evaluation of the pilot scheme to inform policy and practice in preparation for a potential national rollout of THN. The evaluation findings, covering the implementation of the pilot scheme from its commencement on 1 December 2019 up until 30 June 2021 (though the pilot is intended to continue until 30 June 2022), are extremel;y positive.

Improving Access

• More occasions of naloxone supply were recorded: 27,955 supplies over 18 months of the Pilot compared to 3,579 supplies through the PBS in the previous 2 years.

• 1,480 sites registered for the Pilot but only 846 (57%) provided THN during the evaluation period; the active participation rate for other authorised providers was higher (82.5%) than that of community pharmacies (52%).

• More settings provided THN; pharmacies, specialist alcohol and other drug (AOD) services, justice and correction settings, and general health services such as hospitals.

• The majority of nonpharmacy THN sites were providers of AOD services; specialist pain clinics did not engage with the Pilot.

• More people received naloxone during the Pilot, both at risk of experiencing opioid overdose and people who may witness an overdose. Most identified as using prescribed opioids.

• The proportion of people at risk from pharmaceutical opioids who received naloxone increased from 0.15% to 1.63%.

. • Consumers accessed naloxone close to home, 55% within their home postcode, and THN was available in city, regional and very remote areas.

Improving Uptake

• More naloxone was provided to individuals: 43,212 units of THN were supplied in NSW, SA and WA during the Pilot, compared to 4,495 across Australia over the preceding 4 years

• Nasal spray comprised 84% of THN supplied and was the preferred formulation, but pre-filled syringes remained in demand, particularly for refills.

• Having naloxone accessible at services outside the AOD sector (e.g., community pharmacies) provided opportunities to raise awareness of overdose risk among people who did not use illicit opioids but were themselves at risk or likely to witness another person’s overdose.

• One in five people who received THN refilled their supply at least twice in a year; 65% of refills were due to use to reverse an overdose.

• The Pilot has enabled at least 1,649 overdose reversals, the equivalent of 3 reversals per day.

In some areas, the pilot program did not fully achieve all its original intentions, due in part to the challenges of rapidly scaling up existing operations with limited resources, and due to an initial focus solely on the alcohol and other drug sector. There were also significant challenges in attempting to implement a major new health initiative in the competing environment of the COVID-19 pandemic. Even with these drawbacks, however, the results are commendable.

The Institute for Social Science Research evaluation strongly recommended that Take Home Naloxone be expanded and extended into an ongoing national program that forms an integral part of Australia’s opioid safety net. There is an established need to address the significant and ongoing risks of opioid overdose, and this is an excellent opportunity to include an evidence-based and effective intervention. There is a strong impetus among the health sector to implement such a program.

The significant learnings from this pilot program should be taken forward, and the opportunity to continue learning from it ensured.