Saving lives from opioids

Australia is in the grips of an opioid crisis. Opioid related-deaths — some from illicit drugs including heroin, but many more from prescription opioids commonly used to treat pain — have dramatically increased over the past two decades.

In 2022, more than 1,022 people died from opioid drugs in Australia.

What you may not know is that there’s a free, over-the-counter medicine that can prevent opioid overdose deaths — and it’s available in pharmacies across Australia under a Federal Government scheme called Take Home Naloxone.

This is one of the first examples in the world of a free, national program, with access through such a broad range of settings. But the scheme’s uptake has been slow.

Naloxone is a safe and effective medicine that reverses the effects of an opioid overdose. It can be given by injection or through a nasal spray; just one dose sprayed in one nostril is enough to reverse most overdoses.

Naloxone has been an over-the-counter medicine in Australia since 2016. Uptake of the medicine in the community has been slow, originally due to its cost.

But in 2022, naloxone was made available for free — and without a prescription — at community pharmacies around Australia, through the national Take Home Naloxone program.

As part of this program, which research shows is a key strategy to prevent opioid deaths, naloxone is given to laypeople such as family members, peers or carers to administer if they witness an overdose. They’re also given information about the symptoms of overdose and how to use naloxone.

Unfortunately, despite the drug being freely available for two years under the national scheme, naloxone has not been universally adopted by those who could benefit from it.

Research by the Monash Addiction Research Centre explored how common it is for community pharmacies to stock naloxone.

It surveyed 530 community pharmacies across Victoria, New South Wales, Queensland and Western Australia about their stocking and provision of naloxone, and found just 60 percent of community pharmacies stocked the drug.

That’s an increase from 2016, when an Australian study found only 23 percent of pharmacies stocked naloxone. It is also an increase since 2020, when 38 percent of Victorian community pharmacies stocked naloxone — although that same survey found one-third of those pharmacies hadn’t actually supplied it in the year prior.

Other barriers stand in the way of increasing naloxone supply. A big one is knowledge about naloxone for pharmacists and pharmacy staff. There’s also not enough awareness of the drug among the different populations which may benefit from receiving it.

There are several key populations for whom naloxone is relevant, each with different potential barriers to consider.

For people who inject opioids such as heroin, knowledge about opioid overdose is generally high, and naloxone is familiar and acceptable. But unfortunately, stigma often prevents naloxone supply to that group.

Research found Australian pharmacists were less comfortable discussing overdose with people who use illicit opioids compared to people who are prescribed opioids for pain. Further efforts are needed to address stigma in pharmacies and other healthcare settings.

Access to naloxone could also be increased across a range of other harm reduction and health settings. For example, naloxone will soon be made available in vending machines across Victoria, which may further increase access while removing barriers including stigma and opening hours.

People who are prescribed opioid pain medicines are another key population for overdose information and naloxone supply. For this group, there is often limited knowledge about signs of opioid overdose, and a limited recognition of opioid-related risk factors.

People who use other drugs, such as stimulants like cocaine or methamphetamine, MDMA or ketamine, haven’t typically been a focus of naloxone programs. But this is changing following recent concern around the threat of synthetic opioids such as fentanyl and more recently nitazenes contaminating the illicit drug market.

If these synthetic opioids turn up in other street drugs, people who use them may unknowingly ingest opioids and be at risk of opioid overdose. The lack of drug checking services across most of Australia means most people who use illicit drugs don’t know exactly what’s in the drugs they are taking.

This now makes overdose education and naloxone supply for anyone who may use illicit drugs important.

Having naloxone available via a broad range of settings — including street accessible 24 hour vending machines, night clubs and other entertainment venues — may enable increased access.

Ideally, all community pharmacies across Australia will also increase naloxone in years to come, especially as most opioid overdoses in Australia involve opioids prescribed for pain treatment, and almost all pharmacies supply prescription opioids for pain.

More widespread public education campaigns could help raise awareness, too. Unlike many other drugs, Naloxone is able to be advertised in Australia — as the Therapeutic Goods Administration, the national regulator, allows some over-the-counter medicines to be advertised. But we are yet to see a widescale public education program like that that exists in some other countries such as the US.

New formulations of naloxone are also being explored, such as fast dissolving Buccal tablets that go under the tongue and fit in a wallet, to increase the likelihood that someone will have naloxone on them in case of an emergency.

Finally, an Opioid Safety Toolkit — a partnership between Monash University, Painaustralia, and the Pharmaceutical Society of Australia — will be distributed later this year. Funded by the Commonwealth Government, this toolkit will help raise awareness of naloxone and overdose risk for this population.

Over the past decade, naloxone access has been transformed in Australia — first by removal of the need for a script, and now with a national program to provide free access to all Australians.

The challenge now is to raise awareness of naloxone availability among all populations who may experience or witness an overdose.

This article was written by Louisa Picco and Suzanne Nielsen, the Deputy Director of  the Monash Addiction Research Centre in Melbourne. It was originally published under Creative Commons by 360info™.