The free life-saving opioid antidote that remains unused

A free drug that can save the life of someone overdosing on prescription painkillers is remaining unused on the shelves, with advocates concerned the fear of being labelled an opioid abuser is putting people at risk.

Nearly three million Australians are prescribed opioids, including codeine, oxycodone and fentanyl. The number of unintentional deaths involving opioids has almost doubled over the past 20 years, rising to more than two a day in 2021, with fatal overdoses just as likely to be from prescription medication as heroin.

Nyxoid, a brand of Naloxone, is a nasal spray that blocks or reverses the effects of opioid drugs. Credit: AP

The federal government last July launched a program to offer Naloxone, a drug that reverses the effect of an opioid overdose within 2 minutes to restart someone’s breathing until paramedics arrive, at no-cost.

It can be taken as an inhaler and has no effect on those who have not taken opioids.

Nearly half of NSW’s 2000 community pharmacies have signed up for the $19.6 million Naloxone Take-Home program, with only 23,000 doses distributed across the state since the program launched in July last year, an average of 11.5 doses per participating pharmacy.

Nationally, 136,776 doses have been distributed, reversing an estimated 3000 opioid overdoses, or eight adverse reactions, a day.

‘Nobody ever needs to die of an overdose because it is utterly preventable.’

Dr Marianne Jauncey from the Medically Supervised Injecting Centre in Kings Cross

Director of the King’s Cross Medically Supervised Injecting Centre Dr Marianne Jauncey said more people on prescription opioids needed to be aware of this program.

“The mechanism of death from opiates is identical to heroin. Anyone prescribed significant long-acting opioid medication should be aware of this,” she said.

Jauncey said doctors needed to discuss with patients the warning signs of opioid overdose, such as snoring, along with risk factors including alcohol and sleeping tablets.

“Nobody ever needs to die of an overdose because it is utterly preventable,” she said.

The Take Home Naloxone program was launched in July last year following a $19.6 million investment over four years from the federal government.

During the preceding 2.5-year-long trial, 43,000 units of naloxone were distributed to individuals at risk of experiencing opioid overdose, two-thirds of whom were in NSW, and take-home naloxone was used at least 1649 times to reverse the effects of an opioid overdose or adverse reaction.

NSW has the second-highest rate of unintentional drug-induced deaths, behind WA at 6.7 deaths per 100,000 population.

The Penington Institute developed a naloxone distribution model in 2018 which recommended it be available at multiple points of access, including emergency departments and jails, but CEO John Ryan said the current program instead applied a “very limited” version of the model, resulting in a fraction of the access needed.

Dr Marianne Jauncey at the medically supervised injecting centre in Darlinghurst, which stocks Naloxone. Credit: Janie Barrett

“There’s been no education campaign, no public health education campaign for the community to encourage people to pick up Naloxone, let alone administer it,” he said.

A 2022 UNSW report found less than half of surveyed intravenous drug users had ever been trained in how to administer naloxone, while 25 per cent had used the opioid reversal agent to resuscitate someone who had overdosed at least once in their lifetime.

Chair of the RACGP’s Specific Interests Addiction Medicine network Dr Hester Wilson said Naloxone should be distributed alongside prescription opioids, and both GPs and pharmacists should be having conversations with patients about the importance of the medication.

“It’s about making those conversations everyday ones because it’s like prescribing penicillin against an allergic reaction.

Pharmacies also needed protections for people picking up the medication, especially in smaller communities where neighbours might recognise one another in the queue, she said.

“What setup is there to make it actually accessible?”

Wilson also stressed stigma may make people, even those accessing opioids legally, wary of picking up naloxone.

“If you’re engaged with a drug and alcohol service, and you’re in treatment, you’d be having those conversations. But if you’re picking up your medicines from a pharmacy, you might be worried about that being flagged ... and not getting your prescription.”

A spokesperson for the Pharmaceutical Society of Australia said it advised pharmacists to identify patients at high risk of opioid overdose, initiate a discussion about their risks and encourage them to have an emergency supply of naloxone.

A spokesperson for the federal Health Department said needle and syringe programs, alcohol and other drug treatment centres and custodial release programs can register as Take Home Naloxone Program providers.

“The department is continuing to work with state and territory governments to increase Take Home Naloxone Program participation for non-pharmacy providers,” the spokesperson said, though declined to comment on whether GPs should provide Naloxone alongside opioid prescriptions.

NSW Health Minister Ryan Park said the government was committed to maintaining access to naloxone.

“There are a growing number of pharmacies distributing naloxone in NSW as a result of the Take Home Naloxone program, which helps to reduce potential harms for people who use opioids,” he said.

“NSW Health also provides naloxone free of charge. Through this program, a range of health workers can play a role in ensuring naloxone is available to people in the NSW community who are likely to need it.”

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