Take-home naloxone saves 3000 lives in first year

Plus, pharmacies are adapting fast to the new opioid dependence treatment program settings.

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Free, over-the-counter doses of naloxone are used to reverse an opioid overdose up to eight times per day in Australia, but harm reduction experts say this is just a drop in the pond.

Following various state-run trials, a national take-home naloxone program began in July 2022.

The program funds pharmacies, alcohol and drug treatment centres and needle and syringe exchange services to provide doses of naloxone to people on opioids and their carers at no cost, with no need for a prescription.

Naloxone is provided as a nasal spray or in a pre-filled syringe.

Over 12 months, the Department of Health and Aged Care estimated that the program has resulted in roughly 3000 avoided overdose deaths.

Dr Hester Wilson, a Sydney GP with special interest in harm reduction, told The Medical Republic that while the first-year results of the take home naloxone program were promising, there was still a huge unmet need among the community.

“We’ve probably got, in NSW alone, somewhere between … 25,000 and 48,000 people that have opioid dependence, and only half of those would be in treatment,” Dr Wilson said.

She encouraged other doctors to consider mentioning naloxone whenever they prescribed opioids.

“We still have people dying every year of overdose, and most of them are accidental,” she said.

“Unfortunately, we know from the stats that at least some of them are people who die in a house surrounded by other people who just thought they were sleeping.”

The latest data on overdose deaths from the Penington Institute, which was released earlier this week, found that opioids were implicated in 45% of unintentional drug-induced deaths in 2021.

Over that year, heroin accounted for 297 deaths, the oxycodone/morphine/codeine group were present in 287 deaths and an additional 186 deaths involved methadone.

While these figures represent a significant decrease from pre-pandemic highs, the number of unintentional opioid-related drug deaths have almost doubled since 2001.

The impact of the national naloxone program, which kicked off in mid-2022, will be captured in future iterations of the report.

“Broader naloxone distribution, more careful management and monitoring of opioid prescriptions, and improved early warning systems about contaminated drug supplies are some of the important initiatives worth highlighting since the Overdose Report first held up a mirror to Australia and the then unspoken overdose toll,” Penington Institute CEO John Ryan said.

Pharmaceutical Society of Australia president Dr Fei Sim said that pharmacists were Australia’s most accessible healthcare professionals.

“We are urging anyone taking opioids for pain management, or caring for someone who does, to have a conversation with your local pharmacist about having naloxone on hand,” she said.

“We can also provide advice about identifying an opioid overdose and how to respond during an emergency.”

A more unexpected recent success in the harm reduction space has been in the uptake of the new, nationally consistent opioid replacement therapy program.

Since July, medicines for opioid dependence treatment have been listed on the S100 Highly Specialised Drugs Program, which simultaneously nationalised opioid dependence therapy and eliminated the ability for pharmacies to charge extra for dose administration.

When it was first introduced, some pharmacies signalled that they would cease to provide opioid dependence treatments due to inadequate remuneration.

Speaking at a 60-day dispensing information session for pharmacists on Tuesday, DoHAC opioid dependence treatment director Kirsten Buckingham said that pharmacists had, on the whole, embraced the new program.

Around 1600 pharmacies had submitted claims to date, she said, and 36,000 patients had received prescriptions under the new arrangements.

“In terms of the notion that there are considerable numbers of pharmacies withdrawing from the program – that’s not necessarily what we’re hearing or getting information on,” Ms Buckingham said.

“We do know … that there has been a small number of pharmacies, usually pharmacies with a small number of patients, who have decided to either not take on any new patients at this time or have decided … they are going to stop providing these services.”