Posted: February 25, 2012 in Articles
Expanding Naloxone Availability Q & A
Broad support continues to build for action, and a program is being designed, to expand the availability of naloxone (Narcan ®) in the ACT. The Expanding Naloxone Availability in the ACT (ENAACT) Committee has been driving this work. This Q & A was developed by Professor Simon Lenton, National Drug Research Institute, Curtin University (email@example.com), as a member of, and for use by, the ENAACT Committee. It is hoped that this document will raise awareness and support stakeholder engagement in this work.
NO. Naloxone is a medicine that temporarily reverses the effects of heroin and other opiate drugs. So if a person overdoses on heroin or prescription opiates, naloxone can help bring them around and potentially save their life. Naltrexone is used to treat dependence on alcohol, heroin and other drugs.
NO. For over 40 years naloxone has been used in medicine to reverse the effects of heroin and other opiates. In this capacity it has been shown to be safe, reliable and effective. In Australia, as elsewhere, naloxone is widely used in hospital emergency departments and most ambulance services as a key response to opiate overdose. Naloxone is currently only available on prescription in Australia.
NO. Naloxone has a very specific action in reversing the effects of opiate intoxication. It does not produce any intoxication itself and has no effect on people who donʼt have opioids in their system.
NO. Although the availability of heroin in Australia declined rapidly in 4001, best available statistics show that about one Australian a day still dies from overdose, most involving heroin.
NO. There is no evidence that making naloxone available for administration by trained peers leads to major problems in the community or increased rates of harmful drug use. But internationally there are many thousands of documented cases of naloxone being used by lay people to save peopleʼs lives.
Wonʼt people be less likely to seek treatment and stop using drugs if they know that naloxone is available to help stop them dying from overdose?
NO. Experience overseas shows that including naloxone as part of overdose response training can help to engage hard to reach drug users with service agencies. By sending a message ʻwe care that you liveʼ overdose prevention training including naloxone distribution can help empower users to access treatment and other support.
YES. There is now a growing body of published scientific evidence that drug users, their peers, family members and other potential overdose witnesses are able to effectively manage an overdose situation and to administer naloxone when given appropriate training.
YES. Naloxone distribution and training programs operate in operate in many countries including the U.K., the U.S., Canada, Germany, Georgia, Russia, Spain,Norway, Afghanistan, China, Kazakhstan, Tajikistan and Vietnam. Naloxone has been available across the counter in Italy since 1995. Governments in many of these places have enacted laws to support access to naloxone outside the medical setting and protect members of the public who administer it in an overdose emergency. The experience from overseas that naloxone is a very safe and effective intervention when used by trained peers. As of 4010 there were 155 programs operating in 16 U.S. states with 53,339 naloxone kits having been dispensed and 10,194 overdose reversals reported.
Iʼve heard that there is not enough evidence to support making naloxone available to lay people to prevent deaths. Is this true?
NO. Although there has not been a randomized controlled trial of the impact of the intervention on opiate overdose deaths at a population level, observational studies show that there have been reductions in overdose deaths where naloxone programs have been implemented. Indeed, this is the same level of evidence used to support many public health interventions which are not amenable to evaluation though randomised controlled trials. Importantly, there is good evidence from the implementation of programs in many countries around the world that naloxone is a safe and effective intervention when used by trained lay people and has few, if any, adverse consequences.
NO. Research shows that most deaths occur more than an hour after last injection, and that others (such as friends or family) are usually nearby, but in most cases there is no intervention before death. Experience overseas shows that having naloxone as part of overdose response training assists those present to respond to overdose and helps engage otherwise hard to reach polulations of drug injectors to contact service agencies.
NO. Experience shows that when given smaller doses of naloxone (0.4mg) by intra muscular injection people come around more gently and are far less likely to be aggressive than when given larger dose by intravenous injection which can precipitate rapid opiate withdrawal. Being revived by someone they know, rather than a stranger in a uniform, probably also helps minimise aggression.
NO. Whilst naloxone has the capacity to significantly improve the management of an opioid overdose, the witnesses to an overdose will still need to assess the person, call an ambulance, remove any blockages to their airway, provide rescue breathing while awaiting the naloxone to take effect, place them in the recovery position, evaluate and provide support to the person after the naloxone takes effect.
NO. Internationally, training in overdose management and naloxone administration has been conducted in a variety of settings, durations and formats. Typical components include: Review of the causes and how to prevent overdose; assessment of an overdose, necessity of calling an ambulance; overdose management including airway maintenance and rescue breathing; naloxone and its administration; post naloxone monitoring and support; and communication with ambulance and police services. Evidence shows such training increases knowledge and skills resulting in safe and effective administration of the drug.
In an emergency situation naloxone is typically administered by injection into a muscle. It can also be provided in a device so it can sprayed into the nostrils, but as yet this form is not readily available in Australia.
YES. Naloxone is not an expensive medicine although the cost per dose depends on the forms used. The form most likely used in Australia would be two single dose vials which would cost between about $14 and $45 depending on how it is dispensed. Under programs currently being considered in Australia this cost would likely be met by the program and the medication would be free to program participants.
YES. As long as the medication is being administered to the person to whom it is prescribed, no laws are broken. Many medications are administered this way, probably the most well known being use of an Adrenaline epipen® to treat someone with Anaphylaxis reaction due to allergies. Beyond this, many Australian states and territories also have bystander laws which provide legal protection to people taking reasonable steps to save someoneʼs life in an emergency.
Some people say drug users who overdose should be left to die because itʼs their own fault. Is that right?
NO. Administering naloxone as part of an emergency response to overdose can help save a life. People who inject drugs are someoneʼs child, parent, partner, friend, or workmate. They are a wide and varied group, most donʼt fit the stereotype and many keep their drug use private. Most arenʼt involved in crime, many move away from problem drug use. Some drug users experienced significant trauma in their early lives. In a compassionate society we try and save the lives of people who have come to grief, even by their own actions, be they drug injectors, drink drivers, overeaters, players of contact sports, cigarette smokers or others. All human life is precious.
ENAACT (Expanding Naloxone Availability in the ACT), a group comprising members of the ACT Health Directorate, Canberra Alliance for Harm Minimisation and Advocacy (CAHMA), Alcohol Tobacco and Other Drug Association ACT (ATODA), some medical practitioners, drug researchers and others is facilitating a program to recruit 400 drug users and potential overdose witnesses to be trained in overdose prevention and management including administration of naloxone. The program will be based on the experience of the successful naloxone programs internationally combined with local Australian and ACT expertise.
The program will be evaluated to determine whether participants have learned and retained the necessary skills and collect information about whether and how the naloxone has been used in emergency situations and what the outcome was. It is anticipated that the evaluation will inform further developments in naloxone availability in the ACT and elsewhere in Australia.
Where can I find more information and keep up to date with developments in the ACT?
A webpage has been developed to provide information about developments in the ACT and further background information including the ENAACT Committee terms of reference and membership; naloxone reports in the ACT media; articles, newsletters and bulletins; reference and evidence summaries. Visit: www.atoda.org.au/?page_id=344
Anyone can freely subscribe to the ACT Alcohol Tobacco and Other Drug Sector eBulletin to keep up to date with local developments – just email firstname.lastname@example.org