OD kits backed
Experts say that improved access to naloxone would prevent hundreds of prescription opioid overdose deaths per year.
Naloxone is an opioid overdose antidote naloxone that reverses the effects of drugs such as heroin, morphine and oxycodone if administered by injection or nasal spray to a person who has overdosed.
In Australia, ‘take-home naloxone’ (THN) kits are available. They typically include training and education about opioid prevention and naloxone use, and are available in all states and territories on prescription or over the counter from a pharmacy for a fee.
They are free of charge without a prescription from approved providers in New South Wales, Western Australia, and South Australia under a Commonwealth pilot program.
Researchers from the Burnet Institute have now modelled the cost and impact of THN distribution to people who use opioids outside of injecting drug use.
The study finds that scaling up THN by 2030 to reach 90 percent of people prescribed medium and high opioid doses would save over 650 lives – with a further 146 deaths averted annually from 2030 – and be cost effective ($43,000 per life saved).
“One of the questions that we had was, given the large number of people who receive prescription opioids in Australia, does it make sense to be offering naloxone widely given there is a cost with each dose provided,” says the Monash University Addiction Research Centre’s Associate Professor Suzanne Nielsen.
“This paper demonstrates that it's cost-effective to provide naloxone free of charge to people because the charge for naloxone is small, but the gains are high.”
Based on current trends, there will be 7,478 deaths from prescription opioid overdose in Australia between 2020-2030, resulting in $51.9 million in ambulance costs alone.
The Burnet Institute’s Professor Paul Dietze says findings from the Commonwealth pilot program, which is currently under evaluation, could provide a framework to maximise the impact of THN nationally.
“Assuming there are positive findings from the pilot to liberalise naloxone access, these need to be properly implemented across the country,” Professor Dietze said.
“We need to know how many people we need to reach to maximise the impact, identify how many doses need to go out, and where the gaps are happening.
“We really need to rapidly deploy this kind of initiative because at the moment, people are dying.”
Importantly, the study authors highlight the need to address barriers at the front line of THN supply, including stigma among pharmacists who may associate naloxone with the use of illicit substances, as well as low levels of confidence and understanding.
The authors recommend targeted education for pharmacists, prescribers, and the general population to make the role of naloxone clear to those who supply and receive it.
“Implementing it in pharmacies needs to be really straightforward,” Associate Professor Nielsen said.
“There's no need for complicated rules as to who gets it. Offering naloxone to everybody who's on strong opioids makes sense.
“But just having the drug available may not be enough – we need to raise awareness and to explain to people who are on prescription opioids why they might be offered naloxone and to increase uptake in that way.
“Prescribers and pharmacists need to be properly equipped to have the conversation with people so that they understand that opioids are high-risk medications, and that requires input from peak bodies and support from government and other agencies.”