Guest Columns
Peer-Administered Naloxone Heroin and other opioid use on the streets go hand-in-hand with accidental overdose. Mr Paul Dessauer, of the WA Substance Users’ Association explores the issue.
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atalities caused by heroin or other opioids represent a steadily increasing proportion of accidental deaths in Australia. Nearly four Australians die every day from opioid overdose (OD). In fact, 2012 ABS statistics reveal that fatal overdoses now out-number road fatalities as an accidental cause of death. Exacerbating the problem, on a local level, is the purity of heroin tested in WA. Since 2009 it has been consistently and significantly stronger, compared with other states and territories.
And since 1991, even factoring in an ageing population, the rate of opioid prescription has increased by 228%. Within a period slightly over two years (2007-09) Australia’s rate of accidental opioid-related deaths increased from 30.4/ million to 45.9/m. In WA the increase was from 22.4/m to 54.8/m.
have collaborated for several years to deliver an Opioid Overdose Prevention and Management Peer-Education Program. It trains people who inject heroin or other opioids to recognise OD and respond as firstaiders. Participants have reported treating a large number of ODs and also recorded hundreds of episodes of educating their peers on how to manage OD. This education project formed the basis for a new pilot project in January 2013 prescribing naloxone to individuals at risk of, or likely to witness, an OD. Naloxone has a long history in medicine and para-medicine. It acts quickly and effectively to restore breathing and reverse the respiratory depression caused by OD. It is a highly stable drug with an extremely low risk of adverse effect and has no psychoactive action or “black-market” value.
Of course, death is not the only possible outcome. For each fatal OD there are between 20-30 non-fatal incidents, perhaps more because many are unreported. Nonfatal OD can result in serious sequelae such as brain or organ injury due to hypoxia, or injury due to nerve damage or occlusion of blood vessels resulting from prolonged unconsciousness.
On a broader international level, several hundred peer-administered Naloxone programs have been implemented in more than 16 countries. There is growing evidence that these interventions have the potential to make a significant impact on the incidence of morbidity and mortality caused by accidental OD. In July this year the WHO released guidelines explicitly recommending layperson access to naloxone as a public-health response to OD.
The Drug and Alcohol Office and WASUA
Participants in the WA Peer-Naloxone
project receive a two-hour training session before being assessed by the prescribing doctor. The Naloxone Kits are issued to participants at no cost. It is a simple intervention to implement and it’s cheap. The kit, containing two preloaded doses, costs less than $40. Expanding access to Naloxone has the potential not only to save lives but to reduce public-health system costs. It will also greatly reduce the amount of injury and human suffering resulting from accidental overdose.O References on request.
Availability of Naloxone A
Nov
ll e-Po
The 146 respondents to this question were both GPs and Specialists.
Q
Should naloxone be available to non-medical people to administer to someone in a crisis due to drug overdose? Yes
45%
No
26%
Uncertain
29%
Timely Referral to Palliative Care Cancer Council WA’s Ms Grace Buchanan says much can be done for a terminally ill patient with collaborative care and good communication.
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he quality of life of a patient can be enhanced by incorporating palliative care early in the course of a terminal illness, perhaps even from the day of the diagnosis. There may be an opportunity for oncologists and primary care providers to see Palliative Care Specialist services as partners early in the illness. Being part of the patient’s journey through symptom management support and through to end-of-life care is how palliative care can work collaboratively and effectively. Some physicians may feel that they have failed a patient when they are unable to cure illness and it can influence the timeliness of their referral of a patient to palliative care. In reality, we know that this is not true, though medicalforum
for medical practitioners who have longstanding relationships with patients, it is a real dilemma. Referral to a specialist palliative care service, according to Melvin & Oldham (2009) is appropriate at any time in the disease trajectory when a patient with a life-limiting illness, or family, believe there are needs, be they physical, psychosocial or spiritual, are not being adequately met. Conversely, not all patients facing lifelimiting illnesses and death will require the input of a specialised service. These people and their families may be well catered for by their inpatient medical and nursing team, staff at a residential aged care facility or GP and community nurse. (South Australia Health 2009)
Australia and New Zealand Society of Palliative Medicine’s position is that patients with evidence of tumour progression, following failure of conventional cancer treatments should be referred in a timely manner to Specialist Palliative Care services. This timely referral will support best practice management of pain and symptoms, identification and support for complex psychosocial issues with less incidence of depression, improved continuity with primary providers of palliative care and the improved likelihood of good end-of-life planning.O ED: Grace Buchanan is palliative and supportive care education team manager at Cancer Council WA. 23