REMOVING THE BARRIERS TO ACCESS

Implementation of the national Take Home Naloxone program began on the first of July this year. Between now and November, when the rollout is due to be completed, naloxone will be made available without a prescription and free of charge through participating pharmacies and service providers across Australia.

The federal government has launched a program aimed at increasing naloxone access across Australia by the end of 2022. Naloxone, the life-saving drug that reverses opioid overdose by blocking the brain’s opioid receptors, was previously only available free of charge in three states under the pilot Take Home Naloxone (THN) program. The success of that trial prompted the federal government to expand the program to all Australian states and territories.

The national program is a victory several years and thousands of workhours in the making. In 2018 Penington Institute presented Australia’s first detailed outline for a national naloxone program. Following the roadmap set out in that document, the pilot THN program was launched in 2019, making naloxone available free over the counter in Western Australia, South Australia and New South Wales. The trial was widely hailed as a success – an evaluation undertaken by the University of Queensland found that it was saving an average of three lives per day – and it laid the groundwork for national scale-up.

On the heels of the pilot program, the federal government began a phased national rollout in July 2022. Phase one involves making naloxone available through pharmacies and approved medical practitioners – these are the program’s ‘approved providers’. Phase two will target ‘authorised alternative providers,’ a category that includes NSPs, drug treatment providers, and homelessness outreach services, among others. The end goal is to achieve complete national coverage by the first of November.

Jarrod McMaugh, manager for the Victorian branch of the Pharmaceutical Society of Australia, confirms that the program is currently being rolled out by the Victorian Government.

“Pharmacies can now provide naloxone without prescription and with no out-of-pocket charge, and NSPs will soon be able to do the same. Each state is updating their regulations to allow naloxone to be provided from community health centres and NSPs so that non-pharmacists can provide it, with additional training.”

While pharmacists are already trained in the provision of naloxone to clients, Jarrod explained that they will also provide advice on the use of naloxone products. “Pharmacists will provide counselling to clients who request it, whether they’re a person who injects drugs themselves or they’re someone who may witness an overdose.

For the nasal spray it’s a relatively straightforward process, and for the ampoules and the Prenoxad [pre-filled syringes] – which have a particular storage device that can be a little tricky to open – the pharmacist will confirm that the client knows how to operate that correctly. If they’re ampoules, the pharmacist will also check if the client needs clean injecting equipment.”

Robert Kemp, Principal Public Health Officer at Queensland Health, says that Queensland is in negotiation with the Commonwealth regarding the details of the THN program. “While we have had some level of take-home naloxone provision going on outside of the trial, it’s been at a relatively small scale,” Robert explains, “so we’re seeing that scaled up significantly in a short period of time, and we’re also trying to estimate what the demand turns out to be.”

Frontline workers and policy officials are encouraged by the trial and eager for national rollout to occur, but there is some concern about stock shortages. “There’s a worldwide shortage of naloxone products,” Robert says, “and ever since COVID-19, there have been supply issues. So there are logistical things that will be overcome with time, but [which] might present some challenges along the way.”

A source from the Western Australian Mental Health Commission, however, said “there’s some extra stock of naloxone being diverted and redirected to Australia, so we don’t think it will be an issue at this time. There might be some pressure, but it should be resolved in the next month.”

Rebecca Biglane, Coordinator of Health Promotion and AOD at Perth-based sexual health and harm reduction services provider WAAC, affirms that the THN program has been a great win for her clients. “WAAC was on board with the pilot in 2019,” Rebecca says, “and we’ve implemented that through our NSP, distributing naloxone to clients who seem like they’re at risk of overdose or likely to witness overdose.”

The additional funding that comes with nationwide rollout has meant organisations can step up their service delivery: WAAC is expanding their service from NSPs to outreach programs and postal services.

“Through education we’ve been able to advocate for peers,” Rebecca continues, “and they’ve administered naloxone and saved lives. I’ve had clients who have administered naloxone and they’ve felt really empowered to be able to respond in that situation. Giving them the tools to get someone breathing again and having the education and knowledge on how to respond properly has given them a lot more confidence and empowerment.”

Some people who use opioids may have apprehension about accessing naloxone, or not recognise they need it. Jarrod elaborates: “There is concern that health providers would have stigma-associated interactions, but there’s also self stigma: some individuals don’t want to seek help because they don’t think they want to be treated or think they don’t deserve it, and that’s a real insidious misconception that we want to overcome as much as possible.

There’s also a lack of recognition from people who have been prescribed opioids that they’re at risk.

"People who are using opioids, regardless of the strength and regardless of whether they’ve been prescribed them, are still at risk of overdose and they still need access to this medicine."

Rebecca also endorses this model of supported-yet autonomous decision making and the creation of ‘safe spaces.’ “We build rapport with clients,” she says, “which allows us to raise these conversations. We acknowledge that people are going to use drugs, we just want to talk about how to do it safely so naloxone becomes part of that conversation. It’s been easy for us to implement, and clients are happy to take it on board.”