August 2021

Second Life: Heart-starting stories from the naloxone front lines

The terror. The anxiety. And the relief that follows.

William Wood, Referral Coordinator and Clinical Nurse Consultant at Sydney’s Medically Supervised Injecting Centre (MSIC), has stories to share about how naloxone saves lives.

He recalls a client who “cried as she described the relief of being able to revive her partner, knowing full well that help in the form of an ambulance was far away”.

William even has a story of his own – about how he managed to revive someone he saw unconscious on the street.

“Something didn’t seem right, but I was running late for work,” he says, adding that he almost kept walking. “But a gnawing feeling got the better of me – and I’m glad it did.”

William couldn’t wake the man and, on closer inspection, noticed blue lips, pinned pupils and weak breathing – tell-tale signs of an opioid overdose. “I deal with overdoses fairly regularly at work, but I was out of my comfort environment and by myself. I felt anxious.

“I called 000 and gave him two doses of naloxone – one in each nostril – and then another dose two minutes later, and put him in the lateral position.”

William stayed with him until the ambulance arrived, by which time the young man’s breathing had improved but he still couldn’t be woken up.

I’m so glad I stopped and went to help – I kick myself that I considered doing otherwise.

William Wood

“I’m so glad I stopped and went to help – I kick myself that I considered doing otherwise.”

Naloxone is the best way of responding to an opioid overdose. But not everyone arrives at the scene of an overdose in time or has naloxone on them when it’s needed most.

Michelle (not her real name), who was previously dependent on drugs and is now a peer support worker, recalls the time when a friend died because their partner didn’t have the power to bring them back.

“Whoever finds the person feels extremely powerless,” Michelle says.

“My friend’s partner attempted first aid, but I always wonder if having naloxone could have saved their life.

“I was lucky: a family member found me when I overdosed. But not everyone is so lucky.”

Michelle says greater access to naloxone – including for people who have jobs where they are likely to witness an overdose – can also reduce stigma and start important conversations.

We have to face facts: we live in a world with drugs so we need ways to respond.

Michelle

“We have to face facts,” she says. “We live in a world with drugs, so we need ways to respond.

“Naloxone is the second chance at life that everyone deserves.”

The current pilot of Take-Home Naloxone, underway in NSW, South Australia and Western Australia, as well as the determination of NSPs in other states, has improved access to this lifesaving medication.

As Myf Briggs, NSP Coordinator at the Tasmanian Department of Health explains, up until last year, there was little demand for naloxone in the state. Doses would sometimes sit, unused and expiring. This was mainly for two reasons, she says: needing a prescription was acting as a barrier to naloxone access for many clients, and there was a perception that pharmaceutical opioids didn’t present an overdose risk.

“I could be chatting about take-home naloxone to a client and they’d say ‘No, no, I just take my ’done [methadone]; I just take my dose. I’m not at risk’.”

Between July 2020 – the month in which Tasmania implemented its own pilot of take-home naloxone – and February this year, 300 kits were distributed and at least 17 opioid overdoses were reversed. And, equally importantly, the program afforded workers an opportunity to address common misconceptions.

“On unpacking what our clients believed, we’d say ‘You know, the risk is there if you mix pharmaceuticals with benzos or alcohol – other central nervous system [CNS] depressants’, and our clients would be like ‘oh, well, I do take Valium and I do drink occasionally’.

“All of a sudden you’ve gone from having someone who thinks they’re not at risk at all because they’re not on heroin, basically, to having them then realise ‘I am at risk, because I’m taking multiple CNS depressants’.”

Similar results have also been seen in Western Australia, where the federal take-home naloxone pilot has helped to increase accessibility.

“Suddenly we didn’t have to get people to come to our premises once a month – we could provide it whenever they just asked for it,” says Harm Reduction WA’s Outreach Coordinator, Paul Dessauer.

Paul says WA has had take-home naloxone since 2013. However, with the arrival of further government funding as part of the current pilot, take-home naloxone in WA has been able to find its way into more hands.

“We don’t just run a fixed-site needle exchange; we also run outreach services that cover the whole Perth metro area and South West region,” Paul says. “We can send our workers, if they’ve been authorised, out to someone’s house and they can spend 10 minutes talking to them and then give them naloxone.

“That mechanism has made it much, much more accessible for people who might witness an overdose.”

This innovation – providing clients with access to naloxone even if they physically can’t enter an NSP, has been a lifesaver, according to Paul.

“People are so grateful for having access to this intervention,” he says. “We’ve had people say things to us like ‘I’ve been in overdoses before and I didn’t know what to do. I panicked, called an ambulance and just stood there’.

“Now they come back and say, ‘thank you so much – I’ve saved my friend’s life’. And they also say, ‘I was perfectly calm because you’d taught me what to do’.

“This is a really, dramatically effective intervention for how little it costs. It literally saves people’s lives.”

Naloxone says “We care whether you live or you die. We trust and we know that you care about your loved ones and the people in your orbit and strangers – that you want to be able to do something.

Craig Harvey

Craig Harvey, Harm Reduction Coordinator at Barwon Health in Victoria, is in no doubt about what naloxone really means. “It says ‘We care whether you live or you die. We trust and we know that you care about your loved ones and the people in your orbit and strangers – that you want to be able to do something’.”

He recalls the time a mother was able to save her own daughter’s life.

“She said ‘My daughter overdosed last night in the living room and I was able to revive her. I just wanted to phone and ask for some more, because I don’t want to be without it, knowing how easy it is now’. She told us how much less worry she had, how much more in control and confident she felt, and how much easier their living situation was at home.”