May 2017

NSPs to dispense naloxone in NSW pilot

Amid concerns Australia is about to be caught up in the worldwide increase in opioid deaths, the NSW Health Department has funded a pilot project on the feasibility of Needle and Syringe Program workers dispensing the overdose antidote drug naloxone.

Naloxone is literally a life-saver. It temporarily reverses the effects of an opioid overdose, preventing death or acquired brain injury that can result from depressed respiratory functioning.

Naloxone is safe, non-addictive and experts want it to be more available within the community to prevent unnecessary deaths.

Sydney University Addiction Medicine Specialist Professor Nick Lintzeris says several barriers to obtaining naloxone need to be overcome, “particularly for the more difficult to reach or more marginalised populations”.

Naloxone is available on prescription in Australia, and from pharmacists without a prescription since February last year as part of the Take Home Naloxone (THN) program. Unfortunately, soon after the introduction of THN, production ceased of syringes preloaded with naloxone, called minijets. Glass ampoules of naloxone replaced the minijets but many found them harder to use. Additionally, whilst naloxone is available on the PBS for only $6 for five doses, purchasing it without a prescription at a pharmacy costs a prohibitive $60.

“You need to access a doctor to get a prescription and that needs to be done on Medicare to reduce costs, so they need to find one who bulk bills and then find a pharmacy that stocks (naloxone),” Nick says.

In many parts of Australia, in regional and even metropolitan cities, it can be hard to find a GP as often there are shortages – particularly of GPs that are knowledgeable and work with people who inject drugs.

Professor Nick Lintzeris

“In many parts of Australia, in regional and even metropolitan cities, it can be hard to find a GP as often there are shortages – particularly of GPs that are knowledgeable and work with people who inject drugs.”

To try to overcome those barriers, Nick is working on a pilot project investigating the delivery of naloxone through NSPs and Drug and Alcohol Services. The pilot will use a newly-approved UK product, Prenoxad, which is a pre-loaded syringe containing five dose of naloxone.

Prenoxad has been fast tracked for use in Australia and it is anticipated it will be available on the PBS in coming months. Nick says the syringes are much easier to use in the high-stress environment of assisting someone who is overdosing.

Harnessing NSPs to distribute Prenoxad makes sense, Nick says.

“You have a skilled workforce; they know how to talk to people who inject drugs, they are very effective at doing education, this is just adding in the naloxone supply so, in effect, it becomes a one-stop shop.”

Five Local Health Districts have enrolled in the pilot, three in metropolitan Sydney and two in rural and regional NSW, encompassing up to 25 services that have NSPs and Drug and Alcohol Programs.

The first distribution of naloxone as part of this project is slated to begin within weeks.

Nick says whilst this is only one approach to increasing the use of THN, initial feedback has been positive.

“Workers, and consumers themselves, have been very keen to look at more effective ways to increase the take-up of naloxone.

“If this model works, and it’s cost efficient, then I think there will be a lot interest from around Australia to replicate this in other states,” he says.

“There is a lot of science around the world suggesting that opioid use may well be having a resurgence, certainly in the US it’s taken off again, and I think we need to be prepared and have strategies up and running.”

The pilot is being led by the University of Sydney and the South East Sydney Local Health District and involves collaboration with a range of academics, researchers and consumer groups across Australia.

Details of the pilot are still being finalised. Future editions of the Anex Bulletin will provide an update on the model, authorisation, logistics and other issues related to the project.

Kate Robertson