September 2016

Hope for NSPs and naloxone in fighting overdose deaths

Needle and Syringe Program workers, doctors and the families and friends of people using opioids need more information and support about naloxone to help stem the grim rise in accidental overdose deaths.

So says NSP frontliner, Ms Sally Finn. Ms Finn, founder of International Overdose Awareness Day and a social worker at the Salvation Army’s Crisis Service Centre NSP in St Kilda, Melbourne, says there needs to be a bigger conversation about prescription opioids.

While NSP workers have a crucial role to play at the frontline of providing information about the overdose-reversal drug naloxone, doctors, family and friends can have an important part in preventing deaths from accidental overdose, too, she says.

“My sense is that we don’t want to see anybody under-medicated,” she says. “That would be a tragic mistake and we don’t want doctors to overreact. We want them to be clear and teach people about the properties of these drugs, that they are opioids and the risk is they shut down the respiratory system.

“My personal opinion is that every time somebody is prescribed opioids it should be suggested – or they should be given – a prescription for naloxone. I think that signals to them the kind of risk we are talking about. Even if it is never used, it is very good to have it there… they would talk to their family members or whoever is close at hand about administering the naloxone. That would glue the whole conversation together in their minds that this is a real thing, not just a warning [on a packet].”

Ms Finn has been stunned by the recent overdose report compiled by Penington Institute from Australian Bureau of Statistics data which show deaths due to accidental overdose rose 61 per cent in the decade to 2014, from 705 to 1137.

In her work, Ms Finn says she has long been affected by the deaths-by-overdose of clients but she didn’t realise the cumulative personal impact until 2008 when one particular client died. She had got to know the man well through his frequent visits to the NSP and she had filmed him for a video one year for Overdose Awareness Day. “He remains on the web in that film,” she says.

Learning about his death by accidental overdose, she decided – unusually – to attend his funeral, which she describes as a celebration of his life, an event that helped his family see how much he was loved.

As she was leaving the service, Ms Finn burst into tears. Fortunately, she was with another woman who could support her. “I said ‘I can’t explain this, it’s ridiculous’. It was uncontrollable, I couldn’t contain it. I tried not to make too much noise or a scene of myself. But she was very kind and said it was completely understandable – and I said it’s just that there has been so much [death] there over the years.”

At the time, she had been working at the Salvation Army NSP for 10 years. “I realised just how emotional I was.”

There is an undertow from the outside world that doesn’t give much credence to these deaths.

Sally Finn

The type of culture developed among NSP workers is crucial to feeling supported, she says. “There is an undertow from the outside world that doesn’t give much credence to these deaths,” she says. “You forget about that a lot of the time and then something happens and you are reminded there is a lack of respect for the people you are helping, who are your clients.”

– Andrew Stephens

Overdose: the toll 

Australia’s Annual Overdose Report 2016 reveals:

  • Between 2008 and 2014, there was an increase in accidental overdoses from 3.1 deaths per 100,000 to 5.7 per 100,000 – an 83 per cent increase. Meanwhile, the rate per capita in metropolitan areas has moved only slightly from 4.2 per 100,000 in 2008 to 4.4 per 100,000 in 2014.
  • Over the period 2008-2014 there was an 87 per cent increase in prescription opioid deaths in Australia, with the greatest increase occurring in rural/regional Australia which saw a 148 per cent increase.
  • Accidental deaths due to drug overdose per capita for Aboriginal and Torres Strait Islander people grew between 2004 and 2014 with an increase of 141 per cent – from 3.9 per 100,000 in 2004 to 9.4 per 100,000 in 2014 in the five jurisdictions with data.
  • Western Australia is the worst state for overdose deaths per capita with 5.8 per 100,000 in 2014 followed by NSW with 5.1 per 100,000.