NALOXONE UPDATE 08:
I arrived at work the other day (last Thursday) and opened up my inbox to check my email. As I scrolled down the list deleting all the unwanted ones, I noticed a common thread appearing in one of the many e-lists I subscribe to. The subject line said ‘Naloxone rescheduled to over the counter!’
The same subject line kept popping up again and again so I opened up the emails and was thrilled to discover that it was actually true! Finally there is an option for people to simply walk into a chemist and buy mini jets of naloxone without a prescription from the doctor. Woo hoo! About #*cking time, I say!
You see, that has been one of the major barriers as far as putting naloxone into the hands of the people who are most likely to need it and use it. Training someone in how and when to administer naloxone is pretty much a waste of time if they don’t actually have any naloxone to administer. But training someone and providing them with naloxone at the same time is a logistic nightmare because each person needs to see a doctor to get a script.
How on earth are we supposed to make that work? Do we employ our own GP? Well, that’s not really an option but it would make the process a lot easier. I’ve always said….wouldn’t it be awesome if I could go and buy a whole heap of naloxone and then get on with training more and more people until there comes a time when no one dies from an opioid overdose. Because I seriously believe that that day will dawn. If we had access to naloxone without needing a prescription we could flood every user network with it and then they could spread the word and it could start the naloxone snowball rolling and well, you know how it goes.
Back to the email action with the subject line ‘Naloxone rescheduled to over the counter!’ Rescheduling naloxone from an S4 (you need a prescription) down to an S3 (you can buy it over the counter) is something that has been discussed by various groups and committees and individuals for years and they all agreed that it needed to happen. Then it was brought to our attention that if naloxone was rescheduled to an S3 and could be bought over the counter (which translates to: YAY! Way more people will be able to access it!) It would no longer have PBS status and the cost would rise considerably (which translates to: BOO! No one can afford it!)
One way around that was for naloxone to have a dual listing – that is both S3 and S4 – which would mean that if you have a prescription it would come under the S4 schedule and you could still get it at the lower PBS price ($6.00) but if you got it over the counter (with no prescription) then it would come under the S3 schedule and you would forfeit the PBS benefit, meaning no discount and a price tag way too expensive for most people – and I’m talking like more than $100!
In order to have a drug rescheduled written submissions need to be sent to the Pharmaceutical Benefit Advisory Committee (PBAC) detailing why you think it should be changed along with any evidence to support your reasoning. PBAC is made up of people appointed by the Minister for Health and it’s their job to thrash out these sorts of recommendations and then present the facts to the Minister who says either yes or no (well, it kinda works like that).
Many groups, committees and individuals wrote submissions in support of the rescheduling of naloxone and then it was in the hands of PBAC who finally came to a decision and hence the subject line ‘Naloxone rescheduled to over the counter!’ So while various people are cheering about the announcement that naloxone is available over the counter I am feeling rather underwhelmed and unexcited by it all. Now before you start thinking that I’m ungrateful or unappreciative I would like to explain the way I’m feeling.
What will change for me? Well, nothing really because I still can’t go out and buy a heap of naloxone over the counter and get on with training more and more people because it will be way too expensive. All the people that I train will still need to get a prescription in order to access it so that leaves me right back where I started with that logistic nightmare. I guess the one thing that I am happy about is that it will have the dual listing I mentioned so at least the more affordable option is still available. It would have been a major disappointment if it just got rescheduled to S3 and the only option was the more expensive one. In fact that would have been tragic because it would have meant that all the people who now have access to naloxone would end up not being able to get it anymore due to the price increase. It would have been a huge step backwards, actually. Money is tight for most people these days and the thought of having to fork out more than $100 for something that you hope you will never have to use, it just wouldn’t happen. I encourage people to learn how and when to administer naloxone and the odds are that it’s not going to be used on yourself, is it? So while I’m asking people to be prepared in the event of an overdose, what I really mean is look out for others – and hopefully those ‘others’ will return the favour and look out for you.
My final thought is, “Is that it?” I learnt that naloxone has been rescheduled by a subject line in an email and I’m ‘in the know’ and on a harm reduction e-list. Forget the fact that no one is going to be able to afford the new option, because even if they could, how will they know about it?
NALOXONE UPDATE 07:
Hi there, it’s me again, banging on about….you guessed it!….naloxone. Things are going from strength to strength with more than 540 people trained and competent in how and when to administer naloxone. And that’s from attending HRV’s training, not to mention the emergence of new places becoming available for people to get equipped with naloxone.
It’s slowly starting to happen and I couldn’t be happier. The way I see it, the more places there are that people can get sorted with their very own naloxone kit, the better. As I’ve said in earlier posts, I can’t wait for the day when naloxone is a staple in every opiate user’s cupboard and it’s more a case of who hasn’t got naloxone rather than who has?
A lot of people have been asking me lately how they can access more naloxone now that they have used what they had. If you are after more naloxone you need to re visit a doctor so that you can get another script. Once you’ve done that then all you need to do is take it to a chemist and get it filled. It’ll cost you $6.10 if you have a current health care card and it’ll be upwards of $35 if you don’t. Yes there is a cost involved, I wish I could say that there wasn’t but just like most things in life, naloxone doesn’t come free. For those of you who attended one of our training sessions you would have received your first script for free but unfortunately that’s not something we can afford to fund over and over again. I’m pretty sure that if you have used your naloxone to save a mate’s life, then you can see the value in it. And $6.10 isn’t really that much when you weigh it up against a friend’s life.
If paying for the script really is impossible for you then please give us a call and we will do our best to help because we do see the value in having naloxone around…it’s priceless!
And while I think about it, if you do get a script filled yourself please be aware that the mini jets do not come with sharps/needles so you need to get some 23g tips from the NSP. Otherwise you won’t be able to administer it, if and when the time comes.
Something else I want to raise here is the issue of police and naloxone. I was horrified to hear that some people have had their naloxone confiscated by the boys in blue. This should not be happening and we are doing our best to get it sorted. In the meantime, please be patient! Sometimes information can take a while to filter down the ranks. While the head honchos in the police force are aware and very supportive of naloxone distribution especially among people who use drugs, some of the officers further down the ranks are less informed. They just see needles and some sort of drug that they don’t know about and their automatic reaction is to confiscate it. Remember It’s not illegal to have naloxone and there is no good reason to confiscate it. But I guess their attitude is simply ‘when in doubt, confiscate’!
I’m pleased to report that all the people who have had it confiscated have ended up getting it back but it would have been better if the whole situation been avoided in the first place. So, until every police officer is informed and familiar with it, unfortunately there may be more incidents like this. The best way to avoid it is to always keep the box the prescription came in which will have your name on it and the doctor who prescribed it – just like any other prescribed medication. If you do find yourself in a situation where the police question you about it the best thing to do is remain calm and explain what it is to the officer. There’s no value in carrying on and being rude or angry because as we all know, your attitude may dictate the way the police handle the situation. Worst case scenario, everything goes wrong and they insist on taking it, rest assured that you won’t be charged and it’s just a matter of time before they learn that they have made a mistake.
So, until my next post, stay safe, look out for your mates and help me by spreading the word about naloxone.
NALOXONE UPDATE 06:
I can’t believe it’s been 5 months since my last post! Time really does fly when you’re having fun, or in my case…. doing workshops and getting naloxone into the hands of as many drug users as possible.
A lot has been happening. The number of people trained is almost at the 500 mark (well, 475 to be exact!) and the number of reported reversals has reached 60. It’s hard to know how accurate this number is as we know we don’t get to hear about every single reversal and the actual number could be a lot higher.
Since beginning naloxone training in August 2013, I have heard so many positive stories and the person telling the story is usually on a natural high because they have saved a mate’s life. As different as each reversal is, the recurrent theme is “lucky I had naloxone”! And then I get to hear how everything went down.
Unfortunately not every overdose has a happy ending and I was gutted to learn of several recent fatalities. On each occasion, the person was using on their own and with no one around to intervene when they overdosed, the result was another avoidable death. In many ways, the lives that were lost were worlds apart: one person was homeless while another was at home surrounded by a lifetime’s collection of worldly possessions; one was unemployed while another had built a successful career over many years. There was a mix of male and female; some were in happy relationships and some were happily single. In fact the only common denominator, apart from the fact that they were all long-time heroin users, was that they were all alone at the time.
Overdose doesn’t discriminate; it can happen at any time and to anyone. Contrary to expectation, statistics also show that it’s usually older experienced males who are most likely to die from an overdose. And if you are on your own the chance of a fatal OD is that much more likely simply because there is no one there to intervene.
I understand that there are lots of different reasons for using alone: not everyone wants to use with someone else, for some of us our drug use is a very private thing while for others it’s due to cost i.e. you can’t afford to chop someone out each time you use. Whatever the reason, it’s important to be aware of the risks you’re taking . . . and how you could reduce those risks. Getting some naloxone would be a good place to start Take it home (or where ever you are) and show it to your mates (whether they are users or not) and then store it somewhere easy for people to find in the case of an emergency (e.g. they happen to find you overdosed and need to administer it.)
In fact I was thinking it could be a good idea for those of us who have naloxone in our possession to wear some sort ID bracelet that would alert those of us ‘in the know’ that we have it on us. Last week I stumbled across a guy who had dropped in the street; the ambulance was already on the scene when I arrived but I hung around because the guy looked familiar to me and I thought I knew him.
To cut a long story short….turns out I had met him before! He had attended a naloxone workshop and once the paramedics left the scene he delved into his bag and pulled out his naloxone kit! How ironic! Hence my thinking along the lines of an ID or similar, to deal with those sorts of situations when you come across an OD and you don’t have your own naloxone on hand. I guess it would be a way of saying that it’s OK to look in your bag for your naloxone.
I realise that there are probably lots of reasons why something like that couldn’t or wouldn’t work. The idea just came to me and it’s an interesting propostion, something to ponder over the Easter break.
If you have any comments or thoughts that you’d like to share then I’d love to hear them.
So, enjoy your Easter, do what makes you happy. The religious concept of Easter is a bit lost on me but a long weekend is very appealing no matter how it gets packaged….so eat lots of chocolate, love all the little Easter bunnies and pray for more public holidays. But most of all be safe. You know what I mean!
NALOXONE UPDATE 05:
I haven’t given you an update for a while now. Sorry about that, I guess I must have been busy doing workshops!
It’s been over a year since we first started training people who inject drugs about how to administer naloxone and we’re still going strong. At last people seem to be embracing naloxone as a necessity in their using lives. It’s crazy to think that not so long ago it was only available from the ambos or at a hospital emergency department and that many users had very negative attitudes towards the very mention of naloxone (or narcan).
As time goes on I hear about more reversals and more “happy outcomes” rather than the tragic chain of events that can so easily result from an overdose. I can even include myself in those stats (of people who have had to administer naloxone) and all I can say is ‘thank god naloxone was available’.
As I have said in an earlier post, the number of reversals doesn’t necessarily equal the number of lives saved but it definitely equals the number of overdose incidents that were managed effectively and with considerably less stress and distress. And that goes for all parties involved, in situations where naloxone was available:
- The person responding to the overdose appears a lot calmer. Rescue breathing + knowing naloxone is on hand is way better than rescue breathing + not knowing how far away the ambulance is.
- The person being revived appreciates that the responder is known to them. I know if it was me I would much prefer to be revived by someone I know rather than a stranger in a uniform.
- The response from paramedics has always been positive and supportive. As highly trained and experienced as these guys are, I’m sure it’s better for them too, to arrive and find the patient calm, conscious and alive.
A common question is…“How hard is it to be trained to administer naloxone”?
The simple answer is…. “Not hard at all!” It’s really very straight forward and all that’s required is a quick demo in how to use it. Our training aims to put naloxone administration into context so we cover more than just the administration part. We start with what causes an overdose and how to prevent it, then we cover how to recognise an overdose and then, in the event of an overdose, what to do including how to administer naloxone. We also cover other effective ways to respond to an overdose including rescue breathing (mouth to mouth) and we discuss things like the pros and cons of calling an ambulance and police attendance at overdoses. While the naloxone administration part is a very simple procedure, attending an overdose is still a highly stressful situation. I’ve lost count of how many overdoses I have attended yet I’m still overcome with fear and panic (the very things I try to tell people not to do! LOL). I think it’s only natural to react with panic to every overdose you witness, no matter how many times you’ve been there and done that.
Another one that comes up often is…“If I’ve got naloxone, do I still need to call an ambulance”?
It’s always better to call an ambulance and get professional medical help on the way. I think it’s kind of obvious. However, I do understand that there are times and reasons why calling an ambulance might not seem like the best thing to do. For example:
- At a dealer’s house and the fear of ‘red lighting’ the premises is paramount.
Although calling an ambulance doesn’t mean the police will attend, some people don’t or won’t believe it.
- You are a single mother with nosey neighbours who just seem to be waiting and watching for an excuse to ring human services and tell them what a bad parent you are.
Sometimes all it would take is an ambulance arriving at your house and said neighbours would already be dialling the number.
- You are somewhere where evidence of your drug use would mean your certain eviction, expulsion or similar so calling an ambulance is out of the question.
I’m sure there are more circumstances and as I said, I do understand there are reasons why sometimes it’s just not possible to call an ambulance. If that’s the case I strongly suggest that you take your mate to see a doctor as soon as possible after the event. Even if they are feeling OK, there are things that can go wrong and by the time you realise, it’s may be too late to be easily fixed.
There’s still a lot of work to be done before naloxone is the norm and everyone knows what it is and how it’s used – and that’s what I’d like to see. But until then, Harm Reduction Victoria will keep at it with one group of users at a time at various sites around Melbourne and Victoria.
If you’re reading this and you need to get naloxone into your network of using mates, please get in touch either by email firstname.lastname@example.org or give me a call at the Harm Reduction Victoria office on 9329 1500.
NALOXONE UPDATE 04:
To date, 252 drug users have been trained to administer naloxone and given a naloxone kit containing everything you need including a sheet of instructions. And 25 reversals have been reported since the program began 10 short months ago – there could well be others that we haven’t heard about. As I’ve already explained in a previous update, that doesn’t mean that 25 people would have died but it does mean that the overdose was made way less stressful for the person who responded. We have always had effective overdose response strategies (e.g. rescue breathing, calling an ambulance, etc.) but naloxone adds another “tool” to the kit which can only make us more effective and result in more successful reversals.
With access to naloxone, no one needs to die of an overdose!
One thing that has been worrying me though is the stuff that I’m hearing about people’s experiences when calling 000. For those of you who have never had to make that 000 call, you need to be aware that it can be a bit of a harrowing experience in itself. The operator on the other end of the phone asks lots of questions that you may not know the answer to and may seem irrelevant at times. Rest assured that there is a good reason for all their questions and at the end of the day all they are trying to do is help you keep your mate alive. Best way to handle this is to answer everything as honestly as you can and to be aware that the ambulance is already on the way.
You don’t have to say that the person has overdosed. If you prefer you can just say that they are unconscious and not breathing (if that’s the case). Rest assured that if in the midst of a crisis, such as your mate overdosing, all your overdose response knowledge disappears and your mind draws a complete blank….the person on the other end of the phone will talk you thru what you need to do.
It’s at this point that things may get a bit confusing because the operator will start to instruct you to do basic life support i.e. to deliver 2 quick breaths and then to commence chest compressions. When a person overdoses their breathing slows down to a point where it stops and that’s where rescue breathing (or mouth to mouth) is needed. With an opiate overdose, if breathing stops and no one intervenes, eventually the heart will also stop beating. If you are with someone and they are alive and talking, and then they drop…trust me, their heart will still be beating. However, if you come across someone you think has overdosed but you have no idea how long they have been passed out then the heart may have already stopped – and of course you need to feel for a pulse (heartbeat). In that situation, compressions (pushing on their chest) are needed to try and get the heart to start beating again but if the heart is still beating there is no need for compressions and all they need is oxygen or rescue breathing.
Confusing, isn’t it? Which is why it all gets so confusing when you are taking directions from a phone operator, who will probably instruct you to commence compressions when it’s most likely not needed. All you need to do for the person is rescue breathing. So, why does the operator ignore this fact and tell you to do compressions? Well, because the official guidelines in Australia, which were developed to cover a whole range of emergency situations and not only overdose, say so and the operators are taught to follow these guidelines to the letter. Personally, I find this so frustrating because in the event of an opiate overdose the best (not to mention….easiest) response is rescue breathing. Thankfully the World Health Organisation (WHO) is in the process of developing their guidelines for opiate overdose response and they reinforce exactly what I am saying. All you need to do is breathe for the person!
We have met with lots of services including police and ambulance services to let them know about the naloxone training. We have told the police that there is a good chance that they will find naloxone among drug users’ possessions and we have alerted the ambulance officers to the fact that they may arrive at an overdose and discover that naloxone has already been administered. The responses have been overwhelmingly positive from the people we have spoken to but it may take some time before this sort of information becomes common knowledge. So don’t be too shocked if every police officer in the state isn’t aware of naloxone. If you are stopped and questioned or searched by a police officer who has no knowledge of naloxone, rather than getting upset or angry, my advice is to calmly explain why you have it and ask them to check out your story with their superiors. It won’t take long for them to discover that you are telling the truth and that it’s a ‘good thing’ that you are carrying it.
Unfortunately the issues with 000 operators seem to be taking a bit longer to sort out. I have had reports of someone calling 000 and telling the operator that they have naloxone, only to be told to stop and that they shouldn’t inject the person with anything. All the caller really wanted was for someone to talk them thru the situation so it must have been very confusing to be told not to do it. Thankfully the person was confident enough to proceed anyway which resulted in a positive outcome and a very grateful and alive patient.
The point I want to stress in this post is that access to naloxone for drug users is a relatively new concept in Australia and it will take some time before it becomes common knowledge. So, until then be prepared for some hiccups!
NALOXONE UPDATE 03:
The naloxone workshops have been going really well and we’re up to a total of 186 peers that have taken
part in the training and left with a naloxone kit in their hands. At this stage we have 15 reported reversals. It’s important to remember that the number could even be higher because there is no guarantee that we will hear about every one that takes place (even though we would love to!)
The first peer education program about naloxone for people who inject drugs in Australia was in Canberra, ACT and they have finally completed the evaluation. Some of the key findings so far are:
- Participants’ overdose identification and response knowledge, particularly their knowledge about naloxone, was higher after the completion of training than before training.
- All reported overdose reversals (n=23) using program-issued naloxone were successful.
- Participants displayed a good knowledge of overdose identification and response and were able to administer naloxone in a non-medical setting.
An additional positive outcome and perhaps the most surprising was:
- Participants’ experience of empowerment.
That last one really makes me happy! To hear that people are feeling really good about having access to naloxone and the ability and confidence to save someone’s life is kind of obvious but it’s not something that was initially thought about.
I was actually privy to reversal number 15 and I have to say that it was so good to watch someone who had attended a workshop, spring into action and come to the person’s aid with their naloxone! Although the person who administered the naloxone wasn’t well known to the person who had dropped, the happy end result made everyone who had witnessed it feel good. Saving someone’s life is a great thing and anyone who does that deserves to feel good about it, don’t you think?
There was one issue that came up, that I hadn’t really anticipated and that was the fact that the rescuer ended up using their last mini jet of naloxone on…for all intents and purposes…a stranger! It was never an option to not use it but when it was all over, they commented that now they had no naloxone left for any future overdoses. So I’d just like to make it clear that for anyone who uses all their naloxone and requires a replacement script, please just give me a call here at HRV on 9329 1500 and I will organise a visit to a GP for you. I would hate to think that someone was reluctant to use their last mini jet on a stranger out of fear of not being able to get more. Naloxone is here to stay, folks! And we’re here to make sure you can get it when you want it!
NALOXONE UPDATE 02:
Since my last update I’ve done workshops in Dandenong, St Kilda and Collingwood which puts my workshop tally at 19 and the total number of drug users trained and equipped with naloxone at 156.
There’s also been two more reversals reported making it a total of 13 so far.
I was talking to a bunch of people last week and there was a bit of confusion about the number of reversals and what that actually means.
So what do I mean when I refer to 13 ‘reversals’?
I’m saying that 13 people overdosed, but that these incidents of overdose were much less stressful for the friends who intervened because naloxone was available; they all reported that they felt a lot more confident about responding to the overdose and calling an ambulance because they had naloxone on hand and they knew how to administer it.
I’m not saying that 13 people would have died if naloxone hadn’t been administered – although it is quite possible and all 13 could have ended tragically.
The workshops have been going really well and this week I’m meeting up with some more GPs to discuss doing workshops in Frankston and Ballarat.
The word is out! Current drug users are being trained in how to administer naloxone in the event of an opiate overdose. We, here at Harm Reduction Victoria, have been out and about running workshops that cover all aspects of overdose response, including naloxone
The logistics of providing participants with the actual naloxone on completion of the workshop is a bit of a challenge but it’s not impossible. It has involved good communication combined with forward thinking and topped off with a willing and able GP to write the scripts.
Then, there is the cost of the naloxone multiplied by 10 (because that’s how many participants attend each workshop) So far the cost has been one of the biggest barriers to putting naloxone into people’s hands. Some people are of the opinion that $5.90 isn’t a lot of money and won’t be a barrier to access. I guess for some it’s not but the majority of people I talk to at workshops are having a hard time of it and don’t have much small change to spare.
A lot of agencies have managed to come up with the funds to pay for the naloxone scripts – and I’d like to say a big ‘thank you!’ It makes such a difference to be able to give participants their very own kit containing naloxone and everything else they will need rather than just telling them about it and hoping for the best – i.e. that they are inspired enough to see a doctor and ask for a script and then take that script to the chemist to be filled and pay for it themselves. A naloxone script or knowing how to administer it isn’t enough – you need to have the naloxone to save a life!
So far, the agencies that have facilitated workshops are:
Access Health (who had the courage & compassion to “just do it”)
North Richmond Community Health
To date we have delivered 15 workshops to 120 people & there have been 11 reversals reported.
This is fantastic news! From now on I will be providing regular updates about what’s happening with naloxone at Harm Reduction Victoria. So, watch this space!