Take Home Naloxone for pharmacists

Overview

From July 1, 2022, Victorian pharmacists can supply naloxone free-of-charge, to any person at risk of overdose, or who may witness an overdose. This may include those taking prescribed opioid medicines, those using illicit opioids, or any family members, friends, carers or any other person who may witness an overdose.  

All three forms of naloxone are included in this program – nasal spray; prefilled, multi-dose syringe; and ampoules.

Nasal spray vs injection

The choice of naloxone presentation may be influenced by the client’s preference, the patient’s circumstances, and the likely setting of the overdose incident.

The nasal spray provides ease of use in all settings, a fast response and a sustained systemic level of naloxone, at least equivalent to the injected form, after two dose of the nasal spray. It is expected that most end-users of THN will prefer the nasal spray to the injection.

The injection, in both the ampoule and pre-filled syringe form, requires the end-user to be comfortable with giving an intramuscular injection in an emergency first aid setting. It may be preferred by repeat users, or those familiar with giving intramuscular injections.

It is recommended that the form of naloxone supplied under the THN program be decided after discussion with the end-user. It should also be noted that it is allowed, under the program, to supply two forms of THN at once. e.g. 1 x prefilled syringe + 1x 2 pack nasal spray, and this should also be provided as an option.

Naloxone nasal spray and injections remain schedule 3 medicines, and in all cases, pharmacists supplying these medicines should ensure the end-user is properly counselled and instructed in the use of the medicine.

Illicit opioids vs prescription opioids

The THN program provides for supply of naloxone to any person at risk of overdose, or who may witness an overdose. This includes those at risk from prescribed opioid medication, as well as those at risk from illicit opioid medicines such as heroin, or illicitly obtained prescription medicines. It is very important that those using illicit opioids are not excluded from the THN program, and that they have equal access to naloxone.

It should also be noted that a person does not need to be currently using opioids to be considered at risk of an overdose. Anticipated future use of opioids may also be considered.

Risk factors for overdose

There are many factors that may increase the risk of an opioid overdose. These included, but are not limited to:

• Recent hospitalisation or multiple hospitalisation in the past 6 months
• Substance use disorder for any substance;
• Concomitant alcohol use;
• Bipolar disorder or schizophrenia;
• Stroke (cerebrovascular accident, CVA) or other cerebrovascular disease;
• Chronic kidney disease with clinically significant renal impairment;
• Heart failure;
• Non-malignant pancreatic disease (e.g., acute or chronic pancreatitis);
• Sleep apnoea;
• Chronic pulmonary disease (e.g., emphysema, chronic bronchitis, asthma, pneumoconiosis, asbestosis);
• Chronic headache (e.g., migraine);
• The patient uses fentanyl, morphine, methadone or hydromorphone;
• The patient uses an extended-release or long-acting (ER/LA) formulation of any prescription opioid;
• Prescribed benzodiazepine;
• Prescribed antidepressant;
• Maximum prescribed opioid dose ≥ 100 mg morphine equivalents per day.

Safescript

SafeScript is a useful tool to assist in determining a patient’s risk of opioid overdose. Noting a patient’s history, including red or yellow alerts can help open honest and respectful dialogue about reducing opioid risk

More information and support

Use the links opposite for more information about this program, and the resources available to pharmacists, patients and carers, including important guides to recognising overdose, and administering the various forms of naloxone.