‘Lifesaving’ medicine added to PBS

The newly listed nasal spray version of naloxone will also be made available as an option for the take home naloxone pilot

A nasal spray form of naloxone, a medicine that can reverse the side effects of an opioid overdose, has been added to the PBS from today (1 November 2019), Health Minister Greg Hunt announced this week.

Ready-to-use intranasal spray Nyxoid was registered as a Schedule 3 medicine with the TGA in late 2018, and earlier this year made it onto pharmacy shelves.

However it was only available over the counter and not subsidised by the government.

Depending on individual pharmacy mark-up, a twin-pack of Nyxoid intranasal spray was retailing for between $75 and $85.

From 1 November, the cost of Nyxoid is now reduced to the flat rate of $40.30 with a prescription, and for those with a health concession card it will cost $6.50 per script.

Prior to the availability of Nyxoid, naloxone was required to be injected to reverse the side effects of an overdose.

Jarrod McMaugh, pharmacist and board member of Harm Reduction Victoria welcomed the availability of Nyxoid.

“Anything that makes it easier for someone at risk of opioid overdose to access and benefit from a lifesaving opioid reversal agent is a big step forward,” he said.

“Not everyone in the community is comfortable handling syringes, so the availability of a discreet nasal spray that requires minimal training is an important development.”

The needle-free delivery system reduces the risk of needle-stick injuries for those who are administering the medicine.

Pharmacists should consider recommending Nyxoid to people who are using opioid painkillers at high doses, Mr McMaugh told AJP, as its nasal delivery system reduces some of the stigma associated with naloxone use.

“Most people who are using the naloxone are doing so because they might be using opioids recreationally and people who are doing that are probably not going to be worried [about using injections or spray] one way or the other,” he says.

“But there is a large amount of people who are getting a lot of opioid painkillers and they’re not realising that they’re at the same risk of overdose as everyone else. These people can be more comfortable with using nasal spray.

“I don’t think pharmacists necessarily think about providing naloxone for patients who are on high-dose opioids for pain, so there is a group of people who have a risk – not an overall high risk – but once people get above 50 mg eq morphine BD you should consider having access to naloxone at any time as it becomes more dangerous.”

Nyxoid would also be a good treatment option for people who are passed out, says Mr McMaugh.

“Unlike other nasal sprays, for example antihistamine sprays where you need to direct it in such a way that it hits the sinuses, with Nyxoid you can spray it into the nose and it will work regardless of directional placement of the device,” he says.

“You pretty much can’t get it wrong. There were some people who were worried that the dose would be too high but I don’t think it is. It’ll work and give people enough time to become conscious.

“There are many barriers to people at risk of opioid overdose having ready access to a reversal agent. Nyxoid has removed one of these barriers, but the focus now needs to be on ensuring easy and cost-effective access for those who will benefit from having one of these devices in their possession,” he added.

A naloxone pilot

The listing of Nyxoid follows the Federal Government’s commitment of $10 million for a PBS subsidised take home naloxone pilot in NSW, South Australia and Western Australia.

Nyxoid will now be made available as an option for the take home naloxone pilot, which provides naloxone for free and without a prescription from various locations including community and hospital-based pharmacies, alcohol and other drug treatment centres, needle and syringe programs, custodial release programs, first responders (police) and GP clinic access.

The pilot is expected to commence from 1 December 2019 and run through to 29 February 2021, with a final report expected in mid-2021 to be provided to the government as part of possible considerations for a national roll‑out.

It will target individuals who use illicit and/or prescription opioids who are at risk of, and/or family or community members who are likely to witness, an opioid overdose.

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