Angelo Pricolo, the Brunswick pharmacist who successfully applied to the TGA to have the life-saving medicine naloxone downscheduled to S3, has expressed surprise at an ABC story claiming that the medicine was not being used as much as expected.
And far from being a let-down, the naloxone downschedule in Australia may be informing better health practice internationally, he says.
The article and audio story, by Penny Timms at The World Today, highlighted that deaths due to opioid overdoses were on the rise in Australia, with 13 people dying in Sydney recently from what the NSW coroner referred to as a “deadly” batch of heroin.
“There has been a low uptake of the heroin-reversing drug Naloxone since being made available over the counter, and experts say the cost is a barrier for drug users,” the article says.
It quoted an expert from UNSW’s National Drug and Alcohol Research Centre, who said “there were many pharmacists who had not had any requests for the drug over the counter”.
But Pricolo told the AJP that particularly given it takes time for messages about changes to medicines availability to get to consumers, uptake has actually been good.
“The idea of changing the schedule was to increase availability, and we know that in this sector, any change usually takes quite some time before it gets down to the end user,” he says.
“It’s not a huge population from the start; and there have been difficulties compounded by the fact that the distributor in Australia has sold the product, and not replenished their stock. So we’re almost out of stock now.
“The reality is that information from them shows sales of the product since the schedule change have more than tripled. When you read stories like this one [the ABC story] you wonder what the expectation was… did they think that out of 10,000 pharmacy lines we would start dedicating a whole bay to naloxone?”
Pricolo says that informing the population about naloxone’s downscheduling is not just about educating people who misuse opioid drugs; it’s also about letting their support network know. It’s unrealistic to expect that people misusing opioids would be the purchaser, and certainly not the person to administer the drug, he says.
“There’s always difficulty in getting the message out to the people you intend to receive it, and this is no exception.
“But we are actually seeing awareness slowly rising,” he says. “All of a sudden, people are talking about naloxone. For the first time in 30 years, in my practice I’ve even received a prescription for it.
“This isn’t just about me being able to sell it over the counter; it’s also about dealing with local doctors. I deal with a clinic where they can send patients down to me with a requisition and I can charge that to the clinic, not to the patient.”
The article suggests price may be a factor in lower than expected uptake and that some pharmacists have not been welcoming of the change.
“The cost hasn’t changed,” says Pricolo. “If the Government isn’t going to pay for it, the end user has to. But really, it’s $25 to save somebody’s life; an Epipen costs five times as much.
“I think what people are doing is comparing the price of the item to the price where it’s subsidised in a doctor’s bag or a PBS script… you could do the same thing with cancer treatments costing $10,000 or Hep C treatments, and come up with ill-informed comments!
“And not every pharmacy is seen as a destination for addiction. There are 5,500 pharmacies in Australia, so of course there will be some pharmacies who say, ‘nobody asks me for naloxone, I don’t stock it,’ in the same way as there are 3,500 McDonalds and they don’t all sell lots of Fillet O’Fish.”
He encouraged pharmacists who are unsure about getting involved with addiction treatment to give it some consideration.
“Dip your toe in the water… you’re not going to start working in addiction and know everything at once, but once you start to work with people affected and see some of the results – which is what happened to me and it’s why I got involved – you can really see the difference you can make and your attitude starts to change.”
Australia is only the second country in the world (after Italy) to make naloxone available over the counter. And international stakeholders are watching, Pricolo says.
“Parts of the US have already organised programs to make naloxone more available, though of course there will be states with a more liberal attitude to this than others,” he says.
“The Australian example hasn’t gone unnoticed over there. Even if it’s just a small part of what happens there, it’s still a catalyst for change.”