Naloxone report calls for end to ‘onerous’ barriers

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A new report from the Penington Institute has called for free take-home naloxone to be available from pharmacies and other sites, as Health Minister announces new product

A report released this week by the Penington Institute, a not-for-profit organisation that advocates for effective strategies for tackling problematic drug use, has proposed a model for a national take-home naloxone program for Australia.

The organisation argues that while naloxone has been used in Australia in emergency settings for decades – and is theoretically available for access via prescription or over-the-counter – in practice naloxone remains largely out-of-reach for those at-risk of opioid overdose.

“The significant cost of purchasing naloxone over-the-counter and the onerous process of accessing it via prescription, serve as barriers for those most likely to benefit from facilitated access to the medicine,” says the institute.

“Purchasing naloxone ‘over-the-counter’ from a pharmacy incurs a considerable cost (this varies but is generally estimated between $50-$80),” says the report.

“With a prescription, this cost is reduced to a flat rate of $39.50, and for those with a health concession, further to $6.40. While $6.40 may not seem like much, for many people who misuse substances it is a substantial enough barrier to make the difference between accessing and not accessing.

“In addition, accessing naloxone at this reduced cost involves having a health concession, attending a doctor, getting a prescription (which the GP may refuse to issue), and then attending a pharmacy and spending limited resources: an onerous process that constitutes a significant barrier for many people who would benefit from having naloxone.”

To combat this, the report proposes a model for a national take-home naloxone program that makes the product available free-of-charge to those who need it – people at risk of overdose and people likely to witness overdose i.e. those using opioids, their friends and family members.

It suggests several agencies should be authorised to distribute take-home naloxone through the program.

These key distribution points would include pharmacies; needle and syringe programs (primary and secondary); select community agencies (that work with at-risk clients including outreach and homelessness services); custodial facilities (including remand and youth justice centres); drug treatment facilities and programs; and emergency departments.

Public awareness of overdose and naloxone also needs to be improved, says the Penington Institute.

“Without awareness and knowledge, demand cannot be effectively generated,” reads the report.

“This must be done in a clear and non-stigmatising manner, both to the public broader and targeting specific at-risk populations, and utilising a range of media.”

In launching the report on Wednesday, Health Minister Greg Hunt said the government would be taking its recommendations seriously.

“This report about the Australian naloxone access model…is extremely valuable,” said Minister Hunt.

“We will very very seriously consider the recommendations here… there has to be more action to get naloxone into the hands of those who need it.”

At the launch, Minister Hunt also announced that intra-nasal naloxone has now been approved by the TGA for sale in Australia, which should become available later this year.

Currently only an injectable formulation of naloxone is available for use.

The PSA welcomed the launch of the new product.

“The intranasal preparation will hopefully reduce some of the stigma that might be associated with using an injectable product, so it might just improve accessibility and reduce some of the barriers to the availability of the product,” said PSA national president Shane Jackson.

Regarding the report, Dr Jackson said: “Affordability is probably the main stumbling point that we have at this point in time. While the product is available as a pharmacist-only medicine and can be prescribed on the PBS, I think less than 1000 prescriptions have been written…

“And so at this point in time we’re still not getting it into the hands of people who may need to have it.

“What the Penington Institute was trying to identify is that essentially take-home naloxone is available in other countries at reduced [cost] and often free.

“We believe that pharmacy is the key site that we can provide availability across the country. The advantage of involving pharmacists, especially within community pharmacy, is that they may well be the only health professional that sees that individual who may be at risk,” says Dr Jackson.

“So they have an opportunity, once they’ve identified that a person may well be at risk of unintentional overdose, of being able to potentially supply that lifesaving naloxone to an individual, whether it be the injectable product or the future intranasal product.

“Once a pharmacist has identified somebody, they need to be able to do something about that. And currently, one of the main barriers that we have is that affordability issue.

“It’s certainly my view that we should have some sort of program that involves the Commonwealth, states and territories to say, okay, we’re going to really tackle this affordability issue of naloxone so that we do get it into the hands of people who need it or who may need it in the future, so that we do deal with that affordability issue, and essentially save lives – because we know naloxone will save lives.”

Request access the full report here

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