Pharmacists crucial to overdose prevention

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A coroner has highlighted that some areas in Melbourne have higher numbers of drug overdose and therefore higher need of prevention strategies

In mid 2017, two men in their 30s died from drug overdose within one a day of each other in St Albans, in Melbourne’s north west.

Jason David Hill died on the 23 June 2017 and Dale James William Halligan the following day in the same area from overdose of heroin—with benzodiazepines also implicated in one case.

Victorian coroner Caitlin English has recently looked into both deaths, finding that some areas of Melbourne have very high levels of drug overdose deaths.

The City of Brimbank, which contains the suburb of St Albans, was the site of the highest number of heroin-involved deaths in 2017.

And within the City of Brimbank, St Albans was a location with a higher concentration of heroin-involved overdose deaths.

The Victorian Coroner recommended that there should be place-based approaches to drug overdose prevention “with a view to promoting public health and safety and preventing like deaths”.

Coroner English also pointed to an August 2018 finding by Coroner Audrey Jamieson about Samuel Jack Morrison, who died in the City of Yarra from an overdose of heroin combined with benzodiazepines.

Coroner Jamieson had suggested that locally specific responses to the continuing rise of drug overdose fatalities – such as the Medically Supervised Injecting Room (MSIR) in North Richmond – may require broader strategic coordination.

Coroner Jamieson also said there is a need for “continued development of risk reducing strategies for people who inject drugs”.

The MSIR in North Richmond that opened in June this year is already saving lives, addiction medicine pharmacist and MSIR Advisory Group member Angelo Pricolo recently told AJP.

And the MSIR is building referral pathways with gateway service providers including community pharmacies.

Local pharmacist Perry Moshidis, also a member of the Advisory Group, said, “It was always very important to me as a pharmacist that the MSIR could build bridges to the services community pharmacy provide.

“We are an underutilised and often undervalued resource but building a relationship with the MSIR is beneficial for all parties.”

Pharmacists play a crucial role in spreading awareness and supply of naloxone, a drug that helps to reverse an opioid overdose including heroin overdose.

“Naloxone is really important, but far too few people know about it, and there is a stigma attached to it that isn’t necessary (and is in fact dangerous),” says Melbourne pharmacist Jarrod McMaugh, who is also a board member of Harm Reduction Victoria.

Mr McMaugh says he has supplied many naloxone kits for the purposes of heroin overdose and/or recreational use of pharmaceutical opioids.

He has also provided them a number of times to people who have associates that are taking higher doses of opioids or have an opioid dependency.

Mr McMaugh says as health professionals, pharmacists should be talking to all people using opioids due to the potential for accidental overdose.

“As health professionals, we should talk to all people who are using above 50mg equivalent of morphine daily, due to the potential for accidental overdose.

“Accidental overdose can happen to anyone using doses this high, because of the way side effects can be influenced by other medications, use of alcohol, and even illnesses such as chest infections,” he says.

“Despite this, the awareness by patients is very low; some patients and health professionals see it as only for people who use medications in a way that is unsafe (i.e. using more than prescribed, using recreationally, etc.) when all people on mid- to high-range doses are at risk of overdose.”

Through drug services such as the MSIR, people who inject drugs are more often able to safely inject, with health professionals available to administer naloxone if required.

“Naloxone is available OTC but the price means that it is out of reach for most,” explains Mr Pricolo.

“If your pharmacy has a relationship with a drug and alcohol clinic often they have funding available. Failing this, doctors can still write a prescription although unfortunately this does not happen often. 

“It is alarming that so many people are overdosing,” he told AJP.

“We should continue advocating to allow pharmacists to access the PBS and to supply naloxone at the PBS price. High price slows down uptake.

“But we also have a role in informing people that opioids almost always are responsible for overdose deaths when other central nervous system depressants are involved. So be careful with concurrent use of benzos, alcohol, cannabis and psychotropics.”

Coroner English closed her finding by advising the Victorian Department of Health and Human Services to set “ambitious” targets for reducing overdose deaths in high-risk areas of Melbourne.

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