Take-home naloxone ‘saves lives’

Morgan Liotta

25/03/2020 2:19:12 PM

Currently in a pilot phase across three states, naloxone would be more effective if further patient education was provided, one expert says.

Dr Paul Grinzi
GPs are well placed to have honest and respectful discussions with patients about risk of opioid overdose, says Dr Paul Grinzi.

More than three people in Australia die each day from opioid overdose.
There was a 25% increase of hospitalisations due to opioid poisoning between 2007­–08 and­­ 2016­–17, with the rate of deaths resulting from opioids rising by 62% from 2007 to 2016.
Naloxone ­– a short-acting opioid antagonist that reverses the effects of an opioid overdose – is available free through pharmacies across New South Wales, South Australia and Western Australia as part of a Government-funded pilot aiming to increase community access to those at risk of, or likely to witness, an opioid overdose.
Given the magnitude of rising harm from opioid misuse, GP and addiction medicine expert Dr Paul Grinzi deems nationwide implementation, as well as patient education, of take-home naloxone as a significant approach to minimising these harms.
‘Put simply, take-home naloxone saves lives,’ he told newsGP.
‘It’s akin to having an EpiPen for those at risk of anaphylaxis – it buys time whilst an ambulance is called for someone who has stopped breathing due to opioid poisoning.’
Dr Grinzi noted that patients who are at high risk of overdose are also more likely to witness someone else’s overdose, so the supply of naloxone into the community can ‘potentially save lives beyond the index patient’.
Despite current availability across three states and nationally on the Pharmaceutical Benefits Scheme (PBS), adoption of take-home naloxone is not without challenges. This is mainly to do with the lack of access and awareness of the medication’s role, according to Dr Grinzi.
‘There is a need for limiting access barriers and cost is a barrier to many in our community, including those at higher risk of overdose,’ he said.
‘The majority of opioid overdoses are from prescribed opioids. As a profession, the medical community needs to take responsibility and offer our patients and their families some harm minimisation strategies, including take-home naloxone.
‘Stigma is also a challenge, with some healthcare providers holding judgemental ­– and, in my opinion ­unprofessional – views about higher-risk populations. I doubt those same prescribers would withhold an EpiPen script for patients at risk of life-threatening allergy.
‘[Naloxone] has been on the PBS for ages, and we now have an intranasal version which avoids the needlestick concerns of past formulations.’
A prescription for take-home naloxone should be considered for all patients at higher risk of opioid overdose, Dr Grinzi recommends.
This includes patients who:

  • have a previous overdose or near-overdose history
  • are prescribed/using opioids with significant comorbidities, eg respiratory conditions, sleep apnoea, depression/suicidality, alcohol and other drug dependencies
  • are prescribed opioids in combination with benzodiazepines or other sedatives
  • are taking higher doses of opioids – the risk increases with doses higher than 50 mg oral equivalent morphine per day. The opioid calculator is a useful tool that provides a traffic-light-colour grading of risk.
‘I believe the key component of prescribing naloxone for overdose prevention is less the actual prescription, and more so the patient education behind the reasoning for the naloxone, [as well as] education around overdose detection, overdose first aid and naloxone administration,’ Dr Grinzi said.
‘Luckily there is COPE, an excellent resource that provides easily digestible material for GPs and patients.
‘Further education [for GPs about take-home naloxone] is not a panacea, but will be essential if we are going to adapt this lifesaving option.’
In addition, Dr Grinzi encourages an ongoing holistic patient–doctor relationship.
‘An honest, open and respectful discussion with patients may have more impact than the naloxone itself,’ he said.
‘Preventing an overdose has a greater impact than treating one, yet the former is a “hidden” benefit – we will never know of the overdoses that never happened.’
The RACGP recently delivered a guide to naloxone for GPs as part of its drug and alcohol webinar series. The Alcohol and Other Drugs GP education program also provides a suite of educational resources for GPs to best support their patients using alcohol and other drugs and apply harm minimisation strategies.

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