Despite now being available over the counter, take-home naloxone programs designed to be used by potential overdose witnesses to prevent opioid-related harms, are not being bought in increased numbers, according to the authors of research published by the Medical Journal of Australia.
The researchers, led by Associate Professor Suzanne Nielsen, Deputy Director of the Monash Addiction Research Centre, and Burnet Institute Honorary Principal Fellow, say it is critical that programs bolster community access to improve naloxone coverage in Australia.
“The Pharmaceutical Benefits Scheme (PBS) has subsidised take home naloxone since 2013, but few programs have focused on broader community supply, including to people receiving prescribed opioids,” the authors wrote.
“This gap in coverage is important, as 70 percent of opioid-related deaths in Australia are caused by pharmaceutical opioids.
“Impediments to broader naloxone supply have included its cost, its’ requiring a prescription, and the stigma attached to substance use.”
The researchers analysed data from monthly naloxone prescriptions from the PBS and sales data from IQVIA, from the period 2014–2018, for Australia and by state and territory.
Total naloxone supply to community pharmacies in Australia increased between 2014 and 2018, but rescheduling that enabled over-the-counter access did not significantly influence the volume of non-dispensed naloxone, Associate Professor Nielsen and colleagues found.
“Individually prescribed naloxone accounts for only two-point-nine percent of all community naloxone, which suggests that take home naloxone coverage is limited,” the researchers wrote.
“The lack of change in the non-dispensed volume of naloxone after rescheduling suggests that only a small volume of naloxone is sold over the counter.
“Our findings indicate that requiring a prescription was not the only barrier to expanding naloxone supply, and removing this requirement is only one step towards improving naloxone access in Australia.”
The authors noted that opioid overdose-related mortality declined substantially in the US following a change in legislation that allowed pharmacists to supply insurance-subsidised naloxone, and they say the provision of subsidised over-the-counter naloxone through pharmacies should be considered in Australia.
They noted also that user-friendly naloxone preparations, such as intranasal naloxone, are unlikely to become widely available in Australia because they are prohibitively expensive.
Associate Professor Nielsen and colleagues concluded that “barriers such as cost, provider training, and consumer awareness warrant further examination”.