Salvation Army Southern Australia Territory Alcohol and Other Drugs Unit
Fact Sheet: Naloxone
Naloxone

Opioids are a group of drugs that are derived from opium such as heroin or morphine and include synthetic and semisynthetic pharmaceutical drugs such as oxycodone. They depress the central nervous system (CNS), and reduce the
rate of respiration.

In the case of an overdose, respiration can cease completely which can lead to permanent brain injury, other major organ
damage and if untreated, opioid overdose can lead to cardiac arrest and death.

Whilst heroin related overdoses have decreased since the late 1990’s the number of fatal overdoses occurring due to
pharmaceutical opioids such as oxycodone and slow release morphine products has increased.

Deaths from opioid drugs in Australia are rising steadily. Opioid drug overdoses increased 95.8% between 2007 and
2010. The number prescriptions for opioid painkillers have also increased over a 15 year period. The increase has been
threefold to 7 million a year.

At least three Australians die every day from overdoses. Overdoses outnumbered road fatalities in Australia in 2011.
According to the Australian Bureau of Statistics overdose deaths totalled 1,383, while road deaths, which have
been steadily declining, ended the year at 1,323. In Victoria prescription drug-related deaths now outnumber those
caused on the road. Prescription drugs are present in most overdose deaths.

Death and/or disability caused by heroin or pharmaceutical opioids overdose are preventable by administering a dose of
Naloxone.

Naloxone is a drug known more commonly by the trade name of Narcan® . Naloxone is a full pure opioid antagonist that
reverses the effects of natural, synthetic and semi-synthetic opioids including codeine, heroin, methadone, morphine and
oxycodone.

Naloxone Hydrochloride has no other action than to reduce the effect of heroin and other opioids. It has been used to
safely reverse the effects of opioid intoxication in hospital and pre-hospital emergency situations for decades. It has no
psychoactive effect thus does not cause intoxication, is not a drug of dependence, and therefore, is not a drug which is
likely to be diverted or misused.

Naloxone comes in a liquid form for either for injection or for inhalation. It can also be administered via a nasal spray
device which converts the naloxone liquid into a fine mist, disabling concerns regarding possible needle-stick injuries.

At present, intranasal preparations of naloxone are not licensed in Australia, although application by nasal spray has been
trialled in Victoria by paramedics where it was found to be effective and safe.

In Australia Naloxone is currently used by medical personnel such as paramedics and emergency room personnel.

Although Naloxone is currently only available on prescription in Australia, international evidence shows that non-medical
personnel can be trained to safely administer Naloxone, thus preventing death and/or disability.

Naloxone has been available from pharmacies as an over-the-counter medication in Italy since 1995 and therefore is
available for peer administration. Accruing international evidence since 2000 suggests the distribution of Naloxone to
opioid users, their peers and family members can occur with very few, if any, adverse effects and/or negative
consequences.

In the USA as of December 2008 there were 52 peer-Naloxone distribution programs operating across 17 states and in
the UK it is also now available to non-medical people through pilot programs. Legal protection has been extended to nonmedical personnel who administer it in the United Kingdom and parts of the United States.

At present in Australia, naloxone can only be provided to members of the general public via medical prescription.

These issues have been discussed for more than a decade in Australia. In the longer term, naloxone could be
‘rescheduled’ to make it available as an ‘over-the-counter, pharmacist involved’ purchase in pharmacies; this has been
the case in Italy for many years.

The sustained mortality among opioid users highlights that current overdose prevention strategies are not sufficient.
Treatment programs, such as Opioid Substitution Therapy (Pharmacotherpay), are not primarily aimed at overdose
prevention, although they do decrease many of harm associated with drug use.

Abstinence-based treatments (eg detox) reduces tolerance to opiods and increases the risk of overdose if use resumes.
Distributing naloxone to people who come into contact with opioid users helps preserve life and maintain future treatment
options.

On 16 December 2011, the Australian Capital Territory (ACT) Government announced that Australia’s first program to
provide naloxone to trained potential overdose witnesses would commence in 2012. It will be independently evaluated.

Under the ACT program, naloxone is being provided under prescription and 200 people will be trained in overdose related
risk factors, recognising opioid overdose and responding to opioid overdose (including resuscitation techniques, calling for
an ambulance and the administration of naloxone).

At a recent forum held by the Burnet Institute, it was clarified that there are no legal, financial or technical barriers in
Victoria to the implementation of peer programs training people in the use of the life-saving opiate overdose reversal drug
Naloxone.

As a result the City of Yarra which has one of the highest overdoses rates in the state, is calling as a matter of urgency for
Naloxone to be distributed to drug users , their peers, families , friends and anyone else who may potentially witness and
overdose and who can potentially save the life of another.’

In order to facilitate the introduction of Naloxone the Yarra Drug and Health Forum is set to develop a strategy for the
implementation of a Naloxone Distribution Program in the City of Yarra and is calling for others in the AOD sector to
advocate and/or support their call for a distribution program. Advocates of this include:
Alcohol and Other Drugs Council of Australia
Anex – Australian Association Harm Reduction
Australian Drug Foundation
Australian Medical Association (Vic)
Australian Research Centre in Sex, Health and Society
Burnett Insitute
AVIL – Australian Intravenous Injecting League
City of Yarra
Family Drug Help and the Family Drug Helpline
Victorian Alcohol And Drug Association (VAADA)
Law Enforcement Against Prohibition Australia.
National Drug Research Institute
Public Health Association of Australia
UnitingCare ReGen Moreland Hall
University of New South Wales Drug Policy - Modelling
Program
Canberra Alliance for Harm Minimisation and Advocacy
(CAHMA)
Expanding Naloxone Availability in the ACT (ENAACT)
Committee
References
http://www.overdoseday.com/facts-stats/
http://www.anex.org.au/what-we-do/current-interests/access-to-naloxone/ Anex (2012), Australian Drug Policy: Lifesavers - accessto naloxone to reduce
opioid overdose-related deaths and morbidity. Anex, Melbourne, Australia.
http://www.atoda.org.au/wp-content/uploads/The_heroin_reversal_drug_naloxone_FIN2.pdf Paul Dietze and Simon Lenton The case for the wider distribution
of naloxone in Australia December 2010
http://www.atoda.org.au/policy/naloxone/ Expanding Naloxone Availability in the ACT
Stancliff S, Mathews B, Rath C. Building Capacity in Overdose Prevention. Symposium: Increasing community access to naloxone to prevent opioid overdose
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Dean R, Negus S, Bilsky E. Opioid Receptors and Antagonists: From Bench to Clinic. New Jersey: Humana Press, 2010.
Lenton SR, Dietze PM, Degenhardt L, Darke S, Butler TG. Now is the time to take steps to allow peer access to naloxone for heroin overdose in Australia.
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