Vol 16 Edition 1

Naloxone program takes to the streets

Free take-home naloxone and new training initiatives in Victoria are offering those most likely to witness an overdose the power to reverse it.

The Proactive Overdose Response Initiative (PORI) operated by Melbourne’s Youth Projects networks with community health services and those at-risk of encountering overdose to provide access to and training about naloxone – the opioid overdose reversal medication.

PORI project officer Tristan Duncan says the initiative is working to save lives.

“We have a lot of clients that have experienced overdose, have encountered and witnessed overdose, and unfortunately haven’t had the capacity to respond to those events,” says Tristan.

“The training that comes alongside naloxone equips these people with the ability to respond to overdose in a more comprehensive manner.

“We’ve had 24 recorded reversals and lives saved using naloxone, so we certainly see the positive effects of distributing naloxone.”

The need to challenge clients

Frontline drug and health workers say they still face barriers in distributing access to and education about the medication.

cohealth Peer Overdose Educator Natalya Kanaef, who works on the streets of Melbourne’s Maribyrnong and Brimbank suburbs, says she frequently challenges many of her clients who associate naloxone with bad experiences of overdose, including stigmatisation and precipitated withdrawals.

“Experiences of naloxone, for a lot of people, have been brutal. You know, waking up to people in uniform, flashing lights. I had a client come out of an overdose and an ambulance officer said to him, ‘why don’t you just get off the shit’, while straight away he’s coming down. A lot of people associate it with those stigmas,” says Natalya.

While ambulance officers frequently administer high doses of naloxone, Natalya says people could still save a life without acute side effects if they have the knowledge and capability to administer their own naloxone.

“We explain that if you use it in smaller doses, you still feel stoned half an hour later. It’s about challenging people’s understanding of what naloxone is. I don’t think anyone is averse to saving someone’s life.”

While naloxone administered by overdose witnesses is a potentially life-saving emergency interim response to opioid overdose, it should not be seen as a replacement for comprehensive medical care. This means always calling an ambulance for an overdose.

Understanding what overdose looks like

Natalya says another barrier she frequently encounters is a misunderstanding of what overdose actually looks and feels like.

“Overdosing to people who have never overdosed sounds pretty scary, but for people who have overdosed, it’s actually a great feeling. You’re stoned and you’re drifting off, and a lot of the time people don’t even realise, and go ‘oh, what do you mean, I was just nodding off’. People just don’t even realise they’ve gone over,” says Natalya.

“A lot of our work is saying to people, ‘when you did nod off for five hours and wake up with a dead arm, that was actually an overdose’. People are becoming a lot more aware of that.”

Opioid overdose symptoms include being unresponsive, pale, ashen or clammy skin, a limp body, bluish or purple fingernails or lips, vomiting or gurgling/snoring noises, an inability to wake up or speak, and slow breathing or heartbeat.

Natalya and other health and drug workers can provide people in the community with naloxone training and access at no charge, thanks to the support from PORI and the Naloxone Subsidy Initiative, introduced by the Victorian government in 2017.

Call for a wider community approach

Tristan Duncan commends the work of frontline health workers like Natalya and says a wider community approach was also vital to help stem the flow of fatal drug overdoses.

“Overdose isn’t just something that is the responsibility of clients, but requires a whole community response,” says Tristan.

“Part of that is upskilling sector staff and community members in naloxone training. We encourage all people – if they’re working in NSP, the homeless sector, if their family members are in a vulnerable position, or even if they’re just community members living in hotspots. We can offer naloxone training and also facilitate subsidised provision of naloxone.”

Tailored answers to negative responses

Tristan advises NSP workers not to be put off by negative responses to naloxone access and training, and instead to try and understand the barriers they may be experiencing.

“It’s important not to be discouraged by clients who initially don’t want to participate in the training. Try to work out the themes around this reluctance – what are the concerns that people are bringing up, and how can you tailor your response to some of those barriers,” says Tristan.

“Take-home naloxone is a life-saving intervention, [so] it’s worthwhile having conversations about it, but for some clients the advantages are not immediately clear. It’s about trying to open up that dialogue and speak about naloxone in constructive and insightful ways.

“The good thing about naloxone is it opens up those conversations around drug use, around opioid use, around the risks and potential harms. It allows us to address some of those myths and concerns that individuals might have.

“It’s all about working with clients to find that appropriate advice, and it can take a little bit of persistence. It’s only with the rapport and the relationships that we have with clients that we’re able to encourage them to take part in the naloxone initiative.”

– Tom de Souza

Tips for NSP workers

  • Don’t be discouraged by an initial negative response by clients to naloxone access or training; try to understand the barriers that person may be facing.
  • Encourage a soft approach to naloxone.
  • Encourage the wider community to be involved in naloxone access and training.
  • Try to dispel common misunderstandings of what naloxone is and what it does.
  • Build relationships and rapport – this is crucial to encouraging naloxone access and training.

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