Take Home Naloxone Program: Information for Pharmacists

Approved providers include community pharmacies (s90), hospital-based pharmacies (s94) and approved medical practitioners (s92), who will supply naloxone and then be reimbursed by the PPA.

For information on how to register for the THN Program, follow the simple instructions in the Community Pharmacy Portal User Guide Take Home Naloxone.

Participating sites are required to provide data to the PPA, via the PPA portal. This data will allow PPA to make payments and allows the Commonwealth to understand the uptake of the program

Brands include:

• Nyxoid (naloxone 1.8 mg/actuation nasal spray, 2×1 actuation)
• Prenoxad (naloxone hydrochloride 1 mg/mL injection, 2 mL syringe)
• Naloxone Juno (naloxone hydrochloride 400 microgram/mL injection, 5×1 mL ampoules)
• Naloxone Hydrochloride (DBL) (naloxone hydrochloride 400 microgram/mL injection, 5 x 1 mL ampoules)

In Queensland, these forms of naloxone are available as a Schedule 3 medication.

If you are an s90 pharmacy, you will need to order stock through your normal wholesaler/s. Any stock given out as part of the THN Program can be claimed for payment via the PPA portal.

Pharmacists can provide a participant with a maximum of two times the PBS maximum quantity of product per visit. This may be two units of the same product or one unit of two different products, depending on the participant’s preference. However, there is no limit on the number of visits an individual can make to access naloxone. Importantly, each visit must be entered as a separate individual supply claim in the PPA portal.

It is important that pharmacists communicate with their patients who use drugs in order to provide support. People who use drugs, and particularly people who inject drugs, experience stigma and may be fearful of accessing health services. It is important to be non-judgemental and treat these patients with empathy.

Further, in Australia prescribed opioids contribute to 75 hospitalisations and 2 deaths per day. Research indicates that most patients prescribed opioids for pain would appreciate and expect to receive information about opioid safety and the availability of naloxone. Anyone who takes prescription opioids will benefit from keeping naloxone at home in case of emergency.

Patients are at an increased risk if they:

• Take other psychoactive medicines (benzodiazepines, gabapentinoids, other psychiatric medications)
• Have other comorbidities that would increase their risk (respiratory conditions including COPD, renal or hepatic impairment)

Pharmacists can provide naloxone to anyone who is at risk of an overdose or adverse reaction, even if they are not currently taking opioids. Further, naloxone may be provided to anyone likely to witness an overdose.

Counselling of consumers or family members accessing naloxone should include:

• Symptoms of a suspected overdose – person will not respond to voice or touch, person may have blue or purple tinged lips and nails, person may display slow, irregular breathing, snoring or 'gurgling'
• Positioning of patient - position the person in the recovery position to open their airway
• Explaining that opioids can cause respiratory depression that is disproportionately severe compared with their sedative effect. Consumers should be informed that the first-line treatment of a suspected overdose is support of airway and breathing. If the patient is pulseless, start cardiopulmonary resuscitation according to life support protocols and call an ambulance.
• Immediately give 400 micrograms of naloxone by intramuscular injection (in the thigh or deltoid) or administer nasal spray
• Continue rescue breathing
• Repeating naloxone every 2-3 minutes until the person begins to wake up
• Advise not to cancel the ambulance or leave the person once they wake up
• Tell the ambulance how many doses of naloxone have been given

Consumers should be reassured that naloxone will not harm someone who is not experiencing an overdose or overdosing on a non-opioid substance.

Ampoules

Importantly, the ampoule form does not come with needles or syringes. A 3mL syringe and 23G needle should be supplied with the ampoules. These may be purchased or accessed through other services that provide clean injecting equipment. If you supply ampoules, make sure that opening the ampoule is covered in your counselling.

The ampoules each contain 400 micrograms of naloxone (a single dose). Ideally a minimum of two ampoules should be supplied each time to allow for repeat dosing. A single dose may not be sufficient to reverse overdose. A dose of 0.8mg (800mcg) administered intramuscularly in adults is the most appropriate to achieve adequate respiration, reverse coma and avoid the need for repeat doses (TGs).

Pre-filled syringe

Naloxone is also available as a pre-filled syringe with the brand name Prenoxad®. The container contains two needles and one pre-filled syringe.

In order to administer the dose, a cap must be removed from the syringe and the needle attached.

The syringe itself contains 2mg of naloxone, which is the equivalent of FIVE 400mcg doses. There are lines on the side of the syringe that denote each dose. When counselling ensure that this is clarified, to avoid using the whole syringe in error. If a second or subsequent dose is required, the same syringe may be used with a new needle.

Resource: Prenoxad Injection Training Fact Sheet

Nasal Spray

Naloxone is also available in a nasal spray with the brand name Nyxoid. Each nasal spray contains one dose (1.8mg) of naloxone.

Resource: Video on how to use nasal spray Nyxoid

Payments are made in accordance with provider type and via the PPA portal. For further information and detail on payments for each individual supply of Naloxone, see the “Payment” section of the Pharmacy Programs Administrator website.

• Take Home Naloxone PPA Program Rules
• Naloxone Pharmacist Poster
• Video: Naloxone information for pharmacists who dispense prescription opioids