In Queensland, take home Naloxone (THN) is available over the counter at pharmacies for a fee or with a prescription. However, financial and legal difficulties are seen as barriers to accessing Naloxone.1
The aim of this pilot was to design, implement and evaluate a roll-out of a model of care for THN for services that are in contact with people at high risk of opioid overdose and those with a history of opioid dependence.2-5
The team designed a brief opioid overdose prevention educational package 6,7 and provided free naloxone to at risk populations with the goal of preventing avoidable opioid deaths and morbidity.8 Similar interventions are generally focused on people who use injected drugs or those who present to an emergency department.9-12 The main concern with this is that typically, those prescribed medically-assisted opioid treatment programs are at increased risk of an opioid overdose and are not routinely provided with opioid overdose prevention education or given the antidote naloxone.13-17
Without existing procedures to provide opioid overdose prevention to patients in alcohol and drug services in Queensland, nurses took the lead. This evaluation was approved by The Prince Charles Hospital HREC (HREC/2020/QPCH/61924).
The main components of the nurse-led opioid overdose training were to (i) recognise the signs and symptoms of an opioid overdose; (ii) how to respond in the event of an opioid overdose; and (iii) understand what naloxone is and how to administer it.18,19
Registered nurses from three outpatient public medically-assisted opioid treatment centres in Queensland were trained. The educational intervention took between 15 and 45 minutes to complete depending on the level of knowledge that the patient already had; 100 education sessions to patients were delivered amid COVID-19 disruptions. There was a measured increase in opioid overdose prevention knowledge20 sustained at three months follow up, and four opioid overdose reversals with naloxone nasal spray supplied during the pilot. We also received positive feedback from patients:
“You never know when you might just need to save someone’s life, and by having the naloxone nasal spray, I have it with me everywhere I go as you never know when you need it, and with the right training I now know how to use it and feel confident to do so.”(Female, 24 years)
“I found that it is important to know what to do during an overdose, you never know who or when it could happen. Training session was good, it was thorough.” (Female, 18 years)
Opportunities and conclusion
Seminar presentations on this project and its outcomes have opened doors for existing initiatives of QuIHN to partner with Queensland Health to develop a training package that is accessible for all health professionals to learn about opioid overdose prevention. Nurses who led this study have inspired introducing other opioid overdose prevention programs in Queensland, both within and outside the public service. This all started with one nurse in one team having the vision to save one life.
1 Li HK, Durant L, Higgins N, Hayllar J. Establishing nurse-led overdose prevention training in public medically-assisted opioid treatment centres: lessons learned. Drug and Alcohol Review Australasian Professional Society on Alcohol and other Drugs (APSAD) Conference. 2021. doi: 10.1111/dar.13384
2 Australian Government Department of Health. Upcoming changes to reduce harm: Australian Government Department of Health – Therapeutic Goods Administration; 2020 [cited 2020 17 Apr]. Available from: https://www.tga.gov.au/alert/prescription-opioids-hub#industry.
3 Australian Institute of Health and Welfare. National drug strategy household survey 2019. Drug Statistics series no. 32. PHE 270. Canberra: AIHW; 2020.
4 Australian Institute of Health and Welfare. National framework for protecting Australia’s children indicators. AIHW; 2018.
5 Australian Bureau of Statistics. Opioid-induced deaths in Australia 2019 [cited 2021 19 Jul]. Available from: https://www.abs.gov.au/articles/opioid-induced-deaths-australia.
6 Penington Institute. Not just naloxone: Insights into emerging models to reduce drug harm. Carlton, Victoria: Penington Institute; 2017. Available from: http://www.penington.org.au/wp-content/uploads/2017/08/Not-just-naloxone-insights-into-emerging-models-to-reduce-drug-harms.pdf.
7 Dietze PM, Stare M, Cogger S, Nambiar D, Olsen A, Burns L, et al. Knowledge of naloxone and take-home naloxone programs among a sample of people who inject drugs in Australia: Variations across capital cities. Drug Alcohol Rev. 2018;37(4):457-63.doi: 10.1111/dar.12644
8 WHO Guidelines Approved by the Guidelines Review Committee. Community Management of Opioid Overdose. Geneva: World Health Organization; 2014.
9 Dwyer R, Olsen A, Fowlie C, Gough C, van Beek I, Jauncey M, et al. An overview of take-home naloxone programs in Australia. Drug and Alcohol Review. 2018;37(4):440-9.doi: 10.1111/dar.12812
10 Kilaru AS, Xiong A, Lowenstein M, Meisel ZF, Perrone J, Khatri U, et al. Incidence of treatment for opioid use disorder following nonfatal overdose in commercially insured patients. JAMA network open. 2020;3(5):e205852.doi: 10.1001/jamanetworkopen.2020.5852
11 Mullennix SC, Iseler J, Kwiatkowski GM, McCann-Spry L, Skinner J, Kuhl N, et al. A clinical nurse specialist-led emergency department naloxone distribution program. Clin Nurse Spec. 2020;34(3):116-23.doi: 10.1097/nur.0000000000000515
12 Eswaran V, Allen KC, Bottari DC, Splawski JA, Bains S, Aks SE, et al. Take-home naloxone program implementation: lessons learned from seven Chicago-area hospitals. Annals of emergency medicine. 2020;76(3):318-27.doi: 10.1016/j.annemergmed.2020.02.013
13 Follman S, Arora VM, Lyttle C, Moore PQ, Pho MT. Naloxone prescriptions among commercially insured individuals at high risk of opioid overdose. JAMA network open. 2019;2(5):e193209.doi: 10.1001/jamanetworkopen.2019.3209
14 Kimber J, Larney S, Hickman M, Randall D, Degenhardt L. Mortality risk of opioid substitution therapy with methadone versus buprenorphine: a retrospective cohort study. Lancet Psychiatry. 2015;2(10):901-8.doi: 10.1016/s2215-0366(15)00366-1
15 Degenhardt L, Randall D, Hall W, Law M, Butler T, Burns L. Mortality among clients of a state-wide opioid pharmacotherapy program over 20 years: risk factors and lives saved. Drug Alcohol Depend. 2009;105(1-2):9-15.doi: 10.1016/j.drugalcdep.2009.05.021
16 Cornish R, Macleod J, Strang J, Vickerman P, Hickman M. Risk of death during and after opiate substitution treatment in primary care: prospective observational study in UK General Practice Research Database. BMJ. 2010;341:c5475.doi: 10.1136/bmj.c5475
17 Winhusen T, Wilder C, Lyons MS, Theobald J, Kropp F, Lewis D. Evaluation of a personally-tailored opioid overdose prevention education and naloxone distribution intervention to promote harm reduction and treatment readiness in individuals actively using illicit opioids. Drug Alcohol Depend. 2020;216:108265.doi: 10.1016/j.drugalcdep.2020.108265
18 Brenner DS, Stolbach AI, Zschoche J, Bright L. Severe prolonged agitation due to intranasal naloxone overexposure. Am J Emerg Med. 2020.doi: 10.1016/j.ajem.2020.08.069
19 Yousefifard M, Vazirizadeh-Mahabadi MH, Neishaboori AM, Alavi SNR, Amiri M, Baratloo A, et al. Intranasal versus intramuscular/intravenous naloxone for pre-hospital opioid overdose: a systematic review and meta-analysis. Adv J Emerg Med. 2020;4(2):e27.doi: 10.22114/ajem.v0i0.279
20 Williams AV, Strang J, Marsden J. Development of Opioid Overdose Knowledge (OOKS) and Attitudes (OOAS) Scales for take-home naloxone training evaluation. Drug Alcohol Depend. 2013;132(1-2):383-6.doi: 10.1016/j.drugalcdep.2013.02.007
Louise Durant RN, Nurse Unit Manager, TPCH Chermside Community Health Centre in Qld
Hoiyan Karen Li BSc (Psych), MClinPsyc, PhD, Advanced Clinical Educator, Insight at Metro North Health in Qld
Jeremy Hayllar BA(Hons) MB(Hons) MSc MD FRACP FRCP(UK), FAChAM DTM&H, Medical Officer, Director Alcohol & Drug Services, Biala Alcohol & Drug Service, Qld
Niall Higgins RN PhD, Adjunct Associate Professor, J Floor Mental Health Centre, Royal Brisbane and Women’s Hospital, Qld