What is the opioid reversal drug naloxone, how does it work, and where can I get it?
Dash loves going to music events ranging from pop concerts to festivals to drum and bass raves. (Supplied)
Scrolling through TikTok, Dash* came across a video about the opioid reversal drug naloxone, and the government scheme that makes it available for free in Australia.
The 22-year-old student from Melbourne was on a walk with her cousin when she spontaneously popped into a chemist for a pack.
"I thought, 'Oh yeah, that's kind of smart … might as well.'"
A week later, in a chill-out area at a techno event, a man across the room started overdosing in his chair, struggling to breathe.
"Everyone was freaking out, screaming. They'd got him into recovery position," Dash says.
While others set out to find a medic, she grabbed the naloxone from her bag.
She gave the nasal spray to the man's friend and told him how to use it.
"He sprayed it up his nose and within two or three seconds, he immediately settled down."
The medical team arrived and the man was carried out on a stretcher. When Dash went to visit him in the medical tent 45 minutes later, he was sitting up, "perfectly fine".
Dash found some naloxone after hearing about it on TikTok, and her fast access to it in an emergency may have saved a man's life. (Supplied)
She says the ordeal was "overwhelming", but worthwhile. She now keeps a dose of naloxone in her bag wherever she goes.
"You never really know how you're going to react in an emergency situation. And I've definitely never had anything like that happen to me [before].
"But I saw a man feeling unwell at a festival, and I was like: 'Oh my god, this can help him.' And it did."
Dash accessed naloxone through the federal government's Take Home Naloxone program, a public health initiative that makes it available for free to people who may experience or witness an opioid overdose.
So what is naloxone, how does it work, and is it risky to give it to a stranger? We asked the experts.
How non-opioid drugs cause an opioid overdose
While you may associate narcotic overdoses with heroin or oxycodone, potent synthetic opioids have been found mixed with stimulants such as MDMA, cocaine and ketamine.
"Even if you think it's ice or ecstasy or coke or whatever, the issue is that sometimes you may not have got what you thought you were getting," NSW Health's Chief Addiction Medicine Specialist and GP Hester Wilson says.
"You can't tell by the look of the substance itself."
It can be difficult for medical teams to reach people quickly in large crowds. (Getty Images: Zakarij Kaczmarek)
A deadly group of opioids known as nitazenes have authorities especially concerned, with the drugs linked to recent overdoses in people intending to take stimulants.
Both nitazenes and fentanyl — another highly potent synthetic opioid — are known for their fast onset, meaning there may not be time for medical help to arrive before an overdose becomes deadly.
When a person overdoses on an opioid, you may notice the following:
- quick onset of very slow, difficult or shallow breathing, and possible snoring
- cold and clammy skin and low body temperature
- confusion
- fainting
- slow heartbeat
- muscle twitching
- gurgling sound in the throat from vomit or saliva
- bluish skin and nails
- coma and death.
"Opiates shut things down. They send you to sleep, they make you more relaxed, they slow down your breathing," Dr Wilson says.
She says pinpoint pupils are also a sign of opioid overdose.
"It's really the opposite reaction to what we might expect if someone's taken something like cocaine or MDMA," adds Suzanne Nielsen, the deputy director of the Monash Addiction Research Centre and a registered pharmacist for more than 25 years.
"If somebody's taken what they think is a stimulant and they become very drowsy, very slowed down and sedated, that would be unexpected … and I would definitely be questioning if there could be an unintended consumption of opioids."
What is naloxone?
Naloxone is known as a "short-acting opioid antagonist". Essentially, it temporarily blocks opioid drugs from exerting their effects on the body.
Naloxone is available over the counter as an injection and nasal spray. (ABC News: Bridget McArthur)
Opioids work by binding to opioid receptors in the brain, producing pain relief and drowsiness, among other effects.
Naloxone knocks opioids off and locks onto the receptors instead.
"So if somebody's taken opioids and that stopped them breathing, and you administer naloxone, it'll reverse the effects of those opioids and that person will resume breathing again," Professor Nielsen says.
Dr Wilson says it's important to understand that naloxone is a temporary solution, so you must also call an ambulance or find an onsite medical team.
"It'll reverse [opioid effects] for a short period of time, but you do need to seek help … to make sure they don't overdose again."
Although naloxone attaches to receptors in the brain, Professor Nielsen says it doesn't cause any kind of high that people could get hooked on.
"Naloxone doesn't have any intrinsic effect in the body. It doesn't have any psychoactive effects. It doesn't affect the brain in any kind of meaningful way other than just reversing the opioid."
It's regularly used in clinical settings – you may have been given naloxone at the end of a surgical procedure, for example.
How to get naloxone in Australia
In Australia, naloxone is available for free in numerous pharmacies and at harm-reduction services.
Professor Nielsen estimates more than 60 per cent of community pharmacies in Australia already provide naloxone, with more signing up every week.
You can also access a map of pharmacies that stock naloxone in your area, and won't have to give your name or present a Medicare card when asking for it.
While Professor Nielsen understands why some people may be nervous asking for the reversal drug, she says pharmacists have been specifically "trained to provide this in a very non-judgemental manner … in a very open and friendly way".
Naloxone is available in a nasal spray, and as a pre-filled injection.
"If you don't already know how to administer an injection, in the case of an emergency, trying to work that out under pressure is probably not ideal … so the intranasal option is often easier," Professor Nielsen says.
Depending on your location, Dr Wilson says some harm reduction organisations, such as the NSW Users and AIDS Association, will send naloxone for a small postage fee.
"So, for example, if you live in a small country town and you don't want to go into your local pharmacy, you can access it … through those drug and alcohol services as well."
How to use naloxone
You may have seen content around naloxone on social media.
Professor Nielsen says getting the word out is "fabulous", but you need to be careful.
"It's great to see people sharing harm reduction information, but occasionally information that I've seen people share around the dosing or how frequently to administer it hasn't been correct."
Instead, she suggests getting advice from the health provider where you access naloxone, as both pharmacists and harm reduction services can show you how to administer it firsthand.
Health authorities provide information about using naloxone as both a nasal spray and as an injection, and there'll be instructions on its packaging too.
But, Dr Wilson reiterates, the most important thing to do in any emergency situation is to ask for help, either by calling an ambulance or finding the medical team at your event.
"Don't worry about getting in trouble.
"We're not going to be charging anybody. We really just want to make sure that people are safe and they don't come to any harm."
Are there risks to giving someone naloxone?
If you suspect someone is having an opioid overdose, but aren't 100 per cent certain, naloxone is still safe to use.
"The good news about naloxone is if you get it wrong, and it's not an overdose, it's not going to hurt the person," Dr Wilson says.
Loading...Professor Nielsen agrees.
"If in doubt, it's better to administer it than to hold off because you're worried about side effects.
"It is a very well-tolerated drug and any kind of side effects are extremely rare."
Possible nasal spray side effects could include:
- dizziness
- headache
- nausea and vomiting
- high or low blood pressure.
Where occasional side effects have been recorded, Professor Nielsen says it's been in a medical context, when naloxone was being administered to "very sick people".
"We don't have any record of really significant side effects from layperson administration in the community," where only small doses are provided.
"If someone's not breathing, that's the priority, to get them breathing again. When the ambulance comes, any side effects can be managed."
She says the question of potential naloxone allergies has been examined, but in reviewing the global literature on the topic, she's "not aware of any case of a naloxone allergy".
"It's a theoretical risk, but I've never, ever heard of a case, and I don't believe that that is a reason that you should not administer naloxone to somebody who is not breathing because of opioids."
There's chatter on social media of people becoming violent after being given naloxone, presenting a risk to the person dispensing it.
However, Dr Wilson says this comes down to how naloxone was administered in the past: as a big dose in an injection.
"People would start awake and they'd be nauseous and sweaty and really agitated.
"The dose that we have in naloxone [now] is a small dose, so … they don't wake up and become aggressive. They wake up and start breathing again."
*Dash's surname has been withheld for privacy.