Lifesaving Naloxone: The Free, Over-the-Counter Potential Antidote to Synthetic Opioid Overdose

Overdose deaths have been on the rise over recent months as a new type of highly potent synthetic opioid has hit the streets that’s even more deadly than fentanyl, which was the last extra strong synthetic opioid that started being cut with heroin and killing people a decade or so ago.

The new synthetic opioids are a group known as nitazenes, and they put fentanyl to shame in terms of strength.

These substances, which mimic the effects of opium-derived drugs, such as morphine and codeine, are now being cut with the whole spectrum of available chemical street drugs.

And after the Easter weekend, there was a notable line of people waiting for the Penrith needle and syringe exchange to open, as around 20 locals had overdosed over the break after taking heroin laced with what turned out to be a nitazene, and those waiting wanted some take-home naloxone.

Indeed, people who use heroin are well-versed in the fact that naloxone, a drug that reverses opioid overdoses, exists. Yet, many who use other types of drugs aren’t aware of it, as they haven’t needed to know about it, and they often shun those people whose drug of choice is heroin.

But after four people were found dead in a room of a Broadmeadows home on 25 June, which is suspected to have been due to nitazene-laced cocaine causing overdose, right now is a good time for users of coke, MDMA, methamphetamine and ketamine to get acquainted with naloxone.

So, keep reading if not in the know, because one other plus about naloxone is, unlike street drugs, it’s completely free.

Naloxone on hand, regardless

“Basically, it’s getting to the point that anyone who is taking illicit substances should have access to naloxone,” Uniting Medically Supervised Injecting Centre Kings Cross medical director Dr Marianne Jauncey told Sydney Criminal Lawyers.

“Nitazenes have been found in every state and territory, and it’s been found in cocaine, MDMA, ketamine, methamphetamine, heroin and counterfeit prescription medications bought on the web” continued the doctor who oversees the MSIC, which has successfully managed over 11,500 overdoses without a death since 2001.

As explained nitazenes are potent, so much so that when they were developed over 60 years ago as an alternative to morphine, they weren’t released for use, because the synthetic opioids, which come in a variety of different forms, have such a high potential to cause overdose deaths.

The reason why the recent deaths at the Broadmeadows house have been considered to be nitazene-laced cocaine without an official police announcement as yet, is that the Victorian health department has since released a health warning about cocaine laced with prontonitazene being sold.

Jauncey stressed in regard to nitazenes that they “can be crazy strong… and we know from ODs that have occurred in NSW that a person may need multiple doses-high doses of naloxone for it to work”.

And the doctor added that at the MSIC, they do use naloxone to reverse opioid overdoses but often 

because they’re on hand to intervene at such an early stage of the deadly reaction, the trained staff are able to bring a person back around with the use of oxygen.

Over the counter and completely free

Prior to 1 February 2016, naloxone was a prescription medicine only. However, because of a Therapeutic Goods Administration decision the year prior, as of that date it was rescheduled and became available over the counter at pharmacies.

The Uniting MSIC has long had naloxone take-home packs available for clients for free. But Dr Jauncey advises that these days it’s also available over the counter without any need to pay for it at participating pharmacies, which accounts for about 60 percent of chemists.

For people in NSW, there is a list of pharmacies online that provide naloxone for free. And there’s also a site to assist in Victoria. Yet, Jauncey warns that over the half dozen times she’s tried to obtain it in this manner, only once did she not have to explain to staff how the program works.

So, if attempting to get a take-home pack of naloxone and the chemist asks for payment, they’re actually in the wrong, and this page explaining how the take-home naloxone program works would be a good source of authority to point to if the need arises to explain that payment isn’t necessary.

“It’s magic stuff, and anyone taking substances, where they don’t know what is in it, should have it on hand,” the MSIC medical director underscored, and added that “by definition that’s all illicit substances in NSW because we have no drug checking services open to the public”.

Administering naloxone

Naloxone is an opioid antagonist, meaning it counters the effects of opioids, which attach to receptors in the brain. If these receptors become overwhelmed, overdose can occur. But naloxone knocks opioids off these receptors to allow normal functions, such as breathing, to resume.

Jauncey explained that naloxone comes in two forms Nyxoid, which is a nasal spray. And two sprays come in the pack, each containing one dose. The doctor further adds that people often press the button to test if the spray works, but she warns not to do this, as it discharges the entire dose.

The other form is Prenoxad, which comes in a pre-filled syringe that has several doses within it, with a black line signifying each dose. And to administer it, press the needle into the outer layer of skin on either the upper arm or a thigh and press down until the first line is reached.

In the case of nitazenes being stronger than most other opioids, as Dr Jauncey has stressed, this means that higher levels of naloxone may be needed to reverse the effects. And she explained if a first dose doesn’t appear to work after a couple of minutes, another dose should be administered.

A miracle drug

SCL asked Dr Jauncey whether in this new climate of drug use, which includes the potential for nitazenes to be cut with any type of drug, if a group of friends were all indulging in MDMA and one appeared to be suffering an opioid-type overdose reaction whether naloxone should be applied.

And the doctor confirmed that it is absolutely safe to do this as, naloxone “is inert and will do no harm”, and “even if someone hasn’t taken opioids, it will be safe”, as “it has one action only, and that is to reverse any opioids.”

In terms of what one is looking for regarding a potential opioid overdose, Jauncey explained that it’s likely when one “becomes increasingly sedated, drowsy, harder to rouse, all the way through to being completely unresponsive”.

“They can start to turn blue, and you may notice that their breathing is shallow, infrequent or absent,” the Uniting MSIC medical director continued. “You may also notice that they have very small pinpoint pupils.”

But she further stressed it’s essential for those at the scene to call an ambulance as well. And another important point people should know is that when calling an ambulance in regard to an illegal drug, the paramedics don’t inform the police about it, meaning they don’t become involved.

So, if someone appears to be overdosing after taking ice, cocaine, MDMA, ketamine or heroin and naloxone is on hand, administer it, as well as call for an ambulance, as the administration of naloxone can’t harm them any further, and the medics won’t dob those using drugs into the police.

And as nitazenes are extra potent, if the first dose of naloxone doesn’t work after a few minutes, then administer a second dose or even a third, after a few minutes more.

But if the person overdosing does come around, don’t cancel the ambulance and do seek medical assistance straight away, as naloxone eventually wears off after half an hour or so and if some highly potent nitazene is still in the individual’s system, they may then commence overdosing once more.

“There’s not too many miracle cures in medicine,” Dr Jauncey added in conclusion, “but this is one of them.”