Preferred Name: Dylan
Age: Early 30s
Who is Dylan?
Dylan lives with his three cats in Melbourne. He describes his ethnic background as ‘Australian’: like both his parents, he was born in Australia. He volunteers for a number of health and alcohol and other drug-specific organisations and hopes to find full-time employment in community services. Dylan has participated in overdose response training twice and has used naloxone 11 times to reverse opioid overdoses. Although he was very supportive of take-home naloxone, Dylan felt there was much more governments could do to reduce overdose deaths.
Dylan describes an occasion when he came across his friend Janette lying on the pavement of an outdoor shopping strip. Thinking Janette might be overdosing, he found out from others present that she’d recently consumed heroin. Drawing on his previous experience, Dylan injected Janette with the naloxone he had on him at the time and started ‘breathing for her’. Waiting a few minutes between injections, Dylan gave Janette three doses of naloxone overall before she started to ‘breathe on her own’. At this point the paramedics arrived and took over from Dylan. Dylan explains that responding to overdose is ‘easier’ if you have a ‘relationship’ with the person who needs to be revived.
While I was doing this, I came across my friend Janette lying down in the middle of the mall [outdoor pedestrian shopping strip]. As I walked over to find out what was going on, a group of people told me, ‘She’s dropped and we don’t know what to do.’
I asked, ‘Do you know what she’s had?’ and they said ‘Yeah, she’s had alcohol, she’s had pills, but we don’t know what pills.’ And they said she’d had heroin too. I said, ‘Okay, she’s potentially overdosing. I need you to call an ambulance. I’m going to start preparing naloxone to give it to her.’
I took the ‘gently gently’ approach, giving Janette one shot of naloxone and waiting to see how she was going before giving her another one, so that she wouldn’t get upset when she woke up. While I was giving the first shot, I noticed that her lips were starting to turn blue. I put her into the recovery position, checked her airway was clear then turned her on her back and starting breathing for her. Two minutes later, there was no response, so I gave her a second shot of naloxone. Her lips weren’t blue any more and it looked like she was starting to breathe on her own, so I just observed the situation. Four minutes had now passed and she still wasn’t awake, so I gave her a third shot of naloxone then paramedics arrived and took over.
Janette woke up, and the paramedics asked me a lot of questions about where I’d gotten the naloxone and whether I was authorised to administer it. I told them I carry it , as do lots of other people in the area, and have done overdose response training at the local community health centre.
Thinking through his take-home naloxone experience in the interview, Dylan suggested that having ‘some sort of relationship’ with Janette helped. He also felt that, as he is well regarded in his community, people generally trust him and know that when he intervenes is events such as these it’s always for ‘their health and well-being’.
While Dylan said he was very supportive of take-home naloxone, he also believed that ‘there’s a lot more that our politicians and our government’ could be doing to reduce overdose deaths.
Dylan (M, early 30s, Vic, non-prescribed opioids) speaks of overdosing after using a mix of drugs, on this occasion Xanax® and heroin.
I have had an overdose experience that was caused by a mixture of opiates and Xanax that somebody put in my mouth. [They] told me it was a Valium and I didn’t know until after I had had a double-overdose experience. I call it a double-overdose experience – it was basically the same overdose but I dropped, was administered naloxone, came good, came clear, and an hour and a half later, I dropped again […] One minute I’m sitting there observing the environment and the next minute, I’m in a medical clinic room, lying on a table with an oxygen mask on. I don’t know whether the oxygen wasn’t flowing properly or if it’s just me, but I was struggling to breathe. I was trying to rip the oxygen mask off, and I’ve got a nurse and the doctor going, ‘No, no, keep the mask on, your oxygen level is really low. We need to get oxygen into you.’
For many participants, the negative effects of naloxone are also important, and some describe trying to revive people without causing undue discomfort. For example, Dylan (M, early 30s, Vic, non-prescribed opioids) describes how he always uses a gentle approach to administration in order to reduce discomfort or illness afterwards.
So, […] I was walking around [name of an inner Melbourne suburb] doing a general check on people, asking people if they need any equipment while I’m around. It was a Thursday morning and [name of a primary health service] doesn’t open until 1pm. It was about 11:30am [when I] came across a friend of mine who was lying down in the middle of the mall. Normally she doesn’t lie down in the middle of the mall. [I] started to approach her and people are going, ‘She’s just dropped, she’s just dropped, we don’t know what to do.’ And I’m like, ‘Okay, she’s just dropped. Do you know what she’s had?’
‘Yeah, she’s had alcohol, she’s had pills, we don’t know what pills.’
‘Has she had any heroin?’
‘Yeah, she’s had about a gram in the last 24 hours.’
‘Okay, she’s potentially overdosing. I need you to call an ambulance. I’m going to start preparing naloxone to give it.’
‘Don’t give her naloxone – she won’t like it.’
‘No, I promise I’m going to be better than the ambulance at this. I know what I’m doing. Just trust me, have faith in me.’
‘All right, but if she comes around and she clocks you one, don’t say we didn’t tell you so.’
So, [using] the gently-gently approach, [I] gave the first shot, and while I was giving the shot, I noticed that her lips are starting to turn blue. So [I] gave the first shot, put her in the recovery position, checked her airways were clear, turned her back on her back and started breathing for her. Two minutes later, [I] still had no response, [so I] gave her a second naloxone shot. Her lips were no longer blue. It looked like she was starting to breathe on her own, so I just observed the situation. She still wasn’t awake after four minutes, so I gave a third naloxone shot [and] by that time the ambulance had arrived.
The potential to save lives appears in Dylan’s (M, early 30s, Vic, non-prescribed opioids) description of storing take-home naloxone at his home, where he also talks about letting other people know he has it.
So, usually I would keep my naloxone on me, but because I’ve just come from a series of managerial meetings this morning, I haven’t been out in the community, so my bag’s full of paperwork. I took my naloxone kit out to fit more paperwork in. When I’m at home, it sits in a drawer underneath my coffee table. Anyone that comes to my house that I use opiate substances with, one of the first things I do is point out, ‘I have naloxone. This is where it’s located. If you need to use it on me, if I need to use it on you, it’s within arm’s reach […] Life-saving medicine is just there.’
Dylan (M, early 30s, Vic, non-prescribed opioids) explains he can pick up take-home naloxone from a number of different organisations.
So the way I access it at the moment, I have one of two avenues. [An advocacy and education organisation] have a doctor that is happy to write prescriptions for all the peer networkers as required and [they] have funding available through the peer networker program that they can use to purchase the naloxone for us on our behalf. The second and I guess third ways I have of accessing it: I can attend one of the regular naloxone workshops and as part of that naloxone workshop, at the end of each training session, each participant gets a take-home kit that they can walk away with. If I can’t make it to that session, our GP that works on site here is authorised and happy to write prescriptions for us and with the script, $6.80 is really nothing. It’s more if we don’t have that prescription. It costs more than I could safely afford to be able to get it over the counter.
Dylan (M, early 30s, Vic, non-prescribed opioids) notes that he’s ‘well regarded’ in his community, and it’s known that he only intervenes in situations in order to ensure the person’s ‘health and well-being’
It’s easier if you have some sort of relationship with the person that you’re administering it to, or if you’re at least known to each other. I’m quite well known and quite, I don’t want to say the word ‘popular’, because that sounds like high school, cliquey kind of [thinking] … but I’m quite well known and […] well regarded within the [inner Melbourne] community. So if I come across somebody that’s having an overdose situation and I respond to it, people generally know that I’ve done it for their health and well-being. It’s not something that I just do for the sake of doing.
Dylan (M, early 30s, Vic, non-prescribed opioids) describes having to convince police that carrying naloxone isn’t against the law. Importantly, the police in his area have assured him that they will not confiscate it in the future.
One of the main concerns I used to have about carrying [take-home naloxone] on me personally is police, a lot of the time, especially if they’re new recruits or new to this area, will stop [you] and one of the questions they ask is, ‘Do you have anything in your backpack you shouldn’t have?’
I respond with, ‘There are items in my backpack that I believe you don’t think I should have, but I’m entitled and authorised to carry them.’
‘Oh yeah, like what?’
‘Well, I’ve got sterile sharps, I’ve got used sharps and I have a naloxone administration kit.’
They generally ask to see it, I pull it out, show them and, initially, as I said, when the naloxone training programs were first being started, police were unsure about it and would confiscate them. They have now given an assurance […] that if they come across us and they see us with a naloxone kit, they will not be confiscating them any more.