Barriers and Obstacles to Take-Home Naloxone Use

NOTE: Quotes are presented word for word apart from minor editing for readability and clarity. Identifying details have been removed. Square brackets show text that has been added or, where ellipses (three dots) appear, removed. For example, ‘Since I actually participated in this Narcan [training], I’ve administered it to two people and it’s brought them around […] I wouldn’t think twice about [doing] it. Saving someone’s life is the main thing.’

While the project on which this website was based collected many positive views on take-home naloxone, some participants describe encountering issues that can make it harder to access or use. These issues range from general practical concerns about availability to broader social problems such as stigma.

Many express concern about the price of take-home naloxone, suggesting that it should be as cheap as possible and that a price shouldn’t be put on something that can save lives. Others wonder why health professionals hadn’t offered it to them when they were in their care.

Stigma and discrimination are often discussed too. Many said people associate take-home naloxone with illicit drugs and may be hesitant to use it. Others explain that stigma is part of the reason they haven’t gotten naloxone themselves yet. Importantly, stigma was raised both by people who consume prescribed opioids for chronic pain and those who consume illicit opioids such as heroin.

The experiences covered in this section make clear that take-home naloxone use, and therefore its life-saving potential, are affected by a range of forces that are not always within the control of people affected by overdose. Read on for details about different concerns raised in the interviews.

Price and availability

While take-home naloxone can be accessed in different ways in Australia, some obstacles still exist, even for those who are keen to use it.

The cost of take-home naloxone is a concern for some participants such as Gabrielle (F, late 40s, Vic, non-prescribed opioids) who argues that prices should be kept down*. (Read her personal story here)

I haven’t had trouble accessing it via a GP because I do see a doctor regularly. If someone wasn’t seeing a doctor regularly, that could be different, but because I do, it’s easy. [Recently I was sick in hospital and] I had a pharmacy student talking to me about it. […] She was doing projects to do with being able to buy it over the counter and she had drawn up some posters so that people could be aware that it was available in the pharmacy that she worked at. If memory serves me right, it wasn’t cheap: $20 or $30 or something like that. I think it would be good if it could be made less expensive. It’s not like people are going to be getting that drug to take it for themselves, it’s a public service as such. So if the cost could be kept down, it would be easier for some people to get. Because not everybody […] sees a GP regularly and [the price should not be a] barrier. They have to have access to the Narcan.

Also discussing cost, Lenny (M, early 40s, Vic, non-prescribed opioids) says you can’t put a price on people’s lives. (Read his personal story here)

I reckon [the price is] a bit harsh, because it’s actually, like, pretty much labelling, you know, if you want to bring back someone to life, this is how much it’s going to cost you. It’s a bit harsh […] If you don’t pay this much, you don’t get this, and it’s like, that’s how much you’re judging a person’s life [to be worth].

Awareness and access to training

Awareness is another issue. Some participants say they hadn’t heard about take-home naloxone, and argue that information about it should be more widely available.

Referring to interactions with healthcare professionals, Simone (F, late 40s, Vic, non-prescribed opioids) says that take-home naloxone is one of the ‘main things’ that doctors should speak about with their patients. (Read her personal story here)

Yeah, everyone should be able to access it – every user should be able to access it. When you’re in the doctors’ and getting your prescription every so many months to take it to the chemist, the doctor never asks you if you want a script for naloxone, which they should. Or [they could ask] ‘Are you educated around it?’ or ‘Would you like to be?’ That’s never mentioned, which I think is wrong. That should be one of the main things they ask you [at] the doctors’, but they don’t […] The needle and syringe program just mentioned it to me, but no doctor has ever asked me about it, which I think they should, yeah.

Kate (F, mid 30s, NSW, non-prescribed opioids) says that she wasn’t offered take-home naloxone at any of the alcohol and other drug services she used but she hears other clients mention it. (Read her personal story here)

No. I didn’t even know there were take-home packs until the girl in [the residential rehabilitation unit] told me […] It was always hush-hush with me, so you know, I didn’t know. Nothing was said at the [methadone] clinic, or anything about this. [Can you tell me about what you’ve heard about take-home Narcan?] Yeah, someone said there was a class that they put on. I’m not sure if it’s at the needle exchange or the [opioid pharmacotherapy] clinic, but it was like a class and someone was showing what to do when [overdose] happens. That’s all I really know. I don’t know any more about it.

Similarly, Riley (M, mid 20s, Vic, non-prescribed opioids) first learnt about naloxone while he was staying in a therapeutic community (a form of residential drug treatment), but explains that he wasn’t free to discuss it.

You can research stuff while you are there, so I sort of researched [take-home naloxone]. And you are able to talk about drugs there, but […] it depends on how you talk about them. You are not encouraged to talk about drug use with other residents. You know, sort of raving about any past drug use and stuff can trigger people and make people leave. I guess it depends on what format you talk about it in, with the therapists or whatever it is.

In order to increase awareness of take-home naloxone, Fraser (M, early 40s, NSW, non-prescribed opioids) says that it should be more widely promoted. (Read his personal story here)

I don’t know many [people who have take-home naloxone], no. I don’t know many people that have been [to the training] or have got it. I don’t think [my friend has] got one. Yeah, if they want to promote it, it’s a good thing and it’s going to save people. […] It’s not out there enough. You’ve got to put an ad on the TV about it and get people out there and tell them: ‘Have this at home and if you see someone down the street or in the pub, grab your kit and you can save a life’.

Stigma and confidentiality

Drug use-related stigma also comes up during these interviews, both among people who consume opioids illicitly and among those accessing them via prescription. Participants often say they think stigma may hamper access to take-home naloxone in significant ways.

Karen (F, early 30s, Vic, non-prescribed opioids) speaks about her concern that she will be ‘judged’ by her GP if she asks for take-home naloxone. (Read her personal story here)

I haven’t gone to my normal GP and spoken to him about [take-home naloxone] because of the judgmental side of it. [This] comes up all the time and you think, ‘Okay, I’m going to get judged because I’m carrying this around, which means people might think I’m a druggie.’ So you have a lot of stereotypes that a lot of people worry about, and I am one of those who worry about it. [So I don’t feel comfortable asking for it.]

Discussing take-home naloxone more generally, Zippy (M, late 50s, Vic, non-prescribed opioids) identifies stigma as a barrier to its use in the broader community, including among those who don’t consume drugs. (Read his personal story here)

Something that just flashed into my head then: it might be good for people who don’t even use drugs to maybe carry [a naloxone kit] in their bloody bag or handbag or something. Even an old lady […] might be in the city one day and someone’s injected themselves and ODed and before an ambulance can get there, [she] could still go, ‘I know how to do this’ click, bang, boom, see you later, you know. […] And she can go home and tell her grandkids that she [helped a drug user] in the city and [she could say] ‘I saved a […] life.’ […] Giving it to everyone would probably be a good idea, mate, you know, but how do you do that? Do you have big signs everywhere when people walk into, chemist’s and that, you know, ‘Would you be a participant in carrying naloxone in case you ever come across a person who’s overdosed?’ I’m sure you’d get a few people saying ‘yeah’, but most people would probably go ‘Ugh druggies, I don’t want to’.

The role of family and friends in responding to overdose was also discussed. To learn more about the importance of family and friends for keeping safe and responding to overdose, see the ‘Help from others: Family and friends’ and ‘Perspectives on take-home naloxone’ sections.

Those who consumed opioids for chronic pain express similar concerns about stigma. Claudia (F, late 20s, NSW, prescribed opioids), for example, suggests that addiction stigma may reduce the appeal of take-home naloxone for people who consume prescribed opioids.

I feel like a lot of people that are maybe either, like, addicted or dependent on opioids for pain reasons would be very resistant to seeing them[selves] as, like, an addicted person because they [see themselves as having] a legitimate addiction, or something like that. So to then be saying, ‘Well, I’ve got a concern about your opioid use and so I want you to do this training: go to the drug and alcohol treatment centre down the road’ – like, I think that would just piss a lot of people off.

Similarly, Farez (M, late 40s, NSW, prescribed opioids) says he’s not comfortable speaking with his doctor about naloxone.

No. No. No. The reason why I don’t do that is that it will get the doctor thinking that I’m using illegal drugs. [Take-home naloxone has] got nothing to do with normal medication. The first thing they’d be thinking is, ‘Why are you asking about this? This is a drug we give to people that have overdosed.’ This is just why I would never bring it up.

This time speaking about an indirect effect of stigma, Cameron (M, mid 40s, NSW, prescribed opioids) wonders whether his appearance is part of the reason pharmacists never offered him naloxone when he was filling prescriptions for opioids.

I’m not sure whether it’s something that none of them [pharmacists] would’ve thought to mention, or whether it was just a case of, ‘He doesn’t look like someone who’s going to need to know this, so I won’t say it’ […] There really needs to be pharmacy-level information, like, ‘Hey, this is available, just so you know.’

* In early 2019 the federal Government of Australia announced the two-year trial of a national take-home naloxone program focussed on expanding naloxone availability for people thought to be at high risk of opioid overdose. The national program may have implications for the price of take-home naloxone in the future.