Perspectives on Take-Home Naloxone

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.’

The people we interviewed for this website have different levels of experience with take-home naloxone. Some hadn’t heard of it until their interview, some know of it but haven’t used it before, while others recount many different experiences of using it during overdose emergencies. They describe how these experiences affect their attitudes to take-home naloxone. While the views of our participants vary, most say they think take-home naloxone is a necessary initiative with life-saving potential (see also, Health professionals’ reflections on take-home naloxone). This is the case both for those who primarily consume illicit opioids and for those who primarily consume prescribed opioids to manage chronic pain.

Many talk about it as a pragmatic tool for protecting themselves, their family and friends and the broader community from the risk of overdose . When discussing the benefits of take-home naloxone, some also refer to the stigmatisation of people who consume drugs.

Our participants also compared take-home naloxone and overdose issues to other health issues such as the risks posed by allergies or the insulin used by people with diabetes.

Overall, our participants have very favourable views of take-home naloxone, and they describe various groups of people they feel might benefit from its use.

A way to save lives

Many of people we interviewed emphasised that take-home naloxone is a relatively easy way of saving lives.

Valentina (F, early 40s, NSW, non-prescribed opioids) says that take-home naloxone is a ‘simple’ way of saving lives. Promoting its use was part of her motivation to participate in our research. (Read her personal story here)

I think everyone should have access to it. That’s what struck me. If we can save lives with something so simple, then yes. So if I could do something to help make that happen, I wanted to help […For example,] if you were dealing out of your house and you had people using there […] it would be in your best interest to go get a prescription and go have some Narcan there because it’s looking after your customers.

Jake (M, early 20s, Vic, non-prescribed opioids) says that take-home naloxone could be used to save the lives of his friends. (Read his personal story here)

Well I wouldn’t mind carrying [Narcan] around yeah. […] Well, I mean if a mate overdoses then I’ve got something to save his life. It happened to one of my mates just a couple of weeks ago and he saved his mate’s life. He had Narcan on him and one of the boys dropped. It was actually in [a Melbourne CBD] toilet and [my friend] was there. Yeah he had it [naloxone] on him and bang. I rocked up five minutes later. [And how was he after?] He was dazed, he was in a daze, but he was fine.

In talking about take-home naloxone, some challenge the stigma experienced by people who consume drugs (see also, Barriers and obstacles to take-home naloxone use).

For Tye (M, mid 30s, NSW, non-prescribed opioids), making take-home naloxone available means recognising that everyone has the right to life. (Read his personal story here)

I believe the regulation should be that if you’re going to dispense it, you should be trained in it and you should be training the people that you’re giving it to […] Maybe once you have completed the training, you could be given a little card stating that you’re trained in it […] Like I said, everyone deserves a life, don’t they? Everyone has a right to be revived and, you know, too, nobody deserves to die that type of death. It’s a horrible […] death, I believe.

Also challenging the stigmatisation of people who consume drugs, Skye-Lee (F, early 30s, NSW, non-prescribed opioids) says take-home naloxone is a ‘useful’ way of helping others and saving lives. (Read her personal story here)

I think [take-home naloxone] would be useful, especially with […] the group of people that […] are in my life. […] I could be walking down the street and [an overdose] could happen, and if you know that you’ve got the skills to help somebody, rather than let them die or get hurt, wouldn’t you want to help them? You know what I mean? I’m not saying I want to be a doctor or anything, but yeah […] It’s like doing your first aid. Because people who have addictions, they’re still human, and just because some people might look at a girl on a heroin overdose as [though she] might deserve it, I don’t agree with that. They’re still human and they’ve got a problem, and if you’ve got skills to help them, then why not? You could be saving a life.

While she hasn’t accessed take-home naloxone herself, Kate (F, mid 30s, NSW, non-prescribed opioids) thinks it’s a ‘clever thing’. (Read her personal story here)

Yeah, it’s very clever thing that they’ve worked [that] out, you know. I know a couple of years ago, everyone was, you know, people were dying. So I reckon it’s really good that the government and universities have jumped on it and worked out something like this. I wouldn’t know how to use it, or anything, but I guess there would be training and that for it.

Bobbi (F, mid 30s, NSW, non-prescribed opioids) argues that take-home naloxone is something that anybody who injects drugs should use. (Read her personal story here)

I think that [there should be] as much knowledge about Narcan […available] as possible […] You guys can help any addicts that may need to have it. So anything that can help, you know, make drug use a bit safer for people, I think is always a good thing […] Like anybody who’s using should [get take-home naloxone], yeah. As soon as you start injecting, I think that you should do it.

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. (Read his personal story here)

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.’

Russell (M, early 50s, Vic, non-prescribed opioids) says that while saving a life is an ‘honour’, we should also think of the other positive effects on families. (Read his personal story here)

The fact remains that if a bloke’s just dropped [overdosed] [and] you understand what’s going on because, obviously, there’s a needle next to him, or you can read a few of the signs because maybe you’ve […] been down that path yourself, [you should be able to help]. Now if you’ve got a lawyer there, a doctor there or an accountant or a mechanic, all these people, you know […], if they can’t bloody administer something, [and] you [can] just step forward […] and save a life – well, mate it’s an honour. […] That person, at that time, if they are revived from it, may not appreciate it [there and then], but when you throw a stone into a pond, people are too busy looking at the splashes instead of the ripples. What about the family? What about the family that would be affected by the death?

The growing availability of take-home naloxone led some participants to reflect on the lives that could have been saved had it been available in the past.

Zippy (M, late 50s, Vic, non-prescribed opioids) asks us to imagine how many people would still be alive had take-home naloxone been available many years ago. (Read his personal story here)

Well, there would probably be a few people alive today if they had done this 10, 20 years ago. Imagine how many more people would still be alive, because a lot of people die by the time the ambulance gets there. Since this has happened, since I actually participated in this Narcan [training], I’ve administered it to two people and it’s brought them around. One of the two, I had to give another shot too, but I’ve got two shots set up in my fridge at home ready to go if someone hits the deck, because I’m a user, I use heroin and I’ve got people who come and use heroin with me […] I wouldn’t think twice about [doing] it. Saving someone’s life is the main thing.

Like Zippy, Jamie (trans-woman, early 30s, NSW, non-prescribed opioids) reflects on the lives that could have been saved had she known about take-home naloxone earlier. (Read her personal story here)

It’s a really good idea and more people should learn it. Even if they’re not drug users, they should learn [how to use naloxone]. I didn’t know the signs of an overdose before, or what to look out for, and that was one of my biggest problems. If I knew about those things, things may have been different for people I’ve known [who] have [had] overdoses. [For example,] snoring, loud snoring. I never knew that [was a sign of overdose], I thought that was just normal […] No one taught me it and so I wasn’t aware of what an overdose entails […] Now I know more about it.

Reflecting the sentiments of other participants, Olive (F, early 70s, NSW, prescribed opioids) suggests that partners or friends of people who consume opioid medications for chronic pain could learn how to use naloxone.

I would like it to be a backstop because I know quite a few people accidentally overdose and I wouldn’t want it to happen to anyone, I really wouldn’t […] I just think people always need a backstop if there is [one], like defibrillators and things like that, and you need people to be confident enough to help if necessary […] I think anyone could be trained, [or] anyone who’s willing and interested. Someone who’s close by [to a potential overdose, too]. So it doesn’t necessarily need to be a [person with] chronic pain. I think, just, if someone’s taking opiate [medications], then someone who can be close by should be trained. Your friend or your partner or whatever.

Lacey (F, late 20s, Vic, prescribed opioids) points out that take-home naloxone could save a life that might otherwise be lost while waiting for paramedics to arrive. She explains further that while she thinks learning how to respond to overdoses with naloxone is a ‘really good idea’, there needs to be proper training on how to use it.

Well, it might save someone’s life. You know, if we could have naloxone to take home, or access to take-home naloxone, it could change someone’s life. [Because] they might live, whereas they might die if it takes 10 or 15 minutes for the ambulance to [arrive] with the naloxone. So I think it’s a good strategy, but that’s just my opinion. [But] I don’t agree that just anyone should be able to do [overdose response training], because [naloxone] is a medication and we want it to be administered in the right circumstances. You know, if just members of the public are doing it without any training, I think there’s a potential for […] harm or adverse reactions. I think it’s a really good idea for drug and alcohol workers to actually talk to people and take them through the process of how to administer it properly. You know, [the] circumstances [of] when to administer it, you know, [and tell them] that it doesn’t work on all medications. [That] it will only work on opiates is an [important issue…] I think we need a bit more knowledge and education around that before it gets handed out to just anyone, but I definitely think it should be subsidised, probably free, or [available for] a small charge.

Concerns about overdose also inform Lacey’s views on naloxone and its potential use.

I also diverted from my workplace my own supply of naloxone. I’m not sure how I thought I could give myself naloxone […] you know, if I had overdosed, but I also thought it’s good to have in the first aid kit in case I was in a situation where I ever found anyone else who had overdosed. Or perhaps I felt … because there is maybe a minute or two where you can feel the effects of the medication […] and I thought maybe if ever I felt like I had injected something and it was too much, then I could potentially reverse it before it became a real issue.

Treating overdoses like other preventable tragedies

The people we interviewed often compare overdose deaths to other preventable tragedies. Very commonly, they compare take-home naloxone with other medications, such as the EpiPens® used to treat allergic reactions (anaphylaxis) or the insulin injected by people with diabetes. In this way, many of our participants present take-home naloxone as an uncontroversial health technology.

Karen (F, early 30s, Vic, non-prescribed opioids) compares take-home naloxone with other healthcare tools such as EpiPens®. (Note: strong language) (Read her personal story here)

Diabetics carry their medication around in case they drop. Other people carry an EpiPen [in case] they get a reaction. This is the same concept – in case someone drops, that’s what naloxone is for. So it’s not hurting anyone, and anyone who does use [opioids] isn’t going to sit there and pump it in their arms anyway, because it’s just going to fuck them up real bad. So unless it’s something that is needed, not many people want to play with it anyway […] It’s liquid to bring someone back who’s near dying.

Claudia (F, late 20s, NSW, prescribed opioids), who consumes opioids to manage chronic pain, asks why you wouldn’t have take-home naloxone at home and argues that it is an important initiative.

Because, I mean, it’s totally appropriate for someone to store their EpiPen here in the fridge. So it’s like, you know, why wouldn’t you have the naloxone at home just in case? […] Having some kind of program where people are getting trained in what to do if they overdose is really important. It’s almost like the emphasis [in information given to people prescribed opioids] is put so much on addiction without sort of a thought about overdose and what that means. So if the doctor or pharmacist also showed you how to use naloxone or something like that, I think that [would be] really important and appropriate.

Likewise, Fiona (F, early 40s, Vic, prescribed opioids) describes take-home naloxone as like medications for severe allergies.

It’s like someone who has an anaphylactic allergy, and it’s kind of the same thing really […] Yeah, no, it’s something that I’ve never thought of. I guess it’s possible for anyone with chronic pain, too, especially because the type of medications we’re taking are […] very strong, they’re so strong, they’re very strong medications and people who have anaphylactic allergies, you carry that with you, so yeah, why couldn’t you carry [take-home naloxone]? […] I mean […] it’s highly likely I wouldn’t overdose. However, if I had the pain levels that I did constantly, well then yeah, you just want to constantly take more medication, so yeah, something like that would be I think, fantastic.

Karlijn (F, late 50s, Vic, prescribed opioids), who also consumes opioids to manage chronic pain, suggests that learning how to respond to overdoses with take-home naloxone is ‘common sense’, including for family and friends of people consuming opioids.

To me [overdose response training and take-home naloxone are] just common sense. Anyone is at risk of overdose if you have access to those medications and, I don’t know, [say] you fall out of a tree in your back garden and you are in so much pain you decide ‘I’ll just take 20’ – I don’t know how much it takes for an overdose – but ‘I’ll take all my tramadol’ or ‘I’ll take all my quetiapine because then I won’t feel anything’. It’s much better for everyone to know what the consequences could be of that. So yeah, family and friends [could benefit too].

Mixed feelings about take-home naloxone

While the majority support take-home naloxone initiatives and many have already used it, some express more ambivalent views. Some said that they didn’t need take-home naloxone at the time of the interview because they weren’t likely to overdose. For example, while Emily (F, mid 40s, Vic, non-prescribed opioids) had been told about take-home naloxone she decided not to get it because she’s no longer using opioids and says ‘I’m not at risk [of overdose] any more’. Similarly, Riley (M, mid 20s, Vic, non-prescribed opioids) doesn’t ‘see the point’ of having take-home naloxone and mentions that ‘I don’t see myself using again in the future’. Gabrielle (F, late 40s, Vic, non-prescribed opioids) speculates that some people are ‘fearful’ of using take-home naloxone because they wonder, ‘What if it didn’t work, would [the overdose death] be my fault?’

A health worker had offered Lewis (M, mid 40s, Vic, non-prescribed opioids) take-home naloxone. He explains that he didn’t take her up on the offer because he primarily consumes heroin alone. (Read his personal story here)

So my explanation to her for why I wouldn’t pursue learning about [take-home naloxone] is that using [heroin] really is exclusively a solitary thing that I do. I understand that’s not safe, but yeah, there’s not going to be anyone there to administer it to me [if I did overdose] and presumably I can’t administer it to myself at that point in time. I guess it’s something useful in case I saw somebody else in that situation.

Where can I pick up take-home naloxone?

Some of our participants had never used take-home naloxone, and those who had done so got it from different places. Among those who primarily consume non-prescribed opioids, many picked it up at alcohol and other drug health services. For example, Bobbi (F, mid 30s, NSW) generally gets it at her local needle exchange, Skye-Lee (F, early 20s, NSW) picks it up at the same service where she doses with methadone and Simone (F, late 40s, Vic) often calls a peer organisation to arrange for them to drop it off to her. Many other participants, such as a Jamie (trans-woman, early 30s, NSW), Lenny (M, early 40s, Vic) and Lance (M, late 40s, NSW), commonly get it from a general health service they use.

The first time Julia (F, mid 50s, NSW, non-prescribed opioids) got take-home naloxone, it was from the same service where she picks up injecting equipment. (Read her personal story here)

[The first time I got Narcan] wasn’t that long ago. [It was] probably […] sometime the year before last, and I got it from the needle exchange […] They offered it to me because I didn’t know a thing about it […] I mean I’m quite a friendly person, so I’m on quite good terms with them […I accepted their offer because] I thought it was a great idea […then] they just told me how to use it, yeah.

Dylan (M, early 30s, Vic, non-prescribed opioids) explains he can pick up take-home naloxone from a number of different organisations. (Read his personal story here)

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.

Take-home naloxone is available at Karen’s (F, early 30s, Vic, non-prescribed opioids) local primary health centre, however, she suggests it would be good if she could get it from the Melbourne-based drug consumer outreach service called Foot Patrol. (Read her personal story here)

It would be easier to be able to get it off the Foot Patrol […] Say it’s a payday, yeah, and everyone picks up big on their payday. Regardless how much they use, on their payday they always pick up big. Well, it would be easier when you go get your fits [injecting equipment], to get it from an easier access point [like Foot Patrol], than having to go to a doctor to get a script, to go get it filled. It would just be easier to go in and get it and leave with it. It’s like having a fit bin. You’d put your fit in there if you got given the bin, but if the bin’s not there, what do you do with it?

Those who had never accessed take-home naloxone offered their perspectives on the best places to make it available. All the participants in our project who consume opioids suggest that take-home naloxone should be available at the other health services they already use for various reasons. Like most of the people we interviewed who primarily consume prescribed opioids to manage health issues, Claudia (F, late 20s, NSW), Maxine (F, late 30s, NSW), Farez (M, early 40s, NSW) and Ken (M, mid 30s, Vic) suggest that GPs and pharmacies would be good places to get take-home naloxone.

Fiona (F, early 40s, Vic, prescribed opioids) says it makes sense for people taking strong medications to have take-home naloxone.

I mean, it definitely makes sense for people who are [on] very strong medications to have [take-home naloxone]. I guess my GP would have that information […] or even the chemist. When you’re on a medication that you haven’t been on [previously], I’ll usually get a printout and get information with the med[ication] that I’m using. So, I guess, yeah, the GP, chemist, they would just print off a document.