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Over the counter naloxone just the first step to better access, Australia

The recent down-scheduling of overdose antidote naloxone to Schedule 3, making it available over the counter (OTC), must be followed up by regulatory changes that allow take-home programs to dispense naloxone directly to their clients, without need for doctor or pharmacist involvement, according to the authors of a Perspective published online by the Medical Journal of Australia.

Professor Simon Lenton, deputy director of the National Drug Research Institute in Perth, and his coauthors, wrote that take-home naloxone (THN) programs “currently provide naloxone via prescription, typically engaging a doctor to attend small-group training sessions”.

“The doctor must then review participants, and both prescribe and dispense the medication.

“While OTC access removes the need for a doctor’s prescription, the requirement for dispensing by a doctor or pharmacist remains.

“Access to naloxone will be maximised when those providing instructions for use (including, for example, allied health or peer workers) also provide the medication. Thus rescheduling to Schedule 3 does little to simplify dispensing arrangements for current THN programs.”

THN programs are designed to help manage opioid overdose events in the pre-hospital setting, the authors wrote. “The programs involve training potential overdose witnesses in overdose response (including naloxone administration) and then prescribing and distributing naloxone to potential overdose victims for later use in an overdose situation. Training typically includes education on risk factors for opioid overdose, signs of opioid overdose, basic life support and overdose response, including resuscitation techniques, calling for an ambulance, administration of naloxone, and post-naloxone management.”

Naloxone is still available on prescription, at a discount.

“We hope that the rescheduling of naloxone to make it available OTC will lead to state and territory health officials exploring ways to similarly allow Australian THN programs to dispense this medication directly and cost-effectively to their clients,” Lenton et al concluded.