Should cocaine and MDMA users carry naloxone, the medicine that prevents fatal opioid overdoses?
More than one million Australians have taken cocaine in the last year and 400,000 have consumed ecstasy.
As recreational drugs are increasingly laced with potentially lethal opioids, experts are highly concerned about overdoses.
Cocaine and ecstasy users represent a “whole new cohort” who should carry naloxone, the life-saving medication to treat opioid overdoses, officials say.
Knowledge of naloxone is typically high among heroin users, says Prof Suzanne Nielsen, the deputy director of the Monash Addiction Research Centre, but it’s a “very new” conversation for those who take cocaine and MDMA.
People who unknowingly ingest an opioid that has been cut into cocaine or another drug likely won’t know what an opioid overdose looks like or how naloxone could save someone’s life, she says.
So what should users of illicit drugs know to keep themselves safe?
How can you know what’s in your drugs?
Access to drug testing across Australia is limited. There are only two permanent fixed-site drug-checking services: one in Canberra called CanTest and the Queensland government-run CheQpoint. Victoria has announced a pill testing trial to begin in summer which will become permanent after 18 months. A small trial is also under way at the Sydney Medically Supervised Injecting Centre.
Rita Brien, from the Penington Institute, a research organisation that promotes harm reduction approaches to drug use, says “there really aren’t a lot of options to support people to make informed decisions” if they don’t live near an existing service.
People can purchase home testing kits online but experts advise users to beware of limitations. Nielsen says sometimes these kits will only indicate if a substance is present or not, but it won’t tell you what else is in there or how strong the substance is. “If you’re just testing to see if the pill that you have has MDMA or not, it won’t necessarily tell you whether or not it’s a very high and dangerous dose,” Nielsen says.
Where do you get naloxone?
Under the national Take Home Naloxone program, the drug is available anonymously and without a prescription from pharmacies. It is available to anyone who could experience or witness an overdose. The federal government this month rolled out a new online map listing 4,600 pharmacies that stock naloxone – with no information retained to assure privacy. Naloxone is also available online, for example through the New South Wales Users and Aids Association (Nuaa) online shop. Naloxone can also be accessed through needle and syringe programs through the medically supervised injecting facilities and peer drug user organisations such as Nuaa.
Naloxone is available as an intranasal product as well as an injectable. Nielsen says the intranasal product is more common because it is easier to explain how to use: people just insert in a nostril and press the spray.
Who should think about carrying naloxone?
Robert Taylor, the policy manager at the Alcohol and Drug Foundation, says the risk of opioid overdose has increased because of “contaminants in the drug supply”.
“So we’re saying that really anyone who’s using illicit drugs, or is around anyone using drugs, should ideally have naloxone or access to naloxone,” he says.
As more people taking stimulant drugs come into contact with opioids inadvertently, Brien says it is important they learn about naloxone and consider carrying it. Brien says parents should inform themselves about naloxone and have a conversation with their kids, including what an opioid overdose might look like.
Taylor says naloxone should be available throughout the community. “We want it to be a standard part of first-aid kits.” More first responders should have it on hand, as police in Western Australia and Queensland do, he says. Institutions such as libraries and shopping malls should carry it, he says, and hospitality venues, like bars in the US now do.
Brien says naloxone should be as common as an EpiPen in a first-aid kit.
Where should you carry naloxone?
Brien says naloxone is “not useful if it’s in a cupboard and you can’t get to it” in the event of an overdose. Taylor says: “Whether or not someone should leave the house every day with it probably depends on how likely they are to be around someone who may be using illicit drugs.” People should certainly carry it if they know they’re going to be with someone who is planning on using drugs, he says. However, distribution of naloxone in the community through more public venues will help prevent fatal overdoses, he says.
What should people know in the event they have to use naloxone?
Brien says if someone administers naloxone it is vital they still call triple zero. “People should still seek medical assistance. [Naloxone is] really just to get somebody breathing again whilst you wait for an ambulance.”
Luke Kelly, the president of the NSW branch of the Pharmaceutical Society of Australia, says naloxone is a very safe medication. There is no harm taking it even if a person isn’t suffering an opioid overdose, Kelly says.
The intranasal product comes with two-single use sprays, Neilsen says. “If there’s no response within two or three minutes, then you can administer a second dose.” The two doses in the nasal spay works for almost all overdoses, Nielsen says, but the higher the dose of opioids, the more naloxone you might need to reverse it.
• In Australia, the National Alcohol and Other Drug Hotline is at 1800 250 015; families and friends can seek help at Family Drug Support Australia at 1300 368 186. In the UK, Action on Addiction is available on 0300 330 0659. In the US, call or text SAMHSA’s National Helpline at 988
