Should cocaine and MDMA users carry naloxone, the drug that prevents fatal opioid overdoses? | Opioids

How do you know what is in your medications?

Access to drug testing is limited across Australia. There are only two permanent drug testing centres at fixed locations: one in Canberra called CanTest and CheQpoint, run by the Queensland government. Victoria has announced that a pill testing trial will begin in the summer, which will become permanent after 18 months. A small trial is also currently underway at the Sydney Medically Supervised Injecting Centre.

Rita Brien of the Penington Institute, a research organization that promotes harm reduction approaches to drug use, says that “there really aren't many opportunities to support people in making informed decisions” if they don't live near an existing service facility.

You can buy home testing kits online, but experts warn users to be aware of limitations. Nielsen says sometimes these kits only indicate whether or not a substance is present, but they don't tell you what else is in it or how strong the substance is. “If you're just testing whether or not the pill you have has MDMA in it, that's not necessarily going to tell you if it's a very high and dangerous dose,” Nielsen says.

Where can I 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 is experiencing or might witness an overdose. The federal government released a new online map this month listing 4,600 pharmacies that stock naloxone – with no information stored to protect privacy. Naloxone is also available online, for example through the New South Wales Users and Aids Association (Nuaa) online store. Naloxone can also be obtained through needle and syringe programs at medically supervised injecting facilities and from drug user organizations such as Nuaa.

Naloxone is available as both an intranasal product and an injection. Nielsen says the intranasal product is more common because it's easier to explain how to use it: you just insert it into one nostril and press the spray.

Who should remember to carry naloxone?

Robert Taylor, policy manager at the Alcohol and Drug Foundation, says the risk of opioid overdose has increased due to “contamination in the drug supply.”

“So we’re saying that really anyone who uses illegal drugs or is around someone who uses drugs should ideally have naloxone or have access to naloxone,” he says.

As more people taking stimulants accidentally come into contact with opioids, Brien says it's important that they learn about naloxone and consider carrying it with them. Brien says parents should learn about naloxone and talk to their children about it, including what an opioid overdose might look like.

Taylor says naloxone should be widely available. “We want it to be a standard part of first aid kits.” More first responders should stock it, as police in Western Australia and Queensland do, he says. Institutions such as libraries and shopping centres should stock it, he says, and hospitality venues such as bars in the US now do.

Brien says naloxone should be as common in a first aid kit as an EpiPen.

Where should you carry naloxone?

Brien says that in the event of an overdose, naloxone “is not useful if it's sitting in a cupboard and you can't get to it.” Taylor says, “Whether or not someone should leave the house with it every day probably depends on how likely they are to be around someone who may be using illegal drugs.” People should definitely carry it with them if they know they're going to be around someone who wants to use drugs, he says. But distributing naloxone in the community in more public places will help prevent fatal overdoses, he says.

What should people who need to use naloxone know?

Brien says if someone administers naloxone, it's important to still call 911. “People should still seek medical help.” [Naloxone is] really just to help someone breathe while they wait for the ambulance.”

Luke Kelly, president of the NSW branch of the Pharmaceutical Society of Australia, says naloxone is a very safe medication. It is safe to take even if a person is not suffering an opioid overdose, Kelly says.

The intranasal product comes in two individual sprays, Neilsen says. “If there is no response within two or three minutes, you can give a second dose.” The two doses in the nasal spray work for almost all overdoses, Nielsen says, but the higher the opioid dose, the more naloxone you may need to reverse the overdose.