Evaluation of the Western Australian peer naloxone education project

November 2014

NDRI: Professor Simon Lenton, Seraina Agramunt

Other investigators: 

Paul Dietze, Burnet Institute
Anna Olsen, Kirby Institute
Allison Christiou and Jessica Miller, Western Australian Drug and Alcohol Office

Project description: 

Naloxone is an opioid antagonist drug that reverses the effects of heroin and other opioid drugs. If a person overdoses on heroin or prescription opioids, naloxone can help bring them around and potentially save their life. It does not cause intoxication. It has been used for over 40 years in emergency medicine and anesthesia. As has been the case in many countries, Naloxone is currently only available on prescription in Australia. In the mid-1990s, calls were made to make naloxone available to opioid (typically heroin) users and their peers and family members through ‘take-home’ naloxone (THN) programs in order to prevent overdose deaths. Such programs have now been implemented in many countries, but with the decline in availability of heroin in Australia in early 2001, and a subsequent fall in overdose fatalities, impetus for more widespread availability of naloxone in this country stalled. But with gradual increases in Australian overdose deaths over the last 5 years, likely associated with increasing use of pharmaceutical opioids, advocacy for THN programs has grown.

Led by Australia’s first THN project, begun by the Australian Capital Territory (ACT) drug user group CAHMA in Canberra in April 2012, a small number of other programs have since commenced in other Australian Jurisdictions.  The Western Australian (WA) Peer Naloxone project, run by the WA Substance Users Association (WASUA) and funded by the WA Drug and Alcohol Office, commenced in January 2013. Participants in the WA program receive a 2 hour training session in overdose prevention and management including naloxone administration which addresses: risk factors for overdose; myths and facts about overdose and about calling an ambulance; first aid response to overdose (DRSABC); when and how to give Naloxone by intra-muscular injection using a Mini-jet® (DRSABNC); post naloxone monitoring and support; and importance of calling an ambulance and tips on communicating with ambulance officers. At the completion of the training session, participants are assessed by a GP who issues a prescription and naloxone kit if satisfied that the participant has sufficient knowledge of when and how to use it. The kit includes 2 Mini-jets of naloxone and needles for intramuscular injection, alcohol wipes, face shields (for CPR), disposable gloves, sharps disposal tube, a step-by-step guide, training certificate, and contact numbers and a contact card for the evaluation team.

Based on the evaluation of the ACT program, which three of the research team are also conducting, this evaluation of the WA Peer Naloxone Project aims to answer four key research questions: (1) Can naloxone be used appropriately by people in a non-medical setting within the WA context? (2) Does the program result in successful overdose reversals? (3) Does the program have any unintended consequences, either positive or negative? (4) Should the program continue and, if so, what changes in the program and its contexts are desirable?

Participation in the evaluation is entirely voluntary. Data collection consists of a pre and post training questionnaire completed on the day of the education session which addresses quantitative data regarding knowledge of risk factors for overdose management, and knowledge and attitudes regarding the role of naloxone in managing overdose. Then, between three and six months after their training session, and/or when they administer naloxone provided under the program, program participants are invited to a follow-up interview. Follow up interviews include both quantitative and qualitative components, the latter of which are audio recorded for subsequent transcription and analysis. They address demographics and drug use history, retention of knowledge from the training, as well as accounts of any overdose reversals including the use of naloxone, and the outcomes of that. The evaluation will include 150 program participants. To date some 100 participants have been through the training and completed pre-post questionnaires.  Almost 40 follow-up interviews have been conducted which include a number of accounts of people being successfully revived using the skills and naloxone provided in the WA program. It is expected that the full report of the project will be completed in the first half of 2016.