Research focus

Over the past decade, both in Australia and internationally, opioid overdose rates have been increasing steadily and remain a public health concern (World Health Organization, 2023). Fatalities due to opioid consumption in Australia rose from 2.5 fatalities per 100,000 individuals in 2002 to 5.0 fatalities per 100,000 individuals in 2019 (Chrzanowska et al., 2023). In 2021, the majority of unintentional drug-induced deaths in Australia were due to opioids, accounting for 46% of such deaths (765 deaths) (Penington Institute, 2023).

Naloxone is an opioid antagonist that is highly effective in reversing the effects of an opioid overdose with next to no adverse effects (e.g., Binswanger et al., 2022; Hill, Zagorski, & Loera, 2022). It has been described as ‘safe, effective, and easy-to-administer’ (Lurigio et al., 2018) and has been recommended by the World Health Organization to reduce opioid-related deaths (World Health Organization, 2014). Since 2016, naloxone has been made available over-the-counter in Australia without prescription (Lenton, Dietze, & Jauncey, 2016). In November 2019, it was added to the Pharmaceutical Benefits Scheme (PBS) (NPS Medicine Wise, 2022) and made available as an intranasal spray (Nyxoid®).

While paramedics routinely administer naloxone to people who have experienced opioid overdose before they are admitted to hospital, police officers are often the first (Hillen et al., 2022), and sometimes the only (Davis et al., 2014), emergency responders on the scene of an opioid overdose (Winograd et al., 2020b; Lurigio et al., 2018; Purviance et al., 2017). Prior research suggests that enabling law enforcement officers to carry and administer naloxone to people who have overdosed on opioids has the potential to significantly reduce the risk of opioid overdose fatalities (Rando et al., 2015).

Furthermore, it has been shown that when police officers can carry and administer naloxone it builds positive interactions with community members (Wagner et al., 2016), by enhancing their public safety role (Davis et al., 2014). Police officers who have been trained in naloxone administration can also provide consumers with information about local drug treatment options (Winograd et al., 2020a) with one study in the Unites States reporting that nearly 20% of consumers who were administered naloxone by police officers sought treatment after a law enforcement officer referral (Dahlem et al., 2017).

This study

The Western Australian Police Force Naloxone Pilot involved training police in use of naloxone to assist in the management of opioid overdoses that they attend in the community. This was a joint initiative of the WA Police Force and the Mental Health Commission (MHC) of Western Australia, which commenced in July 2021.

The National Drug Research Institute (NDRI), at Curtin University, evaluated the 12-month trial. It was anticipated that assessing the effectiveness of the pilot could help improve the quality of training; contribute to reducing opioid-related deaths and harms in the community; highlight benefits, barriers and/or concerns about the program; and, inform decisions about the pilot’s potential continuation and expansion. If effective, it could also serve as an example for police departments in other Australian jurisdictions to roll out similar programs.

The main aim of the quantitative and qualitative evaluation was to examine the effectiveness of the WA Police Force Naloxone Pilot to inform decisions regarding further rollout of naloxone within the WA Police Force. It also aimed to:

• Investigate the immediate impact of the naloxone training by comparing the pre- and post-questionnaires;
• Experience of witnessing overdoses, administration of naloxone and opioid reversal outcomes;
• Investigate knowledge retention following naloxone training; and
• Highlight benefits, barriers or concerns about the pilot.

This evaluation, which consisted of a mixed-methods repeated-measures design, was undertaken from 1 July 2021 to 30 July 2022. Each police officer who received naloxone training completed a quantitative and qualitative paper-and-pencil survey immediately before (pre-training) and immediately after the training (post-training). The pre- and post-questionnaires collected information about knowledge related to recognising and responding to opioid overdose and naloxone administration.

Three to six months after having received naloxone training, participants were invited to complete a quantitative and qualitative online survey. The online survey collected information about the police officers’ demographics, naloxone training, knowledge retention, access and availability of naloxone, sense of competency and readiness to intervene, and whether they had witnessed overdoses since the naloxone training.

Participants who had indicated they had witnessed an opioid overdose since receiving their training were then invited to complete an additional qualitative phone interview to provide further information about the most recent overdose they witnessed, and their experience as a police officer of administering naloxone to consumers of opioids who had overdosed.  

Key findings

A total of 272 police officers completed the pre-post training questionnaires, while 117 participants completed the online survey. Among these online respondents, 23 reported having witnessed an opioid overdose since receiving their training; naloxone was administered by the police officers themselves 16 times. Eight participants who witnessed an opioid overdose agreed to complete an additional qualitative phone interview.

Impact of the naloxone training

The results showed an overall increase in knowledge immediately after the training in recognising the signs of an opioid overdose, signs which increase the risk of opioid overdose, and the action that needs to be taken when witnessing an opioid overdose. The benefits of having received the training were clearly demonstrated by the increased proportion of participants who reported that they would administer naloxone, from 66% before the training to 99% after the training. Additionally, the proportion of respondents who identified they were ‘confident’ or ‘very confident’ to respond to an opioid overdose increased from 35% to 97%. Similarly, the proportion of respondents who identified they were ‘confident’ or ‘very confident’ to use naloxone increased from 28% pre-training to 98% post-training.

Witnessing overdoses, administering naloxone and opioid reversal

Naloxone was successfully used on 16 occasions among our sample to reverse the effects of an opioid overdose. The need to provide naloxone training to police officers as part of their duties was also reflected by the fact that one in five participants (20%) reported having witnessed an opioid overdose since receiving naloxone training. Ten police officers (44%) who completed the online survey reported that they had administered naloxone on one occasion, four (17%) on two occasions, and two (9%) on three occasions. The benefits of the training were also reflected by the willingness of police officers to administer naloxone when witnessing an opioid overdose. Indeed, there was a significant increase in the frequency of participants who reported that they would administer naloxone, from 66% before the training to 99% after the training.  

Several police officers interviewed reported that naloxone provided them with another way to successfully respond to an opioid overdose and provided them with the opportunity to do something valuable and with a sense of confidence. Several participants also wished the pilot was rolled out on a larger scale.

Knowledge retention following the naloxone training

Assessing police officers’ knowledge retention and naloxone administration following the naloxone training showed the majority of respondents were overall still able to identify the major signs of an opioid overdose during the follow-up online survey. Additionally, the majority of participants reported that their competency to administer naloxone increased after the training, while only a minority of respondents responded that it remained the same or unchanged. All respondents reported they would be able to administer naloxone in the case of an opioid overdose, clearly demonstrating their ability to successfully respond to an opioid overdose from a practical point of view.

Benefits, barriers and concerns about the pilot

Overall, the evaluation found that the majority of participants (94%) were highly satisfied with the quality of the training and reported that it was either ‘good’ (61%) or ‘excellent’ (33%). ‘Learning how to use naloxone’ (34%), followed by ‘learning about naloxone’ (32%), and ‘learning about opioids’ (31%) were the most valuable aspects of the training reported by the participants. The majority of participants (92%) also either ‘completely agreed’ (61%) or ‘agreed’ (31%) that everyone at risk of witnessing an overdose should be given a naloxone supply, which demonstrates the need for police officers to be able to administer naloxone to people who have experienced opioid overdose in their daily practice.

Various participants highlighted the fact that naloxone provided them with another way to successfully respond to an opioid overdose, save lives and resources, and provided them with the opportunity to provide early intervention by ‘buying time’ while waiting for an ambulance. It also provided them with a sense of self-confidence and increased positive feelings, while being able to do something positive for the community. Several participants suggested that it should be rolled out agency wide.

Qualitative accounts of witnessed overdoses

When asked how the naloxone training assisted or influenced their response to the overdose, participants responses highlighted three common themes: the absence of adverse effects, an opportunity to do more while witnessing an opioid overdose, and the usefulness of the training received. When given the opportunity to provide additional comments, the need to roll out naloxone agency wide and satisfaction with the training received were common themes.

Conclusion

Overall, our findings suggested that the training was very well received by police officers. It seemed to be effective in increasing police officers’ knowledge associated with drug overdose and improved their capacity to recognise and manage opioid overdoses in a prompt and effective manner.

These findings supported the continuation of the pilot and the continuous provision of naloxone among police officers in WA and suggested that carriage of naloxone by police officers in Australia is feasible, effective and may save lives. The naloxone pilot with the WA Police Force should serve as an example for other jurisdictions to roll out similar programs.

Following NDRI’s evaluation of the pilot, police officers in WA have started carrying naloxone, and New South Wales and South Australian authorities have approached the WA Police Force for advice as they consider similar programs.

For a summary of the main findings of the evaluation, click here, or watch Dr Seraina Agramunt present a summary as part of the ‘Answering key questions on naloxone’ webinar (from 22.00)