In July 2022, Health Minister Mark Butler declared the Take Home Naloxone (THN) program's national rollout could prevent hundreds of deaths across the country.

"I'm really pleased that we're going to see that rollout right through the country and save many, many hundreds of lives," he said in a speech to the Pharmaceutical Society of Australia.

Better known by brand names Nyxoid or Narcan, naloxone temporarily blocks the effects of opioids, making it an effective tool in reducing fatal overdoses.

Naloxone has been available in Australia since the 1980s, but access has long-been difficult, with obstacles such as price, few stockists and a required prescription hindering distribution.

Over the past decade, the federal government has attempted to remove these hurdles, albeit to little effect historically. 

But two years ago, a new measure — the THN program — was introduced nationally, following a brief trial.

Under the program, anyone at risk of witnessing or experiencing an opioid overdose can receive naloxone free-of-charge via participating pharmacies and approved suppliers, with any costs reimbursed by the Commonwealth.

"This will remove any barrier from securing this lifesaving medication for anyone who may suffer, or witness an opioid overdose," then-health minister Greg Hunt said at the time of the planned expansion.

Since the rollout, $26.1 million has been invested into the program. And as of September 30, roughly 465,000 doses have been dispensed — 54 per cent of which since January, and 94 per cent via pharmacies.

Improved access to naloxone is a significant step given reports of rising opioid-related deaths as well as emerging synthetic opioids like nitazenes.

But despite the program's intention to remove them, barriers to naloxone still exist. Across the country, people are reporting challenges securing naloxone from pharmacies, either being outright refused or asked for a prescription, a fee or both.

"I was told to get a prescription a couple times. And then the other times they just said that they wouldn't dispense it to me," said Sean, a 26-year-old living in Brisbane's northern suburbs who has used heroin since he was 18.

Over May and June last year, he was denied naloxone from five pharmacies.

"I paid $46 … it's supposed to be free," said Tracey Lee, a peer volunteer with NUAA, based in south-west Sydney.

Outside the THN program, the subsidised cost for naloxone is $31.60.

"I have been told that I need a prescription. I've been told that it's going to cost me $50 or $60. I've been looked at very strangely and said words to the effect of 'Why do you need that drug?'," Sydney's Medically Supervised Injecting Centre medical director Marianne Jauncey said.

'We're not finished with the job'

Part of the reason for inaccessibility is that pharmacists are not stocking naloxone.

According to one study published in June that surveyed pharmacies in Queensland, NSW, Victoria and Western Australia, roughly 60 per cent stocked naloxone.

According to the study's author Suzanne Nielsen, it's an increase from 2016, when less than a quarter of pharmacists stocked naloxone.

"A number of positive steps have been taken, but we're not finished in the job of disseminating naloxone information yet."

Professor Nielsen, who is also the deputy director of the Monash Addiction Research Centre, has studied naloxone and its availability over the last decade.

Her research has found factors like supply shortages, confidence in prescribing and misconceptions of encouraging riskier drug use can contribute to why a pharmacist may avoid naloxone.

But another is centred around who naloxone may attract.

"We've done a number of studies talking to pharmacists about naloxone over the years, and that has been a finding: That there is stigma around illicit substance use," Professor Nielsen said.

Stigma over drug use is a long-documented phenomenon within the healthcare system, including pharmacies.

In her latest paper, Professor Nielsen found pharmacists were more comfortable discussing naloxone with those prescribed opioids compared to those misusing them.

"We are still seen as people who cause problems," said Ele Morrison, deputy CEO of the Australian Injecting and Illicit Drug Users League.

"It's partly not really understanding the medication and the community that's wanting to access it, along with having stereotypical views about the community that's trying to access naloxone."

Knowledge gaps across pharmacy sector

Deeply-ingrained stigma could explain some pharmacist avoidance, but another reason may come down to confusion.

Research has previously flagged information gaps about naloxone exist throughout the pharmacy sector, including an unfamiliarity with both the medicine and dispensing it to clients.

"There really is a lack of education and a lack of communication that's happening within that pharmacy space," NUAA harm reduction services manager Rochelle Aylmer said.

In her role, Ms Alymer has contacted pharmacies around NSW, finding staff unaware of both the THN program and how to administer naloxone, as well as pharmacists viewing the medicine as not relevant to their practice.

In May, following reports of locals struggling to secure naloxone, harm reduction workers including Ms Aylmer contacted the 40-plus pharmacies across the Blue Mountains listed as stockists. Only seven still supplied naloxone.

Some pharmacy staff were unaware they were listed as stockists, while pharmacists had opted out of the program over demand.

"Some people acknowledged that they used to have it, but it just wasn't popular. Some people had the impression that they didn't have communities or networks of people who use drugs within the local community," she said.

But of those contacted, few pharmacists were interested in restocking naloxone.

'A soft launch'

Little appears to be invested in spreading awareness and information of the THN program since its rollout. In 2022, a review of the program's pilot found there had been no "broad promotion" for the widespread community.

Government figures also state that of the $26.1 million invested, roughly $82,500 has been dedicated to education and training modules.

"The [THN] program itself was … a bit of a soft launch," said Luke Kelly, the NSW president of the Pharmaceutical Society of Australia.

Government-funded education and training modules are available online, but that information may not be enough to reach pharmacists.

Considering the high workload and stress associated with the industry, those unaware of naloxone are unlikely to have capacity to familiarise themselves.

"Unless you have a direct interest in that field, or patients [who] would need it, you would be thinking, 'That isn't something I need to stock or should be stocking'," Dr Kelly said.

"I would love there to be a better communication system. But I don't know what it is."