In short: 

Experts say the increasing prevalence of powerful synthetic opioids in Australia means more naloxone needs to be distributed.

Naloxone can halt overdoses caused by drugs such as heroin, fentanyl, and nitazenes, which are now showing up in a range of other drugs, including cocaine.

What's next? 

There are calls for naloxone to be given to a wider range of workers who engage with drug users, including parking inspectors and firefighters.

When Tony woke up on a street in central Sydney, he had no idea naloxone had just saved his life.

He had overdosed on heroin. One minute he felt a dream-like high. The next, his body started to shut down.

As he lay unconscious, paramedics arrived and gave him a shot of naloxone. The drug blocks the part of the brain that absorbs opioid-based drugs such as heroin and stops an overdose.

When Tony woke up, he was surrounded by friends.

"It just seemed to me like we were sitting around chatting," Tony recalls.

"No-one said I'd been naloxoned."

He didn't know he'd been saved from a potentially fatal overdose until someone told him the next day.

The overdose happened nearly 20 years ago, at a time when naloxone was still new and novel in Australia.

Decades later, Tony's experience has been replicated thousands of times around the country as naloxone has become a vital tool in the fight against overdose deaths.

A recent assessment of a naloxone distribution trial run by the federal government found the treatment was saving about three lives a day.

But as a new, more powerful wave of illicit drugs hits the streets across Australia, experts say much more naloxone needs to get into the community as well.

They say everyone from police, to firefighters, bar workers and even parking inspectors, needs to start carrying the treatment and know how to use it.

It's not just to help people who intentionally use heroin and other opioid-based drugs.

Deadly new opioids linked to new wave of overdoses

Powerful synthetic opioids are increasingly being found in other drugs such as cocaine and methamphetamines.

Hundreds of times more potent than morphine, even a small amount used to line another drug can be fatal.

Tony now works at a needle and syringe exchange program in Sydney, where new types of clients have been arriving and asking about naloxone.

"We are seeing communities we don't usually see at the needle and syringe exchange, people who go to different kinds of parties and don't necessarily use syringes, don't usually inject," Tony told RN Breakfast.

"People who snort drugs or use them in other ways are accessing [naloxone] and coming to us."

The growing emergence of synthetic opioids in Australia's drug supply is driving a new urgency among drug policy experts to get more naloxone into the community.

"We need rapid upscaling," Paul Dietze, chair of the National Naloxone Reference Group, said.

"There's a lot of work to do."

The most well-known synthetic opioid is fentanyl, the drug linked to a staggering 75,000 deaths in the United States last year.

And while Australia has so far avoided the devastation that fentanyl has caused overseas, nitazenes — an even more powerful class of opioids — are now causing overdoses right across the country.

The deaths of four people in a Melbourne home in June were linked to nitazenes, as was a cluster of 20 overdoses in Sydney in April.

The Warning against 'potent' nitazenes was issued last week by authorities in South Australia after two people were arrested and 198 grams of nitazenes was discovered.

Professor Dietze told RN Breakfast workers in a range of industries that came into contact with drug users need to be given naloxone and taught how to use it.

"We should be making sure the fire brigades carry naloxone," he said.

"Other workforces like parking inspectors and others who might come across an overdose, they effectively work in an outreach capacity.

"If they do come across someone and they've got naloxone on board, they can respond quickly and effectively."

He said a program in Western Australia providing naloxone to police should be expanded nationally and that first aid programs should cover the use of naloxone.

Naloxone supply increasing but more needed

Naloxone can be administered via syringe or a nasal spray and it is simple to use.

It's already available to the public for free, with most of it being supplied at community pharmacies, hospitals, and drug and alcohol treatment centres.

A federal government program has massively boosted the amount going out.

In the 2018 financial year, just 1,197 units of naloxone were supplied through the Pharmaceutical Benefits Scheme.

Last financial year, more than 227,000 units were supplied via the Take Home Naloxone Program.

Year	Units of naloxone supplied by the Take Home Naloxone Program
2019-2020	17,984
2020-2021	24,811
2021-2022	21,667
2022-2023	110,963
2023-2024	227,398

In Victoria, the state government has announced a plan to roll out naloxone dispensing machines next year.

As those programs accelerate, Australia's supply of naloxone has faced challenges.

According to Professor Dietze, fears that opioids could be used as a weapon of war have seen the global supply of naloxone redirected to Ukraine.

With those supply issues now easing, Professor Dietze says it's time to scale up distribution in Australia.

Insurance confusion costing frontline workers precious time

As calls for more naloxone to be distributed grow, some health workers who already have access to the drug are being slowed down when using it because of confusion over insurance rules.

Paul MacCartney is an addiction medicine specialist and general practitioner with Cohealth Victoria.

He says some drug outreach workers are being told they need to call an ambulance and take instructions before they can use naloxone to save a client from an overdose.

It's a hold-up that's frustrating workers in an environment where every second counts.

"We don't want to be too sensationalist about this, but with new drugs coming through like nitazenes, which have very rapid onset, time is of the essence," Dr MacCartney told RN Breakfast.

Dr MacCartney has been advocating for naloxone to be distributed to pubs, bars and nightspots, but says staff at those venues could face similar problems.

In Victoria, the Victorian Managed Insurance Authority (VMIA) has been asked to provide assurances that harm-reduction workers are insured to administer naloxone while at work.

In a statement, a spokesperson for the VMIA said it would consider that and provide updated guidance.

According to Professor Dietze, it's an emerging issue across the country.

"There's really almost no risk of adverse events in relation to administering naloxone in good faith, so it's a really strange barrier," he said.