In 2022, 716 Mainers died from a fatal opioid overdose. An additional 9,760 nonfatal overdoses were reported. In 2021, the CDC found that Maine has almost five per 100,000 more deaths due to overdose than the rest of New England. Deaths and long-term harm from opioid overdose can largely be prevented through the use of opioid reversal medication currently available to Mainers. For people using opioids, education and possession of Narcan among those nearby an overdose is the most significant barrier to life saving care.

As we continue to confront the opioid crisis, we should look to Australia for innovative policy solutions, expanding training through public health in spaces where prescription and non-prescription opioids are used.

Narcan, the brand name for an opioid reversal medication called naloxone, blocks our brains from experiencing the effects of opioids. For a person experiencing opioid overdose, breathing and bodily function will be restored. Nasally administered Narcan is easy to use. Once the patient is lying down, the naloxone device is inserted into either nostril and the plunger is pressed. Learning to use Narcan can take as little as 20 minutes with training available online.

Australian territories have also faced challenges with opioid use and overdose, but unlike the United States, they made harm reduction central to their strategy as early as the mid-1980s. As the U.S. experiments with alternatives to criminalization, harm reduction has increasingly informed conversations around overdose response.

In Australia, access to and education about opioid reversal medication have been central to confronting fatal opioid overdose, most notably in their Take Home Naloxone (THN) program.

The THN program made naloxone available at no cost with no required prescription in pharmacies, alcohol and drug treatment centers, needle and syringe programs, and custodial release programs. THN coincided with expanded naloxone training and overdose awareness education, particularly at sites where the medication was distributed.

THN Australia began in 2019 and ran through 2022 in three major Australian territories. The intermediate results of this three year pilot were published in January, 2022. Over half of those who requested naloxone prescriptions refilled within six months, indicating use. Based on refill patterns, the study estimated that three opioid overdoses were reversed each day of the trial.

In over 60 moving accounts, individuals shared their life-saving naloxone administration stories. Many reports of use were in public places, where properly trained individuals were able to save the life of a stranger they suspected was overdosing. Many other reports were in private spaces, where accidental overdoses on opioid painkillers were reversed. THN reached across a broad range of population groups offering overdose and opioid reversal medication awareness, saving almost 28,000 Australian lives.

Overwhelmingly, those who shared stories of overdose reversal through the THN program felt that the program has had a positive impact on the Australian population. Following a successful THN pilot program, the Australian government has invested $19.6 million in national free naloxone access with specific funding towards overdose awareness and education. Similar steps should be taken in Maine and the United States, removing barriers to Narcan use and saving lives.

To that end, Maine has made some important policy decisions. All patients under MaineCare have access to over-the-counter Narcan prescriptions, as well as a number of state and private naloxone distribution programs. Maine residents are legally protected in their use of Narcan on any person they suspect is overdosing. With access to the medication and training in its use, Narcan will continue to save lives. The cost of Narcan is covered by most insurance companies.

For those not covered, public programs in Maine provide free naloxone and education upon request. What Maine lacks, however, is widespread awareness and education of the public in Narcan administration and the need to carry Narcan on their person. Effective public education continues to stand between Maine and more widespread  Narcan use and overdose prevention.

But these are gaps that Maine state and municipal policymakers can continue to close.  As policy choices and financial decisions  towards substance use arise, we should look to Australia’s harm reduction policy and successful THN pilot program.

Expanding education in recognizing overdose and Narcan administration could have substantial positive impacts on Maine’s population, just like it did for Australian territories. In addition, we can take further steps to ensure that those in public-facing roles carry and are properly trained in administering Narcan, as we have begun to do with law enforcement and those working in public schools.

Maine is experiencing a severe opioid crisis, and Mainers deserve access to life-saving measures.

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