Today’s question relates to the use of Naloxone in Victoria. My correspondent works:
… for a council in Victoria across two venues which open to the public, one of which is within a nightlife hub. The council area has no legal injecting sites and local pharmacies do not ready stock Naloxone. I’ve raised the issue, suggesting we add Naloxone to the first aid kits in both venues as a means of filling this void and preparing our workplace for any emergencies that may arise in accommodating members of the public. This has been met with concerns regarding the legal repercussions of employees administering medication to the public and broad recommendations that medications be kept out of first aid kits. As there are already exceptions made for asthma medication and epi-pens I’m wondering whether there may still be argument for the inclusion of Naloxone in our workplace kit. Would employees (non-health related occupations) be covered under the good Samaritan Act? Would the council be at any risk in providing the naloxone?
What is naloxone?
The Alcohol and Drug Foundation says:
What is naloxone?
Naloxone hydrochloride (brand names Prenoxad, Nyxoid) is a drug that can temporarily reverse opioid overdose. Naloxone works by blocking opioid drugs, such as heroin and oxycodone, from attaching to opioid receptors in the brain.
How is it used?
Naloxone can be injected intramuscularly (into a muscle) or delivered by intranasal spray. It may be administered by medical professionals, such as paramedics, as well as family, friends, or bystanders in an emergency where someone is experiencing an overdose.
Best practice is to provide a person who might be administering naloxone with training. See the bottom of this page for information on where to find training providers.
Naloxone, when used for the treatment of opioid overdose, appears in Schedule 3 of the Poisons Standard. Schedule 3 drugs are ‘Pharmacist only medicine’ ie ‘Substances, the safe use of which requires professional advice but which should be available to the public from a pharmacist without a prescription.’ (Therapeutic Goods (Poisons Standard—February 2023) Instrument 2023).
Any substance listed in any of the poisons schedules is a ‘poison or controlled substance’ (Drugs, Poisons and Controlled Substances Act 1981 (Vic) s 4).
The Take Home Naloxone program
The Federal Department of Health and Aged Care says:
The Take Home Naloxone program is for:
- people who are at risk of an opioid overdose or adverse reaction, their carers, friends and family members
- approved providers such as community pharmacists, dispensing doctors and hospital pharmacists
- authorised alternative suppliers such as needle and syringe programs, alcohol and other drug treatment centres and outreach services.
This scheme is provided for in the Drugs, Poisons and Controlled Substances Act 1981 (Vic) and the Drugs, Poisons and Controlled Substances Regulations 2017 (Vic). The Regulations say that approved naloxone providers, and employed approved naloxone workers can obtain, possess and supply naloxone (rr 133F, 133G, 161D and 161E). Where an approved naloxone worker has supplied the drug to someone, that person may then supply the drug to anyone else who needs it for treatment of a drug overdose (r 133H). In short, the plan is that someone who is a drug user, or has a family member who is a drug user, can obtain naloxone from a naloxone worker and can then use it to assist their friends or other drug users in the event of an emergency.
It could be argued that the council workers are people who in the course of their work may ‘witness, an opioid overdose or adverse reaction’ (Federal Department of Health and Aged Care) in which case they could get the drug from an approved naloxone worker but I don’t think that is the intention of the scheme and I don’t think ‘alternative suppliers such as needle and syringe programs, alcohol and other drug treatment centres and outreach services’ would want to supply naloxone to the council. Rather if the council wanted to put naloxone in the first aid kits the council would need to become an approved naloxone provider and then have relevant employees approved as naloxone workers.
The first conclusion therefore is unless the council is an approved naloxone supplier, and the staff are either registered nurses (Nurses, naloxone and emergencies (April 23, 2019)), doctors or approved naloxone workers, then they are not authorised to have naloxone in the first aid kit.
The Compliance Code: First Aid in the Workplace
The Compliance Code: First Aid in the Workplace (2021) is published by WorkSafe Victoria under the Occupational Health and Safety Act 2004 (Vic). According to WorkSafe Victoria:
The purpose of this code is to guide employers on how to provide adequate workplace facilities, in particular first aid facilities, for the welfare of employees…
While the guidance provided in the code is not mandatory, a duty holder who complies with the code will – to the extent it deals with their duties or obligations under the OHS Act and OHS Regulations – be considered to have complied with those duties or obligations.
With respect to medication the Code says
138. Employers should consider including an asthma-relieving inhaler and a spacer to treat asthma attacks and adrenaline (epinephrine) auto-injector for the treatment of anaphylaxis (commonly known as an EpiPen)…
141. In general, administering scheduled medications needs to be managed by a registered health professional. However, in providing first aid, it may be appropriate for a first aid officer in certain circumstances to:
• assist a patient with taking their medication (such as an asthma inhaler)
• assist a patient to take, or administer a medicine to a patient, in line with their first aid training or on the instruction of a registered health professional or Ambulance Victoria (for example, giving an adrenaline (epinephrine) auto-injector in anaphylaxis).
That Code is not ‘binding’ so the fact that it only mentions ‘an asthma-relieving inhaler … and adrenaline’ does not mean that only those drugs should be considered. The issue requires a risk assessment for the employer to determine what issues are likely to be encountered at the workplace. But the Code does not authorise who can carry or use drugs.
The Good Samaritan Act
There is no such thing as a ‘good Samaritan Act’ but this colloquial expression refers to provisions in legislation in all states and territories. In Victoria the Wrongs Act 1958 (Vic) s 31B says:
(1) A good samaritan is an individual who provides assistance, advice or care to another person in relation to an emergency or accident in circumstances in which—
(a) he or she expects no money or other financial reward for providing the assistance, advice or care; and
(b) as a result of the emergency or accident the person to whom, or in relation to whom, the assistance, advice or care is provided is at risk of death or injury, is injured, is apparently at risk of death or injury, or is apparently injured.
(2) A good samaritan is not liable in any civil proceeding for anything done, or not done, by him or her in good faith—
(a) in providing assistance, advice or care at the scene of the emergency or accident; or
(b) in providing advice by telephone or by another means of communication to a person at the scene of the emergency or accident.
An employee whose duties include providing first aid and in particular if they get paid a first aid allowance is not a good Samaritan. But that hardly matters. If the person is an employee and if they are negligent their employer – the council – will be vicariously liable for any negligence.
If the council conducted a risk assessment as required by the Occupational Health and Safety Act 2004 (Vic) and determined that it was appropriate to put naloxone in a first aid kit they should to seek authority to become an approved naloxone provider and identify workers as approved naloxone workers to take responsibility for the supply of the drug to someone suffering a drug overdose.
If they did that the risk of legal liability for having the drug, and using it in accordance with relevant training as an approved worker, would be very low.
Failing that it would not be appropriate to try to buy naloxone from a pharmacist to put in the first aid kit without ensuring that there were adequately trained and authorised staff on hand to manage the supply and administration of the drug.
- For a related post, see Issuing naloxone to Victorian drug outreach workers (February 9, 2018).
This blog is made possible with generous financial support from the Australasian College of Paramedicine, the Australian Paramedics Association (NSW), Natural Hazards Research Australia, NSW Rural Fire Service Association and the NSW SES Volunteers Association. I am responsible for the content in this post including any errors or omissions. Any opinions expressed are mine, and do not necessarily reflect the opinion or understanding of the donors.