Who does this guideline apply to?

This guideline applies to adults and children

Who is the audience for this guideline?

This guideline is for first aiders and first aid training providers.  This includes the family and friends of opioid users trained in the intranasal administration of naloxone for persons suspected to have an opioid overdose.

This guideline may also be used by members of staff at medically supervised injecting facilities where they exist.  

Summary of Recommendations

1. The Australian and New Zealand Committee on Resuscitation (ANZCOR) makes the following recommendations: [all Good Practice Statements]

   1.     Send for an ambulance and start cardiopulmonary resuscitation (CPR) without delay for any unconscious person not breathing normally (ANZCOR Guideline 8).

   2.     Administer intranasal naloxone as soon as it is available in suspected opioid overdose with minimal interruption of CPR.

   3.     People who regain normal consciousness and respiratory function after naloxone rescue should be transported to hospital.

   4.     Administer supplementary oxygen if available and trained to do so.

Opioids are a class of drug (narcotics) which are generally used as pain management medications but are also used recreationally. Examples include morphine, codeine, hydromorphone, methadone, oxycodone, hydrocodone, heroin, fentanyl, tramadol and nitazenes. Different preparations of opioids can be ingested, injected, administered transdermally or inhaled.

Opioid overdose is a common and important type of poisoning in the community and increasing in frequency.^1-3 Overdose can lead to unconsciousness, slowing or stopping of breathing, and can potentially cause cardiac arrest.  Opioid overdose was the cause of death in 1,123 cases in Australia in 2022⁴, the latest year for which data was available at the time of writing.  The rate of mortality doubled between 2003 and 2017.  The majority, 82%, of the deaths in 2022 were “unintentional” overdose, and only 1/3 due to heroin.^4.

Naloxone temporarily reverses opioid poisoning and is effective in the first aid setting.⁵ This is now available for intra-nasal administration and can be dispensed at no cost to people at risk of opioid overdose or people who may witness opioid overdose.⁶  Naloxone is available to the public in settings like pharmacies, harm reduction programs, and through public health campaigns. People at risk of opioid overdose and individuals who may witness an overdose can obtain naloxone for emergency use.  The details of availability and statutory considerations can be found in the appendix to this guideline.

This guideline recommends the prompt provision of CPR to persons who are unconscious and not breathing normally as well as the administration of naloxone as soon as it is available in suspected opioid overdose.  It should be noted there is very little risk of harm from administration of naloxone, the most serious being withdrawal seizure seen in 0.45% for persons suspected to have an opioid overdose administered the drug.⁷  ANZCOR acknowledges the lack of randomized trials but agrees that the weight of published observational trials and the demonstrated benefit of the use of naloxone in the community mean that the skill should be taught in first aid courses in Australia and New Zealand.⁸  It should also be noted that 90% of lay persons trained to administer naloxone in low resource settings did so when the circumstances required it,⁹ meaning this is a skill that is readily acquired in a manner analogous to administration of auto-injector epinephrine for anaphylaxis, but easier to learn and with fewer potential adverse effects.

Opioid use is an increasing cause of illness across the world. Australia has observed an increasing incidence of opioid overdose in the community. Opioid use resulting in life-threatening side effects can occur in a variety of circumstances, including deliberate administration, accidental ingestion, unintentional overdose,⁴ medical error and prescription by healthcare professionals.

Emerging evidence has suggested that many people in the community can successfully deliver the intervention after brief training.⁷ Organisations running naloxone-access programs should ensure that training provided is adequate for the purpose and equips participants specifically to safely deliver naloxone. Trainers should ensure that participants are adequately trained, including in CPR, safe management of persons during and after overdose and infection control techniques.

There remains a significant risk that naloxone administration may be prioritised over CPR, or that starting CPR might be delayed, and training programs should address this risk.  It is also recognised that naloxone should be given as soon as available in suspected opioid overdose with minimal interruption of CPR.

Cost

Naloxone in Schedule 3 preparations in Australia is currently free to members of the general community under the Australian Government’s Take-Home Naloxone Program.⁶ Organisations running naloxone-access programs should determine program participants are eligible to receive naloxone as part of the Program.

This is a summary of the legal position in January 2025 in Australian states and New Zealand on dispensing and administering.

Both in Australia and New Zealand, naloxone is available to the public in settings like pharmacies, harm reduction programs, and through public health campaigns. People at risk of opioid overdose and individuals who may witness an overdose can obtain naloxone for emergency use.

Key points covered by the legal and medical resources include:

• Access: Availability of naloxone without a prescription in certain circumstances.
• Training: How to administer naloxone effectively.
• Regulations: Legal frameworks governing the distribution and use of naloxone.
• Support: Where to get naloxone, including pharmacies and harm reduction services.

These resources ensure that individuals, healthcare professionals, and the general public are well-informed about naloxone’s availability and its life-saving potential.

In Australia, the Therapeutic Goods Administration (https://www.tga.gov.au) is responsible for regulating the supply of medications, however, access and distribution laws vary between states and territories. The overall goal for access and distribution of Naloxone is to provide life-saving interventions for those at risk of opioid overdose. Below is a summary of the legal status of naloxone across each Australian state and territory as well as New Zealand:

Readers should access the websites supplied for the most recent information.

New Zealand (NZ)

Access and Dispensing: 

·       Available as a general sales medicine (Nyxoid) for purchase from PHARMACO NZ. This is not currently funded by PHARMAC NZ. Mundipharma is leaving the NZ market in June 2025, and the country does not currently have another product to take its place. There is work being done to access a replacement intranasal product.

·       (After June 2025) Importation of an unregistered product (i.e. Nyxoid from Mundipharma Australia) under Section 23 of the Medicines Act. This is not funded by PHARMAC NZ. 

Sources:

New Zealand Medicines and Medical Devices Safety Authority:   https://www.medsafe.govt.nz/profs/class/Agendas/Agen68/6.2Naloxone.pdf

·       Pharmaceutical Society of New Zealand (PSNZ): https://www.psnz.org.nz/

·       NZ Drug Foundation: https://drugfoundation.org.nz/

·       https://pharmaco-medicalemergency.co.nz/product-categories/emergency-care/opioid-overdose/nyxoid-naloxone-nasal-spray-solution/.

Australia

1.     New South Wales (NSW)

Access and dispensing: Naloxone is available through pharmacies without a prescription via the Pharmaceutical Benefits Scheme (PBS) for those at risk of opioid overdose.

Take-Home Naloxone Programs: NSW Take Home Naloxone Program, allows individuals at risk of overdose and those who may witness an overdose to obtain naloxone from participating pharmacies.

Good Samaritan Laws: Under the NSW Good Samaritan Drug Overdose Law, a person who administers naloxone in an emergency is protected from criminal prosecution.

Sources:

·       Pharmaceutical Society of Australia (PSA): NSW Opioid Treatment Program (OTP) https://www.psa.org.au/programs/nsw-otp/

·       NSW Health Take home naloxone program: https://www.health.nsw.gov.au/aod/programs/Pages/naloxone.aspx

2.     Victoria (VIC)

Access and Dispensing: Naloxone is available in pharmacies without a prescription through the PBS, specifically for individuals at risk of opioid overdose.

Take-Home Naloxone Programs: The Naloxone Subsidy Program (NSP) in Victoria provides free naloxone for people who are at high risk of overdose or who may witness an overdose. The program is available through participating pharmacies and needle and syringe programs (NSPs).

Good Samaritan Laws: Victoria has a Good Samaritan Drug Overdose Law, providing legal protection for individuals who administer naloxone during an overdose emergency

Sources:

·       Victorian Legislation:  Victoria: https://www.legislation.vic.gov.au/as-made/statutory-rules/drugs-poisons-and-controlled-substances-amendment-naloxone-regulations-2022

·       Victorian Department of Health: The Naloxone Subsidy Program (NSP) https://www.health.vic.gov.au/aod-treatment-services/victorias-take-home-naloxone-program

3.     Queensland (QLD)

Access and Dispensing: Naloxone is available through the PBS, but a prescription is required for dispensing in pharmacies. However, take home naloxone programs are becoming more widely available.

Take-Home Naloxone Programs: Queensland has pilot programs offering free or subsidized naloxone to those at risk of overdose, including through community-based outreach and needle and syringe programs.

Good Samaritan Laws: While Queensland does not have specific Good Samaritan laws regarding naloxone, individuals may not be prosecuted for administering naloxone in an emergency if they are acting in good faith.

Sources:

·       Queensland Legislation: https://www.legislation.qld.gov.au/view/pdf/asmade/sl-2023-0051

4.     South Australia (SA)

Access and Dispensing: Naloxone is available on prescription through pharmacies

Take-Home Naloxone Programs: South Australia runs programs like Take Home Naloxone, where people at risk of opioid overdose, or their friends and family, can access naloxone free of charge.

Good Samaritan Laws: There are protections under South Australia's Good Samaritan Law that apply to those administering naloxone during a medical emergency.

Sources:

·       Government of South Australia: Take Home Naloxone (THN) Program  https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+programs+and+practice+guidelines/medicines+and+drugs/opioids/naloxone+-+preventing+and+responding+to+adverse+effects+of+opioids

5.     Western Australia (WA)

Access and Dispensing: Naloxone is available through the PBS but requires a prescription for dispensing.

Take-Home Naloxone Programs: Western Australia has introduced the Take Home Naloxone Program to provide free naloxone to individuals who are at risk of overdose and those who may witness one.

Good Samaritan Laws: Western Australia has specific legal protections for individuals who administer naloxone in the case of an overdose emergency under its Good Samaritan Laws.

Sources:

·       Government of Western Australia: Structured Administration and Supply Arrangement (SASA): https://www.health.wa.gov.au › Corporate › Word

6.     Tasmania (TAS)

Access and Dispensing: Naloxone is available through pharmacies.

Take-Home Naloxone Programs: Tasmania has implemented take-home naloxone programs through public health services, including harm reduction services and needle exchange programs.

Good Samaritan Laws: Tasmania has Good Samaritan provisions that generally offer protection for people who administer naloxone in an emergency.

Sources:

·       Tasmanian Legislation: https://www.legislation.tas.gov.au/view/whole/html/asmade/sr-2020-022

7.     Australian Capital Territory (ACT)

Access and Dispensing: Naloxone is available through the PBS and can be dispensed with a prescription.

Take-Home Naloxone Programs: Tasmania has implemented take-home naloxone programs through public health services, including harm reduction services and needle exchange programs.

Good Samaritan Laws: Tasmania has Good Samaritan provisions that generally offer protection for people who administer naloxone in an emergency.

Sources:

·       ACT take home naloxone: https://www.act.gov.au/health/topics/drugs-alcohol-smoking-and-vaping/take-home-naloxone

8.     Northern Territory (NT)

Access and Dispensing:  Naloxone is available through the PBS but requires a prescription from a healthcare provider.

Take-Home Naloxone Programs: The Northern Territory has been rolling out programs to provide naloxone to individuals at risk of overdose, including distribution through harm reduction programs.

Good Samaritan Laws: There are no specific Good Samaritan laws related to naloxone, but the NT generally has protections for people acting in good faith during an emergency situation

Sources:

·       Northern Territory Government Naloxone: https://nt.gov.au/wellbeing/hospitals-health-services/naloxone#:~:text=This%20program%20allows%20people%20to,and%20if%20it's%20for%20yourself.

(Appendix naloxone prepared by Craig Ray, Tracy Kidd, Emily Hughes and Finlay Macneil).

1.              Strang J, McDonald R, Campbell G, et al.: Take‐Home Naloxone for the Emergency Interim Management of Opioid Overdose: The Public Health Application of an Emergency Medicine. Drugs. 2019, 79:1395–1418. 10.1007/s40265-019-01154-5

2.              Trends in overdose and other drug-induced deaths in Australia, 2003-2022. Sydney: National Drug and Alcohol Research Centre, UNSW Sydney; 2024. (2024). Accessed: 14/10/2024, 2024: https://www.unsw.edu.au/content/dam/images/medicine-health/ndarc/research/2022-08-ndarc-reports/NIDIP_Drug induced deaths_2003-2022_Report revised.pdf.

3.              Alcohol, tobacco & other drugs in Australia. (2024). Accessed: 14/10/2024, 2024: https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia/contents/drug-types/non-medical-use-of-pharmaceutical-drugs.

4.              Trends in overdose and other drug-induced deaths in Australia, 2003-2022. Sydney: National Drug and Alcohol Research Centre, UNSW Sydney; 2024. (2024). Accessed: 27/1/25: http://hdl.handle.net/1959.4/102236.

5.          Castren M, Perkins G, Kudenchuk P, et al.: 2020 Timing of CPR cycles (2 min vs other) Consensus on Science with Treatment Recommendations [Internet] Resuscitation..http://ilcor.org/

6.              About the Take Home Naloxone program. (2024). Accessed: 14/10/2024, 2024:.https://www.health.gov.au/our-work/take-home-naloxone-program/about-the-take-home-naloxone-program - :~:text=The Australian Government is investing,opioid overdose or adverse reaction

7.              WHO: Community management of opioid overdose. WHO, Geneva, Switzerland; 2014.

8.              Olsen A, McDonald D, Lenton S, Dietze P: Assessing causality in drug policy analyses: How useful are the Bradford Hill criteria in analysing take-home naloxone programs? Drug and Alcohol Review. 2018, 37:499-501. 10.1111/dar.12523

9.              Dietze P, Gerra G, Poznyak V, et al.: An observational prospective cohort study of naloxone use at witnessed overdoses, Kazakhstan, Kyrgyzstan, Tajikistan, Ukraine. Bull World Health Organ. 2022, 100:187-195. 10.2471/BLT.21.286459

When citing the ANZCOR Guidelines we recommend:

ANZCOR, 2025, Guideline 9.5.2 – First Aid Management of Suspected Opioid Overdose, accessed 21 July 2025, https://www.anzcor.org/home/first-aid-for-bites-stings-and-poisoning/guideline-9-5-2-first-aid-management-of-opioid-overdose