Now is the time to take steps to allow peer access to naloxone for heroin overdose in Australia.

Heroin overdose deaths are preventable. Overdose prevention in Australia has largely rested on opioid substitution treatment supplemented with outreach services and education for injecting drug users (IDUs) about overdose risks and responses. We believe now is the time to make naloxone hydrochloride (Narcan ®) available to Australian IDUs to help prevent overdose deaths. At the end of 2000 heroin availability and harm in Australia rapidly declined [1]. Despite this, overdoses involving heroin or diverted pharmaceutical opioids continue to account for most illicit drug-related deaths in this country. In 2005, the last year reliable data were available [2], at least one citizen died from accidental opioid overdose each day, most related to the injection of heroin [3]. Heroin is still the drug of choice among the majority of Australian IDUs [2]. To date, there is no evidence that levels of heroin overdoses have increased to levels seen in the 1990s. However, transient geographical clusters of overdoses are evident in ambulance transport data (e.g. [4]). This pattern is consistent with the high number of low weight 'scatter importations' of heroin (through mail and air passenger traffic) that increasingly charac-terise heroin importations detected at the Australian border since 2004 [5]. Since the mid 1990s there have been calls to make naloxone available to heroin users, their peers and family members to prevent overdose deaths [6,7]. Lenton and Hargreaves reviewed the literature in 2000 and concluded that peer naloxone had real promise as part of a comprehensive overdose–response, but that an Australian trial was needed before naloxone was made more widely available in this country [8,9]. The dramatic decline in heroin overdose that accompanied the heroin 'shortage' [1,10] meant that the proposed trial did not proceed. However, accumulating international evidence since 2000 shows that the provision of naloxone, with appropriate training, to IDU peers, family members and outreach workers can lead to successful heroin overdose reversals with few, if any, adverse effects (e.g. [11–13]). Indeed, many thousands of doses of nalox-one have been distributed for this purpose. In the US alone, over a thousand cases of overdose reversal by peers using naloxone have been documented [11]. By December 2008 there were 52 peer–naloxone distribution programs operating across 17 US States [13]. None of the major concerns about the intervention (such as unsafe administration of naloxone, problems with re-intoxication where longer acting opioids have been used, or more risky drug use if heroin were to …