Demand for a life-saving opioid overdose drug has doubled in one year as a "whole new cohort" of stimulant and hallucinogenic users, fearful of taking lethally laced narcotics, have rushed to get the medication.
Prior to a recent spike in overdose deaths, regular users of illicit opioids were the predominant users of naloxone, which can rapidly reverse an overdose.
However after an increasing number of incidents where synthetic opioids were cut with other illicit drugs, killing some people, health authorities have urged all drug users to have naloxone on hand.
Related: 'Mind-boggling': Victorian outreach workers decry double standard for lifesaving overdose drug naloxone
That warning was directed at more than one million Australians who have taken cocaine in the last year and 400,000 who have used ecstasy.
Officials are particularly concerned about the increasing presence of synthetic opioids called nitazenes - often substantially more powerful than heroin - in drugs such as cocaine.
The Albanese government rolled out the Take Home Naloxone program nationwide in July 2022 to allow free access without a prescription.
In the financial year for 2022-2023, 110,976 units were supplied. That figure more than doubled in 2023-2024, reaching 243,248.
Naloxone, which can be given as a nasal spray or injected, restores breathing after an overdose has slowed respiration.
Luke Kelly, the president of the New South Wales branch of the Pharmaceutical Society of Australia, said until recently the two most common groups pharmacists supplied naloxone to were people with opioid dependence and those on some chronic pain medications.
However, after health authorities urged all drug users to carry naloxone, Kelly said "this whole new cohort" created "a new area of need".
On July 2 the Victorian health department issued a drug alert about cocaine laced with a synthetic opioid. It urged all drug users to carry naloxone. Seven days earlier, four people were found dead in a Melbourne home. Tests established a synthetic opioid was present in all four victims.
The department told Guardian Australia their data on naloxone, supplied through the state's Take Home program, showed an increase across July and August compared to previous months.
Earlier this month NSW Health urged cocaine, methamphetamine and MDMA users to carry naloxone. The warning came after two people died of a heroin overdose after using what they thought was cocaine at a house party in Sydney. Two others were hospitalised.
A NSW Health spokesperson said in 2023-24, the Take Home naloxone program distributed more than 36,000 units, compared to 20,000 in 2021-22.
Dr Mary Ellen Harrod, the CEO of the NSW Users and Aids Association (Nuaa), said stimulant users have been a big driver in demand for naloxone since the rise in reports of people unknowingly consuming opioids and often dying.
Nuaa, which provides naloxone through its online shop, said orders tripled after the NSW Health alert. "Whenever there's an alert, we will see a huge spike in orders," Harrod said.
Related: Cocaine users die of heroin overdoses after consuming tainted drugs at Sydney house party
While knowledge of naloxone is greater among opioid users, as opioids are more frequently laced in stimulants, many others are becoming aware, she said.
Kelly said pharmacists will not judge anyone requesting naloxone but warned of possible shortages if demand were to outstrip supply. The Therapeutic Goods Administration does not list a shortage of naloxone.
"We believe that there still can be a lot of stigma attached to carrying naloxone but the fact is that anyone can witness an overdose," she said.
Polly* said she ordered naloxone after the recent NSW Health alert.
"I'm not a drug user. I don't do drugs or hard drugs, but like anyone my age I know people who do. I have friends who do," the 23-year-old said.
"If it's available and free, and can literally save someone's life, I think everyone should carry it."