Monograph

Ontario's Naloxone Program

In Ontario, one of the leading causes of accidental death is opioid overdose. (1) CityNews reported that between 2011 and 2014, Ontario has had 2,471 opioid-related overdoses. (2) Individuals are at risk of experiencing an overdose if they have just begun to take, or if they are tapering off, opioid drugs. (1) Additionally, regions in Ontario where opioids are frequently prescribed are associated with a high incidence of opioid-related deaths. (1) In 2012, the provincial government attempted to address this issue by introducing legislation to remove oxycontin from the Ontario Drug Benefit formulary with the goal of reducing the amount of opioid drug-related deaths.(2) While the use of oxycodone may decrease, other opioids such as heroin and fentanyl may be used instead. (1) Since the 2012 legislation was introduced, oxycodone overdose deaths decreased by 30%, however, opioid-related deaths increased by 24%. (2)

A recently proposed solution to this public health concern is the implementation of the Ontario Naloxone program at community pharmacies. (4) Naloxone is able to reverse the effects opiates for about 30 to 90 minutes to allow the individual to seek medical attention.1,4 The symptoms of opioid overdose include clammy skin, having the lips or nails turn blue, seizures, muscle spasms and shallow breathing. (1,3) As an antagonist, naloxone outcompetes opioids at receptor sites in the part of the brain that controls breathing. (1) Following administration of naloxone, normal breathing is restored within 2-3 minutes. (1) Interestingly, naloxone is not addictive and does not affect the individual in the absence of opiates. (1,4)

The Ontario Naloxone Program is a harm reduction strategy, and its goal is to reduce the harm of the drug and improve accessibility of these services to individuals. (1) In 2011, Toronto introduced the POINT (Prevent Overdose in Toronto) program which was the first community-based overdose prevention and response program with naloxone distribution. (5) Individuals using opioids received training regarding risk factors associated with opioid overdose, recognizing signs and symptoms of overdose, calling 911, naloxone administration and post-overdose care. (5) The program trained 209 clients in the first eight months. In the 17 naloxone administrations, all had successful outcomes. (5)

As of June 24, 2016, naloxone is available as a schedule II drug for emergency use for opioid overdose. (4) This allows patients to access naloxone kits from any community pharmacy without a prescription and is able to be dispensed free of charge to qualified patients. (6) The Ontario College of Pharmacists outlined that the naloxone kits may include two safety syringes, a rescue breathing barrier, ampoule-opening devices, a pair of non-latex gloves and alcohol swabs as well as a naloxone identifier card. (4)

The pharmacist's role will be pivotal in the successful implementation of the naloxone program. They monitor the use of naloxone as well as provide education for the safe administration of naloxone to patients. Ultimately, the increased accessibility of this service offers a promising solution to decrease the incidence of opioid-related deaths in Ontario.

References:

1. Carter, C & Graham (2013). Opioid Overdose Prevention & Response in Canada. Canadian Drug Policy Coalition. Retrieved from http://drugpolicy.ca/wpcontent/uploads/2013/01/CDPC_OverdosePreventionPolicy_Final_July2014.pdf
2. Amin, F. (2016, March 7). Opioid overdose deaths continue to rise in Canada despite removal of Oxycontin. CityNews. Retrieved from http://www. citynews.ca/2016/03/07/opioid-overdose-deaths-continue-to-rise-in-canada-despite-removal-of-oxycontin/
3. Ontario Harm Reduction Distribution Program. (2016). Opioid Overdose Prevention. Retrieved from http://www.ohrdp.ca/opioid-overdose-prevention/
4. Ontario College of Pharmacists. (2016, August 10). Dispensing or Selling Naloxone: Guidance for pharmacy professionals when dispensing or selling naloxone as a schedule II drug. Retrieved from http://www.ocpinfo.com/library/practice-related/download/Naloxone.pdf
5. Orkin, A., Gassanov, M. A., & Shahin, R. M. (2013). Development and implementation of an opioid overdose prevention and response program in Toronto, Ontario. Canadian Journal of Public Health, 104(3), e200-e204.
6. Ontario Pharmacists Association (2016). Take-home Naloxone. Retrieved from https://www.opatoday.com/professional/resources/for-pharmacists/toolsand-forms/naloxone