Availability of naloxone in Canadian pharmacies:a population-based survey

Cressman, Alex; Mazereeuw, Graham; Guan, Qi; Jia, Wenting; Gomes, Tara; Juurlink, David N.

doi:10.9778/cmajo.20170123

Cited by 21 publications

(21 citation statements)

References 42 publications

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“…[15] These findings align with results of a 2017 survey of Canadian pharmacies demonstrating naloxone availability in only 26.9% of Ontario pharmacies,[26] and suggests that barriers to pharmacy-dispensed naloxone continue to exist across the province. Low pharmacy participation could be related to pharmacists’ reluctance to stock or recommend naloxone due to perceived lack of demand,[26] stigma surrounding opioid-use disorder[27] or underestimation of overdose risk in prescription opioid recipients.…”

Section: Discussionsupporting

confidence: 72%

The uptake of the pharmacy-dispensed naloxone kit program in Ontario: A population-based study

et al. 2019

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BackgroundNaloxone is a life-saving antidote for opioid overdoses. In June 2016, the Ontario government implemented the Ontario Naloxone Program for Pharmacies (ONPP) to enhance access to naloxone.ObjectiveWe examined the initial uptake of naloxone through the ONPP and characteristics of the individuals receiving and pharmacies dispensing naloxone kits.MethodsWe conducted a population-based study of all Ontario residents who received a naloxone kit between July 1, 2016 and March 31, 2018. This involved 1) a cross-sectional analysis of monthly rates of kits dispensed; and 2) a descriptive analysis of all individuals and pharmacies who accessed and dispensed naloxone, respectively. We stratified individuals according to their opioid exposure as: prescription opioid agonist therapy (OAT) recipients, prescription opioid recipients, those with past opioid exposure and those with no/unknown opioid exposure. We calculated a Lorenz curve comparing the cumulative percent of naloxone-dispensing pharmacies and cumulative percent of naloxone kits dispensed and the corresponding Gini coefficient.ResultsNaloxone dispensing through the ONPP increased considerably from 1.9 to 54.3 kits per 100,000 residents over the study period. In this time, 2,729 community pharmacies dispensed 91,069 kits to 67,910 unique individuals. Uptake was highest among prescription OAT recipients (40.7% of OAT recipients dispensed at least one kit), compared with 1.6% of prescription opioid recipients, 1.0% of those with past opioid exposure and 0.3% with no/unknown opioid exposure. Naloxone dispensing was highly clustered among pharmacies (Gini = 0.78), with 55.6% of Ontario pharmacies dispensing naloxone, and one-third (33.7%) of kits dispensed by the top 1.0% of naloxone-dispensing pharmacies.ConclusionThe ONPP launch led to a rapid increase in the number of naloxone kits dispensed in Ontario. Although the program successfully engaged people prescribed OAT, efforts to increase uptake among others at risk of opioid overdose appear warranted. Opportunities for expanding pharmacy participation should be identified and pursued.

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Section: Discussionsupporting

confidence: 72%

The uptake of the pharmacy-dispensed naloxone kit program in Ontario: A population-based study

et al. 2019

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“…Multiple sources studied the availability of naloxone and dispensing patterns (22/52, 42%) ( Appendix C and Appendix D ). Despite the success for the previously mentioned THN programs, several sources found that few pharmacists ever offer or dispense naloxone, despite stocking it in their pharmacies or existing standing orders [ 11 , 12 , 36 , 37 , 38 , 39 , 40 ]. For example, a survey of 284 community pharmacists in Indiana found that over half (58.1%) of pharmacies stocked naloxone, but only 23.6% of pharmacists ever dispensed it at the pharmacy [ 39 ].…”

Section: Resultsmentioning

confidence: 99%

“…For example, naloxone kits are theoretically available in all community pharmacies in Canada based on its removal from the prescription drug list, while in some states in the US, pharmacists can independently prescribe and dispense naloxone through standing orders, where, without a standing order, pharmacists alone cannot initiate a prescription for naloxone without it being written by a physician [ 5 , 6 ]. Many variations exist within community pharmacies with respect to THN access, knowledge, and willingness to obtain or train on how to use naloxone [ 11 ]. Most pharmacy-based THN programs in Canada or the US are not mandatory and there is a considerable variability in the number of pharmacies who stock and/or dispense naloxone [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…Many variations exist within community pharmacies with respect to THN access, knowledge, and willingness to obtain or train on how to use naloxone [ 11 ]. Most pharmacy-based THN programs in Canada or the US are not mandatory and there is a considerable variability in the number of pharmacies who stock and/or dispense naloxone [ 11 ]. For example, in 2018, just over half of all pharmacies in Ontario dispensed naloxone, and a third of the kits dispensed were from only 1% of all pharmacies in large urban centers [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

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What Is Known about Community Pharmacy-Based Take-Home Naloxone Programs and Program Interventions? A Scoping Review

2021

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A variety of new sources describing community pharmacy-based take-home naloxone (THN) programs have emerged recently in the literature. There is a need to define the types of take-home naloxone programs being offered to support future research designs in implementing and evaluating standardized programs that fill pharmacist and patient knowledge gaps and lift current barriers for optimal community pharmacy naloxone provision. The objective of this paper is to summarize the literature on community pharmacy-based THN programs, including specific program interventions used to increase naloxone dispensing, naloxone availability and dispensing patterns, facilitators and barriers for the THN programs, and knowledge gaps. Online databases such as PubMed, EMBASE, Scopus, and International Pharmaceutical Abstracts (IPA) and a search of the grey literature were used to identify eligible sources. Sources were screened by two reviewers for eligibility in COVIDENCE software. Both reviewers compared screening results and resolved conflicts through discussion. A data extraction form for all identified full texts was completed by both reviewers and results were compiled through reviewer discussion. Fifty-two sources met the eligibility criteria. The top three barriers identified were: cost/coverage of naloxone, stigma, and education/training for pharmacists. THN program interventions included screening tools, checklists, pocket cards, patient brochures, and utilizing the pharmacy management system to flag eligible patients. Patient knowledge gaps included naloxone misinformation and lack of awareness, while pharmacists demonstrated administrative, clinical, and counselling knowledge gaps. Naloxone availability was found to be highly variable, where independent and rural pharmacies were less likely to stock or dispense naloxone. Further, pharmacies located in districts with higher rates of opioid overdose deaths and lower household income were also less likely to have naloxone available. This review identified multiple new programs, showcasing that the implementation and evaluation of THN programs are an expanding area of research. Future research should focus on implementing and evaluating a THN program through a randomized controlled trial design that incorporates solutions for the barriers and knowledge gaps identified in this study.

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“…And even when they do, there is no guarantee that they will find what they came for. In a 2017 study, researchers found that only around onequarter of the pharmacies in Canada that they contacted had the drug in stock 2 . And although California's laws allow pharmacists to provide naloxone without a physician's prescription, a 2018 'secret shopper' study of more than 1,000 pharmacies found that just 23% were willing or able to do so 3 .…”

Section: Lazarus Drugmentioning

confidence: 99%

Mitigating opioids’ harm

Willyard¹

2019

Nature

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H aven Wheelock carries a dose of naloxone everywhere she goes. She calls it a "magical medication" with the power to bring people back from the brink of death. Wheelock runs a syringe-exchange programme for Outside In, a non-profit organization that provides medical care and other services for low-income and homeless people in Portland, Oregon. She has administered the opioid-blocking medication 21 times. The drug has never failed, but that doesn't make using it any less terrifying. A few months ago, a woman overdosed across the street from the syringe exchange. Wheelock grabbed her naloxone kit, jumped over a metal barrier and raced across a road to reach the woman. She was lying on a filthy piece of forgotten land next to the motorway, with her lips turning blue. Wheelock squirted naloxone into one nostril, "And then I breathed for her, for what felt like a decade, " she says. It didn't work. Wheelock administered a second dose, this time by injection. By the time the ambulance arrived, the drug had worked its magic. The woman was awake and talking.

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Availability of naloxone in Canadian pharmacies:a population-based survey

Cited by 21 publications

References 42 publications

The uptake of the pharmacy-dispensed naloxone kit program in Ontario: A population-based study

The uptake of the pharmacy-dispensed naloxone kit program in Ontario: A population-based study

What Is Known about Community Pharmacy-Based Take-Home Naloxone Programs and Program Interventions? A Scoping Review

Mitigating opioids’ harm

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