The status of naloxone in community pharmacies across Canada [2020]

Opioids are responsible for approximately 12 deaths per day in Canada. Virtually all (94%) of these deaths could be prevented, as they are caused by accidental opioid use. The burden of the “Opioid Crisis” goes beyond the immediate impact on the individual, their families and their community to affect the health care system as a whole. Indeed, opioid-related harms cost the health care system $3.5 billion per year, or approximately $100 for every Canadian regardless of age.

Harm reduction strategies have been implemented in order to tackle this crisis. The distribution of the opioid antagonist, naloxone, as a take-home kit is a prime example of these strategies. Naloxone has shown great success in treating and reversing opioid-induced respiratory depression (OIRD), the main cause of opioid-related premature morbidity and mortality. Take-home naloxone (THN) kits allow non–health care providers to administer the opioid antagonist to anyone experiencing OIRD.

In Canada, all provinces and territories provide free THN kits. However, distribution varies markedly between provinces and territories, as these programs are managed at the provincial level. For example, an individual can receive a free THN kit at over 1000 distribution sites in Alberta, but they can only access free THN kits at 4 distribution sites in New Brunswick. Such variations create disparities in naloxone access throughout Canada, which in turn creates barriers to obtaining this crucial tool. Indeed, it has been reported that more than 98% of individuals who are at high risk (patients with a history of OIRD, opioid-related substance use disorder, high-dosage opioid prescription or prescribed a benzodiazepine concurrently with an opioid) cannot readily access free THN kits. Thus, there is a need for an innovative way to address this disparity.

Community pharmacists are extremely accessible primary health care providers who are located in the heart of Canadian communities (urban, rural and remote) and see patients who use opioids frequently. As such, they are well positioned to proactively and systematically identify individuals who are at high risk for OIRD, provide THN kits and educate in a nonstigmatizing environment. In fact, pharmacies have already shown great success as naloxone distribution sites. Despite this evidence, community pharmacies are still not universally included as free THN kit distribution sites in Canada.

Community pharmacists can play a vital role in tackling the opioid crisis. A better understanding of the current pharmacy distribution system for naloxone and the associated policies surrounding that will help to enhance the current role that pharmacists in each region can play in the fight against this major public health crisis. The purpose of this study is to report the current naloxone distribution policies and practice for community pharmacists in Canada.

Randy So, BSc(Spec), Yazid Al Hamarneh, BSc(Pharm), PhD, Mark Barnes, BSc(Pharm), Michael A. Beazely, BSP, PhD, Michael Boivin, BSc(Pharm), Julie Laroche, BSc(Pharm), Harsit Patel, BSc(Pharm), PharmD, RPh, Aaron Sihota, BSc, BSc(Pharm), RPh, Tim Smith, BSc(Pharm), Ross T. Tsuyuki, BSc(Pharm), PharmD, MSc, FCSHP, FACC, FCAHS
Canadian Pharmacists Journal / Revue des Pharmaciens du Canada, September 21, 2020