Alberta’s provincial take-home naloxone program: A multi-sectoral and multi-jurisdictional response to overdose

Freeman, Lisa K.; Bourque, Stacey; Etches, Nick; Goodison, Karin; O’Gorman, Claire; Rittenbach, Kay; Sikora, Christopher; Yarema, Mark

doi:10.17269/cjph.108.5989

Cited by 10 publications

(13 citation statements)

References 9 publications

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“…While all Canadian provinces and territories have publicly funded THN programs, research and evaluation of these programs in the scholarly literature is limited. A recent study from Ontario describes uptake of the province’s pharmacy-dispensed naloxone kits in Ontario [ 27 ], and preliminary analyses of provincial THN programs in Ontario [ 28 ], Alberta [ 29 ], Manitoba [ 30 ], and British Columbia [ 15 ] have been published. Data from other jurisdictions are not directly comparable, due to differences in program structure, eligibility criteria, and scope [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

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Accessing Take-Home Naloxone in British Columbia and the role of community pharmacies: Results from the analysis of administrative data

et al. 2020

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Introduction British Columbia's (BC) Take-Home Naloxone (THN) program provides naloxone to bystanders for use in cases of suspected opioid overdose. This study seeks to provide trends and analysis from the provincial BC THN program since inception in 2012 to the end of 2018. Materials and methods BC THN shipment and distribution records from 2012-2018 were retrieved. Frequency distributions were used to describe characteristics of individuals accessing the program. To evaluate correlates of distribution after the addition of hundreds of pharmacy distribution sites, an analytic sample was limited to records from 2018, and multivariate logistic regression was used to evaluate correlates of collecting naloxone at a pharmacy site. Results Since program inception to the end of 2018, there were 398,167 naloxone kits shipped to distribution sites, 149,999 kits reported distributed, and 40,903 kits reported used to reverse an overdose in BC. There was a significant increasing trend in the number of naloxone kits used to reverse an overdose over time (p<0.01), and more than 90% of kits that were reported used were distributed to persons at risk of an overdose. Individuals not personally at risk of overdose had higher odds of collecting naloxone at a pharmacy site, compared to other community sites (including harm reduction supply distribution sites, peer led organizations, drop-in centers, and supportive housing sites) (Adjusted Odds Ratio (AOR): 2.69; 95% CI: 2.50-2.90). Conclusions This study documents thousands of opioid overdose reversals facilitated through the BC THN program. While those at highest risk of overdose may preferentially access naloxone

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Section: Discussionmentioning

confidence: 99%

“…analyses of provincial THN programs in Ontario [28], Alberta [29], Manitoba [30], and British Columbia [15] have been published. Data from other jurisdictions are not directly comparable, due to differences in program structure, eligibility criteria, and scope [9].…”

Section: Plos Onementioning

confidence: 99%

Accessing Take-Home Naloxone in British Columbia and the role of community pharmacies: Results from the analysis of administrative data

et al. 2020

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“…Some programs used laws to enhance naloxone access, such as expanding the pharmacist’s naloxone prescriptive authority [ 19 , 21 , 24 ], making naloxone an over-the-counter medication [ 30 ], or mandating that naloxone be co-prescribed with an opioid prescription [ 27 ]. For the latter study, the program was implemented across several US states and mandated naloxone as a co-prescription to patients with specific criteria [ 27 ].…”

Section: Resultsmentioning

confidence: 99%

“…For pharmacist knowledge gaps, five studies highlighted administrative knowledge gaps in dispensing requirements [ 30 , 45 , 52 , 53 , 61 ]. One of these studies was an interview of patients, who noted that it was apparent that the pharmacy staff lacked training around naloxone dispensing and billing procedures [ 61 ].…”

Section: Resultsmentioning

confidence: 99%

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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“…[30] However, individuals who receive prescription opioids may not avail themselves of naloxone from these non-pharmacy sources, and therefore our estimates in this population are likely accurate. [31] Furthermore, this analysis provides important information regarding patterns of naloxone uptake when this product is made freely available at retail pharmacies, a model that is being considered in other jurisdictions across Canada. [16] Second, there may be some misclassification in our exposure group definitions.…”

Section: Limitationsmentioning

confidence: 99%

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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Alberta’s provincial take-home naloxone program: A multi-sectoral and multi-jurisdictional response to overdose

Cited by 10 publications

References 9 publications

Accessing Take-Home Naloxone in British Columbia and the role of community pharmacies: Results from the analysis of administrative data

Accessing Take-Home Naloxone in British Columbia and the role of community pharmacies: Results from the analysis of administrative data

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

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

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