Impact of policy changes on the provision of naloxone by pharmacies in Ontario, Canada: a population‐based time–series analysis

Abstract

Background and aims In June 2016, the Ontario, Canada government implemented the Ontario Naloxone Program for Pharmacies (ONPP), authorizing pharmacists to provide injectable naloxone kits at no charge to all Ontario residents. In March 2018, the program was amended to include intranasal naloxone and remove the requirement to present a government health card to the dispensing pharmacist. We examined whether these changes increased naloxone dispensing through the ONPP. Design Population‐based time–series analysis using interventional autoregressive integrated moving average models. Setting Ontario, Canada. Participants All Ontario residents between 1 July 2016 and 31 March 2020. Measurements Monthly rates of pharmacy naloxone dispensing. Findings Overall, 199 484 individuals were dispensed a naloxone kit during the study period. In the main analysis, the rate of pharmacy naloxone dispensing increased by 65.1% following program changes (55.6–91.8 kits per 100 000 population between February 2018 and May 2018; P = 0.01). In subgroup analyses, naloxone dispensing increased among individuals receiving opioid agonist therapy (OAT) (3374.9–7264.2 kits per 100 000 OAT recipients; P = 0.04) among individuals receiving other prescription opioids (192.8–381.8 kits per 100 000 population prescribed opioids; P < 0.01), among individuals with past opioid exposure (134.7–205.6 kits per 100 000 population with past opioid exposure; P < 0.01) and in urban centers (56.2–91.4 kits per 100 000 population; P < 0.01). We did not observe a clear impact on pharmacy‐dispensed naloxone to individuals with no or unknown opioid exposure (34.4–39.3 kits per 100 000 population with no/unknown opioid exposure; P = 0.42) and in rural regions (50.4–97.2 kits per 100 000 population; P = 0.09). Conclusions Changes to the Ontario Naloxone Program for Pharmacies to add intranasal naloxone and remove the requirement to present a government health card appeared to increase pharmacy‐based naloxone dispensing uptake in Ontario, Canada, particularly among individuals at high risk of inadvertent opioid overdose.

‘I don't chase drugs as much anymore, and I'm not dead’: Client reported outcomes associated with safer opioid supply programs in Ontario, Canada

“…In 2022, 85% of accidental overdose deaths in Canada included fentanyl [4]. Responses to the worsening overdose crisis include expanded distribution of naloxone [5], implementation of additional supervised consumption services and overdose prevention sites [6], and expanded use of and access to opioid agonist therapy (OAT), including the introduction of injectable OAT programs [6,7]. These responses have contributed to the prevention of some overdose-related deaths [8].…”

Clinical outcomes and health care costs among people entering a safer opioid supply program in Ontario

“…1 This crisis is driven primarily by contamination of the unregulated drug supply with illicitly derived fentanyl and fentanyl analogues, which directly contributed to 87% of opioid-related deaths in Ontario in 2020. 2 In response, several interventions have been adapted or scaled up, including the distribution of naloxone to reverse opioid overdose, 3 supervised consumption services and overdose prevention sites, 4,5 opioid agonist therapy (OAT) and injectable OAT programs (iOAT). [6][7][8] Evidence suggests that the expansion of these harm-reduction interventions across…”

Perceived availability and carriage of take-home naloxone and factors associated with carriage among people who inject drugs in England, Wales and Northern Ireland

“…In Canada and the United States, an increasing number of studies have shown that naloxone access laws (e.g., laws that permit naloxone distribution without patient-specific prescriptions, laws that permit the medication to be dispensed in non-medical settings) have led to increased naloxone distribution (Antoniou et al, 2021;Smart, Pardo, & Davis, 2021).…”