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

Abstract

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.

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

“…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 Subsample taken from distribution data, stratified by eligibility (self-reported risk), from January 2018 to December 2018. � Column percentages A Other genders reported include being a trans, and gender non-conforming B Take-home naloxone kit was replaced due to a previous kit being lost, stolen, confiscated or expired C Other site types include corrections, pharmacy, post-secondary, other (e.g housing sites, treatment centres, non-governmental and peer-led organization)…”

“…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 ].…”

The status of naloxone in community pharmacies across Canada

“…In areas with poor access to naloxone, the perceived OIRD-to-death ratio is much higher, indicating an opportunity for growth and expansion of the free THN program. 12,20 The "standard" form of naloxone available in free THN kits is the injectable form, which is administered intramuscularly. Although injectable naloxone is available in all jurisdictions (except the Northwest Territories) throughout Canada at THN kit distribution sites, this route of administration may act as a barrier for use by the general public.…”

Canadian national consensus guidelines for naloxone prescribing by pharmacists

“…About one-quarter to one-third of opioid-related deaths in Ontario involve prescription opioids. 13,14 In addition, approximately 80% of people assessed at an emergency department for opioid toxicity had received an opioid prescription in the previous 3 years.…”

“…Despite the availability of these kits, naloxone dispensing by pharmacies is highly variable. A population-based study examining the uptake of THN in the Ontario Naloxone Program for Pharmacies in 2017 showed that only 55.6% of community pharmacies dispensed naloxone. 13 However, one-third (33.7%) of those THN kits were dispensed by the top 1% of naloxone-dispensing pharmacies. There was less uptake among prescription opioid recipients and those with past opioid exposure, regardless of their risk of OIRD. Over the 21-month study period, only 3918 of 55,000 (about 7%) of patients receiving high-dose opioids prescriptions ( > 90 mg morphine equivalents per day) were given THN in 2017. …”