The articles and videos below may inspire you to incorporate small changes into your practice that can help make a difference in the Canadian opioid crisis.
Indications and clinical use: NARCAN® NASAL SPRAY is a pure opioid antagonist indicated for emergency use to reverse known or suspected opioid overdose, as manifested by respiratory and/or severe central nervous system depression.
While prescription opioids offer benefits, they also come with some risks.2 In fact, in Ontario, 53% of patients hospitalized due to opioid-related reasons had an active opioid prescription.9 As the most accessible healthcare professionals in Canada, you can help make a difference.19
The opioid crisis is a complex issue; while illegal drugs have caused many of the opioid-related harms, prescription drugs have also contributed.2 Despite patients intending to take their prescribed medication as instructed, there are a multitude of factors that can contribute to the risk of patients experiencing an overdose.8Read now
Uncovering all the factors that could lead to opioid-induced respiratory depression is difficult which is why anyone using opioids may be at risk of having an accidental opioid poisoning.1Read now
You have the power to help prepare patients in case of an accidental opioid poisoning. Think of take-home naloxone kits as a powerful tool in your toolbox, and explain to patients that it’s analogous to any other emergency device or technique.20Read now
Typically, patient selection guidelines for take-home naloxone kits recommend using key risk factor criteria.1-4 However, risk factor information isn’t always easy to acquire. Patients may not be fully forthcoming about their history, especially considering the stigma associated with opioid use.5Read now
Everyone has bias—including patients and pharmacists.21,22 When it comes to opioid use, we may already have pre-conceived notions about the type of people who are at risk of opioid poisoning.7,20,23 This can have an impact on our conversations.22 Here are some ways to break-free from bias and tackle stigma.
As a pharmacist, you may have seen the impact of the opioid crisis firsthand. By acknowledging the social stigma associated with opioid use, and giving patients a positive experience at the pharmacy, you can help make a real difference.1Watch now
Patients taking fentanyl or fentanyl analogues may be at an increased risk, but patients taking medications containing codeine, on its own or in combination (e.g., acetaminophen/codeine tablets), may also be at risk for an accidental opioid poisoning.24,25Read now
Whether opioids are prescribed to treat chronic or acute pain, there are still risks associated with each treatment plan.3,26 Despite best efforts in educating and counselling patients on opioid use, accidents may still occur.Read now
Communication is key! Keep in mind that some people may have been influenced by the negative connotations that media coverage has given to opioid use.7 Remind your patients that anyone using opioids may be at risk of having an accidental opioid poisoning.1Read now
There are a few key words that come to mind when thinking about opioids: “overdose”, “accident”, “epidemic”, “addiction”, “death”. When talking to patients, your role as a pharmacist is to find a balance between the benefits and risks of prescription opioids, and to help keep the conversation positive.
How do you communicate with patients who may be uncomfortable having a conversation about naloxone over the counter and who may have already been taking opioids without naloxone?Watch now
How do you communicate with elderly patients (and/or their caregivers) who may be apprehensive about taking an opioid?Watch now
How do you communicate with patients who may not be aware of the risks of the medication they are using?Watch now
How do you communicate with a patient who may be uncomfortable and feel judged when offered naloxone?Watch now
Always offer a take-home naloxone kit–available as either a nasal spray, like NARCAN® Nasal Spray, or an injection–to any patient receiving an opioid prescription.1,3
Indications and clinical use:
NARCAN® NASAL SPRAY is a pure opioid antagonist indicated for emergency use to reverse known or suspected opioid overdose, as manifested by respiratory and/or severe central nervous system depression.
NARCAN® NASAL SPRAY can be administered by a bystander (non-health care professional) before emergency medical assistance becomes available, but it is not intended to be a substitute for professional medical care. Emergency medical assistance (calling 911) should be requested immediately when an opioid overdose is suspected, before administering naloxone.
Patients who are hypersensitive to this drug or to any ingredient in the formulation or component of the container.
Serious warnings and precautions:
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Can NARCAN® Nasal Spray be used on pregnant women?
Can NARCAN® Nasal Spray be used on a child?
Can NARCAN® Nasal Spray be used past its expiration date?
What are the withdrawal symptoms that occur when you use NARCAN® Nasal Spray? What should you be prepared for?
How does reimbursement work? Can you give it to someone without ID?
Do you need to call 911 if using NARCAN® Nasal Spray?
How much time between doses does there need to be?
How do you order NARCAN® Nasal Spray kits?
How many NARCAN® Nasal Spray kits can you hand out to a person?
Is one dose of NARCAN® Nasal Spray sufficient to reverse an opioid overdose?
References: 1. Tsuyuki R et al. Canadian national consensus guidelines for naloxone prescribing by pharmacists. Canadian Pharmacists Journal. 2020;153(6):347-351. 2. Government of Canada. Canada’s Opioid Crisis. Available at: https://www.canada.ca/content/dam/hc-sc/documents/services/publications/healthy-living/canada-opioid-crisis.pdf(Open in a new window). Accessed July 27, 2021. 3. Ontario Pharmacists Association. Pharmacist clinical tool for initiating naloxone discussions. Available at: https://opatoday.com/wp-content/uploads/Practice/Tools/Naloxone/Pharmacist-Clinical-Tool-for-Initiating-Naloxone-Discussions.pdf(Open in a new window). Accessed July 27, 2021. 4. Government of Quebec. Risks of opioid overdose. Available at: https://www.quebec.ca/en/health/advice-and-prevention/alcohol-drugs-gambling/risks-of-opioid-use(Open in a new window). Accessed July 27, 2021. 5. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. MMWR Recomm Rep. 2016;65(1):1-50. 6. U.S. Department of Health & Human Services. U.S. surgeon general’s advisory on naloxone and opioid overdose. Available at: https://www.hhs.gov/surgeongeneral/priorities/opioids-and-addiction/naloxone-advisory/index.html(Open in a new window). Accessed July 27, 2021. 7. Dassieu L, Heino A, Develay É, et al. “They think you’re trying to get the drug”: Qualitative investigation of chronic pain patients’ health care experiences during the opioid overdose epidemic in Canada. Canadian Journal of Pain. 2021;5(1):66-80. 8. Government of Canada. Opioid overdose. Available at: https://www.canada.ca/en/health-canada/services/substance-use/problematic-prescription-drug-use/opioids/overdose.html(Open in a new window). Accessed July 27, 2021. 9. Gomes, T et al. Comparing the contribution of prescribed opioids to opioid-related hospitalizations across Canada: A multi-jurisdictional cross-sectional study. Drug and Alcohol Dependence. 2018;191:86-90. 10. NARCAN® Nasal Spray Product Monograph. Emergent BioSolutions Canada Ltd. March 5, 2021. 11. Ministry of Health and Long-Term Care: Ontario Public Drug Programs. Funding of Naloxone Nasal Spray through the ONPP and Updates to the Existing Program. 2018. Available at: http://www.health.gov.on.ca/en/pro/programs/drugs/opdp_eo/notices/exec_office_20180321.pdf(Open in a new window). Accessed July 27, 2021. 12. Quebec: Régie de l’assurance maladie. Programme de gratuité du médicament naloxone et de certaines fournitures. 2017. Available at: https://www.ramq.gouv.qc.ca/SiteCollectionDocuments/professionnels/infolettres/2017/info235-7.pdf(Open in a new window). Accessed July 27, 2021. 13. Government of Canada. Naloxone Nasal Spray now available to First Nations and Inuit through Non-Insured Health Benefits program. Available at: https://www.canada.ca/en/indigenous-services-canada/news/2018/04/naloxone-nasal-spray-now-available-to-first-nations-and-inuit-through-non-insured-health-benefits-program.html(Open in a new window). Accessed July 27, 2021. 14. Veteran Affairs Canada. NARCAN NASAL SPRAY 4MG/0.1ML. Available at: https://www.veterans.gc.ca/eng/financial-support/medical-costs/treatment-benefits/poc10/search/form_detail/02458187(Open in a new window). Accessed July 27, 2021. 15. First Nations Health Authority. Nasal Naloxone Listed as a Health Benefit for First Nations in BC. Available at: https://www.fnha.ca/Documents/FNHA-Nasal-Naloxone-Fact-Sheet.pdf(Open in a new window). Accessed July 27, 2021. 16. Government of Canada. Naloxone. Available at: https://www.canada.ca/en/health-canada/services/substance-use/problematic-prescription-drug-use/opioids/naloxone.html(Open in a new window). Accessed July 27, 2021. 17. Quebec: Régie de l’assurance maladie. Instructions de facturation pour le remboursement du médicament naloxone et de certaines fournitures. 2017. Available at: https://www.ramq.gouv.qc.ca/SiteCollectionDocuments/professionnels/infolettres/2017/info256-7.pdf(Open in a new window). Accessed July 27, 2021. 18. Quebec: Régie de l’assurance maladie. Ajout du vaporisateur nasal NarcanMC et de certaines fournitures au Programme de gratuité du médicament naloxone et de certaines fournitures. 2018. Available at: https://www.ramq.gouv.qc.ca/SiteCollectionDocuments/professionnels/infolettres/2018/info046-8.pdf(Open in a new window). Accessed February 24, 2022. 19. Canadian Pharmacy Association. Pharmacy in Canada. Available at: http://www.pharmacists.ca/cpha-ca/assets/File/pharmacy-in-canada/Pharmacy%20in%20Canada.pdf(Open in a new window). Accessed July 27, 2021. 20. Antoniou T, Pritlove C, Shearer D, et al. A qualitative study of a publicly funded pharmacy-dispensed naloxone program. International Journal of Drug Policy. 2021;92:103146. 21. Steinhauser K. Everyone is a little bit biased. American Bar Association. Available at: https://www.americanbar.org/groups/business_law/publications/blt/2020/04/everyone-is-biased/(Open in a new window). Accessed August 3, 2021 22. FitzGerald C, Hurst S. Implicit bias in healthcare professionals: A systematic review. BMC Medical Ethics. 2017;18(1):19. 23. College of Pharmacists of British Columbia. A Message from Our Board Chair: Understanding How Stigma Can Impact Patient Care. March 23, 2018. Available at: https://www.bcpharmacists.org/readlinks/message-our-board-chair-understanding-how-stigma-can-impact-patient-care(Open in a new window). Accessed July 27, 2021. 24. Public Health Ontario. Opioid Mortality Surveillance Report: Analysis of Opioid-Related Deaths in Ontario July 2017–June 2018. June 2019. Available at: https://www.publichealthontario.ca/-/media/documents/O/2019/opioid-mortality-surveillance-report.pdf(Open in a new window). Accessed July 27, 2021. 25. Healthline. Tylenol with Codeine Overdose. Available at: https://www.healthline.com/health/acetaminophen-and-codeine-overdose(Open in a new window). Accessed July 27, 2021. 26. Mayo Clinic. What are opioids and why are they dangerous? Available at: https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/expert-answers/what-are-opioids/faq-20381270(Open in a new window). Accessed July 27, 2021.
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