Tony Antoniou1,2,3,4, Diana Martins1, Tonya Campbell2, Mina Tadrous2,5,6, Charlotte Munro7, Pamela Leece8, Muhammad Mamdani1,2,6,9,10, David N Juurlink2,4,6,10,11, Tara Gomes1,2,6,9. 1. Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada. 2. ICES, Toronto, Ontario, Canada. 3. Department of Family and Community Medicine, Unity Health, Toronto, Ontario, Canada. 4. Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada. 5. Women's College Hospital, Toronto, Ontario, Canada. 6. Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada. 7. Ontario Drug Policy Research Network Lived Experience Advisory Group, Toronto, Ontario, Canada. 8. Public Health Ontario, Toronto, Ontario, Canada. 9. Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada. 10. Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 11. The Sunnybrook Research Institute, Toronto, Canada.
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.
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.
Authors: Kristin K Clemens; Alexandra M Ouédraogo; Britney Le; James Voogt; Melissa MacDonald; Rebecca Stranberg; Justin W Yan; E Scott Krayenhoff; Jason Gilliland; Cheryl Forchuk; Rafique Van Uum; Salimah Z Shariff Journal: Can J Public Health Date: 2022-08-18
Authors: Tara Gomes; Gillian Kolla; Daniel McCormack; Andrea Sereda; Sophie Kitchen; Tony Antoniou Journal: CMAJ Date: 2022-09-19 Impact factor: 16.859