Ontario's move to expand access to naloxone through pharmacies appears to have worked.
A new <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/add.15324?ct=t%28naloxone-distribution_COPY_01%29" target="_blank" rel="noopener noreferrer">study</a> from the Ontario Drug Policy Research Network (ODPRN) evaluated the province's program to distribute naloxone kits, which can reverse opioid overdoses, free of charge through pharmacies.
The Ontario Naloxone Program for Pharmacies started in 2016 to expand access to the lifesaving drug from community-based programs targeting people who use drugs, to pharmacies and the general public. It was updated in March 2018, in the final months of the Liberal government, to add intranasal naloxone, as opposed to the injectable version, and to allow Ontarians to get a kit without presenting a health card.
Pharmacies gave out 65 per cent more kits in the months immediately following the 2018 changes, the study found. The nasal version of the drug made up 73 per cent of all kits dispensed by March 2020.
"Target populations" immediately started receiving more kits after the 2018 changes.
There was a 115 per cent increase in kits received by people undergoing opioid agonist therapy, which involves taking drugs like methadone or Suboxone to reduce cravings. People receiving prescription opioids saw a 98 per cent increase. And people with prior opioid exposure saw a 53 per cent bump in naloxone kits received, the study found.
There was "no significant change," however, in the number of kits received by people with no or unknown exposure to opioids, who made up 57 per cent of total recipients during the study period.
"That was a little surprising," said study author Tara Gomes, the ODPRN's principal investigator. She said she thought the nasal form of the drug would make it more appealing to the general public — but she noted that people who use opioids are likely more plugged into the changes, and so may have acted quicker.
What's important is that most of the kits are still going to people who are "likely bystanders, or family members, or friends of people, who want to be able to intervene if there's an overdose," Gomes said.
In total, 199,484 people received a naloxone kit in the four years the program has been running. Pharmacies dispensed 112 kits per 100,000 people, as opposed to two kits before the program.
Still, nearly two-thirds of kits — 63 per cent — were given to people who presented a government health card, meaning they were likely asked by the pharmacist.
That's an issue, as there's still significant stigma around drug use, Gomes said.
Requesting a naloxone kit can be seen as an "admission of incorrect use or inappropriate use of your medication," she said, which can be a "huge barrier to people requesting this in the pharmacy."
"But we've continued to hear from people we work with that health cards are demanded by some pharmacists, and they say they can only dispense it if the person presents a health card. And that's just simply not the case anymore," she said.
She thanked the Ontario College of Pharmacists for sending out a reminder that health cards are no longer required.
<blockquote class="twitter-tweet" data-width="500" data-dnt="true">
Thank you <a href="https://twitter.com/OCPInfo?ref_src=twsrc%5Etfw">@OCPInfo</a> for sending out this reminder to <a href="https://twitter.com/hashtag/pharmacists?src=hash&amp;ref_src=twsrc%5Etfw">#pharmacists</a> that health cards are NOT required when dispensing naloxone. Please spread the word to reduce barriers to pharmacy-dispensed <a href="https://twitter.com/hashtag/naloxone?src=hash&amp;ref_src=twsrc%5Etfw">#naloxone</a>!<a href="https://t.co/X7oAwZTZBx">https://t.co/X7oAwZTZBx</a>
&mdash; Tara Gomes (@Tara_Gomes) <a href="https://twitter.com/Tara_Gomes/status/1334232423912058880?ref_src=twsrc%5Etfw">December 2, 2020</a></blockquote>
<script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script>
<a href="https://www.qpbriefing.com/2020/06/23/as-overdose-deaths-spike-ontarios-top-doctor-says-the-opioid-crisis-is-complicated-advocates-disagree/" target="_blank" rel="noopener noreferrer">The opioid crisis has ravaged the province</a>, and has only gotten worse during the COVID-19 pandemic. Ontario shot past British Columbia in overdose deaths last year for the first time since statistics started being recorded, and is on track to do so again in 2020.
A report released in November found <a href="https://www.qpbriefing.com/2020/11/10/no-correspondence-between-health-minister-and-top-officials-on-opioids-crisis-this-year-document-request/" target="_blank" rel="noopener noreferrer">overdose deaths jumped by 38 per cent</a> in the first three-and-a-half months of the pandemic, potentially due to more people using alone, a lack of access to normal supports, and a more toxic supply.
It's impossible to put a number on how many lives the program may have saved, but anecdotally, people are using the kits, Gomes said.
"When you speak with people who work in harm reduction and who work within the community, there are many, many examples of people using this tool to reverse overdoses," she said, noting that overdoses can happen anywhere — someone might accidentally take too much medication, or a child may get into a cabinet they weren't supposed to.
Liberal health critic John Fraser touted the program, saying the Liberals "listened to public health experts and expanded access to life-saving naloxone kits by making them available in pharmacies. This report proves that it was the right course of action that helped save lives."
This study is one in a series of papers examining the province's pharmacy naloxone program, Gomes said. The next one will focus on interviews with people who got kits through the program about their experiences.
Gomes said most pharmacists are on board with the program, and now the focus must shift to ending the stigma.
"We really need people to just normalize this a little bit. Have it in their pharmacies, provide it to people, suggest it to people who they might think could benefit from having a naloxone kit, and explain to them why having this can be a safe choice for them," she said.
"I think the government's done a great job making these available free of charge in pharmacies, and now what we need to do is make sure that we aren't creating barriers that shouldn't be there in the first place."

Changes to expand naloxone access through pharmacies worked, study finds

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