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. 2021 Jun;116(6):1514-1520.
doi: 10.1111/add.15324. Epub 2021 Jan 4.

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

Tony Antoniou  1   2   3   4 , Diana Martins  1 , Tonya Campbell  2 , Mina Tadrous  2   5   6 , Charlotte Munro  7 , Pamela Leece  8 , Muhammad Mamdani  1   2   6   9   10 , David N Juurlink  2   4   6   10   11 , Tara Gomes  1   2   6   9
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Impact of policy changes on the provision of naloxone by pharmacies in Ontario, Canada: a population-based time-series analysis

Tony Antoniou et al. Addiction. 2021 Jun.

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.

Keywords: Drug policy; harm reduction; health services research; naloxone; opioid; policy evaluation.

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Figures

Figure 1
Figure 1
Number and percentage of pharmacy‐dispensed naloxone kits in Ontario, stratified according to whether provincial health card provided at time of dispensing. [Colour figure can be viewed at wileyonlinelibrary.com]
Figure 2
Figure 2
Number and rate (per 100 000 population) of pharmacy naloxone distribution in Ontario, July 2016–March 2020. [Colour figure can be viewed at wileyonlinelibrary.com]
Figure 3
Figure 3
Number and rate (per 100 000 population) of pharmacy‐dispensed naloxone distribution in Ontario, stratified by opioid exposure group, July 2016–March 2020. (a) Prescription opioid agonist therapy recipients; (b) prescription opioid recipients; (c) people with past opioid exposure; (d) people with no/unknown opioid exposure. [Colour figure can be viewed at wileyonlinelibrary.com]
Figure 4
Figure 4
Number and rate (per 100 000 population) of pharmacy naloxone distribution in Ontario, by urban and rural region. [Colour figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

References

    1. Centers for Disease Control and Prevention . Provisional Drug Overdose Death Counts. Available at: https://www.cdc.gov/nchs/nvss/vsrr/drug‐overdose‐data.htm (accessed 20 January 2020).
    1. Government of Canada . Apparent Opioid‐Related Deaths: Surveillance of Opioid‐related Harms in Canada. Available at: https://health‐infobase.canada.ca/substance‐related‐harms/opioids/graphs... (accessed 17 August 2020).
    1. Gomes T., Juurlink D. N. Understanding the implications of a shifting opioid landscape in Ontario. Healthcare Q 2019; 22: 6–11. - PubMed
    1. Gomes T., Greaves S., Tadrous M., Mamdani M. M., Paterson J. M., Juurlink D. N. Measuring the burden of opioid‐related mortality in Ontario, Canada. J Addict Med 2018; 12: 418–419. - PMC - PubMed
    1. Ontario Agency for Health Protection and Promotion (Public Health Ontario), Office of the Chief Coroner Ontario Forensic Pathology Service, Ontario Drug Policy Research Network . Opioid mortality surveillance report: analysis of opioid‐related deaths in Ontario July 2017–June 2018. Toronto, Ontario: Public Health Ontario; 2019.

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