Take-Home Naloxone (Narcan®) Kits: an Accessible Life-Saver for

Opioid Overdose

Prepared by: Jason Yung (APPE Student)September 7, 2016

Learning Objectives

By the end of this presentation, you will be able to:1. Summarize the growing issue of death due to

opioid overdose (OD) in Canada2. Discuss strategies to prevent opioid OD in the

community pharmacy setting3. Identify patients at risk of opioid OD4. Educate individuals and patients at risk of

opioid OD on the appropriate use of naloxone

OPIOID

IN CANADA

Opioid Overdose Statistics in Canada

• Canada: 2nd largest consumer of Rx opioids

• Opioid OD killed ~2500 people in Ontario between 2011-14

• From 2005-06 to 2010-11: ~250% increase in no. of ED visits in Ontario due to narcotic withdrawal, OD, harmful use, etc.

• Deaths by opioids from 2002-14: oxycodone > methadone > morphine > fentanyl >> heroin

Risk Factors for Opioid Overdose

• Patient factors– Loss of tolerance– Comorbidities– Previous OD– Using alone

• Opioid factors– Dose– Potency– Contaminants– Route of administration

Signs of Opioid Overdose

NALOXONE: HARM REDUCTION IN OPIOID USE

Harm Reduction• Aim to decrease the health and socio-

economic consequences of addiction without necessarily reducing drug use

• Giving strategies to prevent harm from use• Does not exclude abstinence as a goal

Naloxone Distribution in 2016• March 22: Naloxone from the

Prescription Drug List• June 29: NAPRA reclassified

naloxone as Schedule II drug (free for eligible Ontarians)

• Late June: small distribution of naloxone kits by the Ministry to methadone and suboxone-dispensing pharmacies

Who should receive Opioid OD Response Education and Naloxone Training?

• Current opioid users or past opioids users who may return to use– Abuse Rx opioids or heroin– Required emergency care for opioid OD– Enrolled in opioid dependence treatment programs (i.e.

methadone, buprenorphine/suboxone)– Released prisoners with hx of opioid dependence/abuse

• Family/friend of someone at risk of opioid OD– Live with or in frequent contact with those listed above

(provide naloxone injection))

Naloxone

• MOA: opioid antagonist with stronger affinity for opioid receptors in brain that control respiration

• IM inj: upper arm, upper leg, or buttock

• NOT for non-opioid overdoses (e.g., cocaine, ecstasy, alcohol, etc.)

Naloxone

Rapid onset (3-5 mins)• If no response to 1st dose, give

another dose

Short duration of action (30-90 mins)• Implications for: large doses of

strong opioids (e.g., fentanyl), long-acting opioids (e.g., methadone)

• MUST call 9-1-1

Naloxone Kit ContentsContents Qty

1mL naloxone HCl ampoules (0.4mg/mL) 2

3mL syringes (with 25G 1-1.5” needles) 2

Ampoule snappers 2

Pair of non-latex gloves 1

Rescue breathing barrier 1

Naloxone identifier card 1

Card: POINT – 5 steps to save a life 1

Protective Case 1

Patient Education – POINT Program

5 Steps to Save a Life (Toronto Public Health)1. Shake (at shoulders) and Shout (their name)2. Call 911 if unresponsive3. Inject 1 ampoule (1mL) of naloxone into arm/leg

muscle4. Chest compressions (or full CPR as trained; optional

breathing barrier)5. Evaluate (if no improvement in 3-5 mins, repeat steps

3&4); Withdrawal symptoms? Recovery position?6. STAY UNTIL EMS ARRIVES – Why?

Why stay until EMS arrives?

• An OD can return (in ~20-30mins)• Ensure person knows not to take more drugs

for several hours• Tell person what happened as they may be

confused• Tell EMS everything you know about the

situation so they can provide the best tx

Tips from Toronto Public Health

• Use buddy system (not alone)• Learn signs of opioid OD• Avoid mixing with other sedating substances

(esp alcohol, heroin and other opioids)• Does it smell/taste/look right?• Test dose: try smoking some before injecting• Get naloxone kit, learn CPR, call 9-1-1

Role of the Pharmacist in Preventing Death from Opioid Overdose

Role of the Pharmacist

• Accessible to the public• >1/2 of those who died from opioid OD filled a

prescription for opioids the month preceding• Dispense naloxone kits free of charge to eligible

patients• Assess patients for (rare) allergies: naloxone,

methylparaben, or propylparaben• Provide patient training– MOHLTC: recommends reviewing OPA’s CCEP-accredited

module on naloxone kits

Summary• Death due to opioid overdose is a significant

public health issue in Canada• Signs of opioid OD may be easily identified• Pharmacist: ideal point of access to provide

education about and dispense naloxone• Upon injecting naloxone to opioid OD’d

individuals, call 9-1-1 and provide chest compressions

References• Canadian Centre on Substance Abuse (CCSA). Canadian Drug Summary:

Prescription Opioids. July 2015.• Fischer, B., & Argento, E. (2012). Prescription opioid related misuse, harms,

diversion and interventions in Canada: A review. Pain Physician, 15, ES191–ES203.

• Ontario College of Pharmacists (OCP). Dispensing or Selling Naloxone: Guidance for pharmacy professionals when dispensing or selling naloxone as a Schedule II drug. Aug 10, 2016.

• Ontario Pharmacists Association (OPA). Naloxone: Frequently Asked Questions. June 17, 2016.

• Toronto Public Health. Prevent Overdose in Toronto (POINT) – 5 Steps to Save a Life.

• Naloxone infographic available online at:https://www.opatoday.com/Media/Default/Tools%20and%20Forms%20-%20Naloxone/Naloxone%20Infographic.pdf