The uptake of the pharmacy-dispensed naloxone kit program in Ontario: A population-based study


Autoři: Beatrice Choremis aff001;  Tonya Campbell aff002;  Mina Tadrous aff002;  Diana Martins aff005;  Tony Antoniou aff002;  Tara Gomes aff002
Působiště autorů: Queen’s University, Kingston, Ontario, Canada aff001;  ICES, Toronto, Ontario, Canada aff002;  Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada aff003;  Women’s College Hospital, Toronto, Ontario, Canada aff004;  Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada aff005;  Department of Family and Community Medicine, St. Michael’s Hospital and University of Toronto, Toronto, Ontario, Canada aff006;  Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada aff007
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223589

Souhrn

Background

Naloxone is a life-saving antidote for opioid overdoses. In June 2016, the Ontario government implemented the Ontario Naloxone Program for Pharmacies (ONPP) to enhance access to naloxone.

Objective

We examined the initial uptake of naloxone through the ONPP and characteristics of the individuals receiving and pharmacies dispensing naloxone kits.

Methods

We conducted a population-based study of all Ontario residents who received a naloxone kit between July 1, 2016 and March 31, 2018. This involved 1) a cross-sectional analysis of monthly rates of kits dispensed; and 2) a descriptive analysis of all individuals and pharmacies who accessed and dispensed naloxone, respectively. We stratified individuals according to their opioid exposure as: prescription opioid agonist therapy (OAT) recipients, prescription opioid recipients, those with past opioid exposure and those with no/unknown opioid exposure. We calculated a Lorenz curve comparing the cumulative percent of naloxone-dispensing pharmacies and cumulative percent of naloxone kits dispensed and the corresponding Gini coefficient.

Results

Naloxone dispensing through the ONPP increased considerably from 1.9 to 54.3 kits per 100,000 residents over the study period. In this time, 2,729 community pharmacies dispensed 91,069 kits to 67,910 unique individuals. Uptake was highest among prescription OAT recipients (40.7% of OAT recipients dispensed at least one kit), compared with 1.6% of prescription opioid recipients, 1.0% of those with past opioid exposure and 0.3% with no/unknown opioid exposure. Naloxone dispensing was highly clustered among pharmacies (Gini = 0.78), with 55.6% of Ontario pharmacies dispensing naloxone, and one-third (33.7%) of kits dispensed by the top 1.0% of naloxone-dispensing pharmacies.

Conclusion

The ONPP launch led to a rapid increase in the number of naloxone kits dispensed in Ontario. Although the program successfully engaged people prescribed OAT, efforts to increase uptake among others at risk of opioid overdose appear warranted. Opportunities for expanding pharmacy participation should be identified and pursued.

Klíčová slova:

Critical care and emergency medicine – Death rates – Drug information – Health insurance – Ontario – Opioids – Pharmacists – Public and occupational health


Zdroje

1. Special Advisory Committee on the Epidemic of Opioid Overdoses. National report: Apparent opioid-related deaths in Canada. 2018.

2. Ontario Agency for Health Protection and Promotion. Opioid-related morbidity and mortality Toronto, ON2017 [updated 2018]. Interactive Opioid Tool]. Available from: https://www.publichealthontario.ca/en/dataandanalytics/pages/opioid.aspx.

3. Gomes T, Greaves S, Tadrous M, Mamdani MM, Paterson JM, Juurlink DN. Measuring the Burden of Opioid-related Mortality in Ontario, Canada. 2018;12(5):418–9. doi: 10.1097/adm.0000000000000412 PubMed PMID: 01271255-201810000-00011. 29697503

4. Gomes T, Greaves S, Martins D, Bandola D, Tadrous M, Singh S, et al. Latest Trends in Opioid-Related Deaths in Ontario: 1991 to 2015. Toronto, ON.: 2017.

5. Public Health Ontario. Opioid-related morbidity and mortality in Ontario: Public Health Ontario; 2017 [November 21, 2017]. Available from: https://www.publichealthontario.ca/en/dataandanalytics/pages/opioid.aspx.

6. Leece P, Gassanov M, Hopkins S, Marshall C, Millson P, Shahin R. Process evaluation of the Prevent Overdose in Toronto (POINT) program. 2016. 2016;107(3):7. Epub 2016-10-20. doi: 10.17269/cjph.107.5480 27763835

7. Kerr T, Mitra S, Kennedy MC, McNeil R. Supervised injection facilities in Canada: past, present, and future. Harm reduction journal. 2017;14(1):28-. doi: 10.1186/s12954-017-0154-1 28521829.

8. McDonald R, Strang J. Are take-home naloxone programmes effective? Systematic review utilizing application of the Bradford Hill criteria. Addiction. 2016;111(7):1177–87. Epub 2016/03/31. doi: 10.1111/add.13326 27028542; PubMed Central PMCID: PMC5071734.

9. World Health Organization. Community Management of an Opioid Overdose [Report]. WHO 2014 [cited 2018]. Available from: http://apps.who.int/iris/bitstream/handle/10665/137462/9789241548816_eng.pdf?sequence=1.

10. Tzemis D, Al-Qutub D, Amlani A, Kesselring S, Buxton JA. A quantitative and qualitative evaluation of the British Columbia Take Home Naloxone program. CMAJ open. 2014;2(3):E153. doi: 10.9778/cmajo.20140008 25295235

11. Binswanger IA, Koester S, Mueller SR, Gardner EM, Goddard K, Glanz JM. Overdose Education and Naloxone for Patients Prescribed Opioids in Primary Care: A Qualitative Study of Primary Care Staff. Journal of General Internal Medicine. 2015;30(12):1837–44. doi: 10.1007/s11606-015-3394-3 PubMed PMID: PMC4636555. 26055224

12. Bagley SM, Peterson J, Cheng DM, Jose C, Quinn E, O’Connor PG, et al. Overdose Education and Naloxone Rescue Kits for Family Members of Individuals Who Use Opioids: Characteristics, Motivations, and Naloxone Use. Substance Abuse. 2015;36(2):149–54. doi: 10.1080/08897077.2014.989352 25564892

13. Coffin PO, Sullivan SD. Cost-effectiveness of distributing naloxone to heroin users for lay overdose reversal. Ann Intern Med. 2013;158(1):1–9. Epub 2013/01/02. doi: 10.7326/0003-4819-158-1-201301010-00003 23277895.

14. 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: 2019.

15. Canadian Pharmacists Association. Access to Naloxone Across Canada [Environmental Scan]. Ottawa, ON: Canadian Pharmacists Assocation,; 2017. Available from: https://www.pharmacists.ca/cpha-ca/assets/File/cpha-on-the-issues/Environmental%20Scan%20-%20Access%20to%20Naloxone%20Across%20Canada_Final.pdf

16. Canadian Agency for Drugs and Technologies in Health. Funding and Management of Naloxone Programs in Canada [Environmental Scan]. Ottawa2018. 67:[Available from: https://www.cadth.ca/sites/default/files/pdf/ES0319_funding_and_management_of_naloxone_programs_in_canada.pdf.

17. Levy AR, O'Brien BJ, Sellors C, Grootendorst P, Willison D. Coding accuracy of administrative drug claims in the Ontario Drug Benefit database. Can J Clin Pharmacol. 2003;10(2):67–71. Epub 2003/07/25. 12879144.

18. Wong L, Burden AM, Liu YY, Tadrous M, Pojskic N, Dolovich L, et al. Initial uptake of the Ontario Pharmacy Smoking Cessation Program:Descriptive analysis over 2 years. Canadian Pharmacists Journal / Revue des Pharmaciens du Canada. 2015;148(1):29–40. doi: 10.1177/1715163514562038 26759563

19. Gomes T, Khuu W, Craiovan D, Martins D, Hunt J, Lee K, et al. Comparing the contribution of prescribed opioids to opioid-related hospitalizations across Canada: A multi-jurisdictional cross-sectional study. 2018;191:86–90.

20. Martins D, Khuu W, Tadrous M, Juurlink DN, Mamdani MM, Paterson JM, et al. Impact of delisting high-strength opioid formulations from a public drug benefit formulary on opioid utilization in Ontario, Canada. 0(0). doi: 10.1002/pds.4764

21. Ontario Ministry of Health and Long-Term Care. Narcotics Monitoring System. Available from: http://www.health.gov.on.ca/en/pro/programs/drugs/ons/monitoring_system.aspx.

22. Mamdani M, Sykora K, Li P, Normand S-LT, Streiner DL, Austin PC, et al. Reader's guide to critical appraisal of cohort studies: 2. Assessing potential for confounding. BMJ. 2005;330(7497):960–2. doi: 10.1136/bmj.330.7497.960 15845982

23. Madadi P, Hildebrandt D, Lauwers AE, Koren G. Characteristics of Opioid-Users Whose Death Was Related to Opioid-Toxicity: A Population-Based Study in Ontario, Canada. PLOS ONE. 2013;8(4):e60600. doi: 10.1371/journal.pone.0060600 23577131

24. Gomes T, Mamdani MM, Dhalla IA, Paterson J, Juurlink DN. Opioid dose and drug-related mortality in patients with nonmalignant pain. Archives of Internal Medicine. 2011;171(7):686–91. doi: 10.1001/archinternmed.2011.117 21482846

25. Ontario Drug Policy Research Network. Ontario Prescription Opioid Tool 2018. Available from: http://odprn.ca/ontario-opioid-drug-observatory/ontario-prescription-opioid-tool/.

26. Cressman AM, Mazereeuw G, Guan Q, Jia W, Gomes T, Juurlink DN. Availability of naloxone in Canadian pharmacies:a population-based survey. CMAJ Open. 2017;5(4):E779–e84. Epub 2017/11/10. doi: 10.9778/cmajo.20170123 29117991; PubMed Central PMCID: PMC5741422 of Health and Long-Term Care for research unrelated to the present work.

27. Rosenberg-Yunger ZRS, Ellen M, Mickleborough T. The North American Opioid Experience and the Role of Community Pharmacy. Journal of Public Health Management and Practice. 2018;24(4):301–5. doi: 10.1097/PHH.0000000000000807 PubMed PMID: 00124784-201807000-00002. 29787504

28. Ontario Ministry of Health and Long Term Care: Ontario Public Drugs Program Division. Ontario Naloxone Program for Pharmacies (ONPP) Frequently Asked Questions for Pharmacy Dispensers: Providing Publicly Funded Naloxone Kits and Claim Submission Using the Health Network System 2017. Available from: http://www.health.gov.on.ca/en/pro/programs/drugs/opdp_eo/notices/fq_exec_office_20160817.pdf.

29. Government of Canada. Supervised consumption sites: status of application 2019. Available from: https://www.canada.ca/en/health-canada/services/substance-use/supervised-consumption-sites/status-application.html#app.

30. Ontario Drug Policy Research Network. Naloxone Distribution in Ontario. 2019 April 15, 2019. Report No.

31. Freeman LK, Bourque S, Etches N, Goodison K, O’Gorman C, Rittenbach K, et al. Alberta's provincial take-home naloxone program: A multi-sectoral and multi-jurisdictional response to overdose. 2017. 2017;108(4):5. Epub 2017-11-09. doi: 10.17269/cjph.108.5989 29120311


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PLOS One


2019 Číslo 10