Environmental Scan Naloxone Access and Distribution in Canada Moustaqim-Barrette, Amina; Elton-Marshall, Tara; Leece, Pamela; Morissette, Carole; Rittenbach, Katherine; Buxton, Jane A.
In response to an epidemic of opioid overdose deaths attributed to prescription and illicit opioid use, distribution of the opioid antagonist naloxone has been identified in Canada and abroad as a key emergency measure to effectively prevent rising mortality (1,2). The current environmental scan was produced in order to better understand current practices and programs aimed to distribute naloxone for use in suspected opioid overdose, to assess uptake of these programs across Canadian provinces and territories (P/Ts), and to understand barriers related to knowledge and evidence in the use of naloxone, as well as operational obstacles to achieving widespread population coverage. Publicly funded take-home naloxone (THN) programs have been rolled out across every province and territory in Canada in response to the current opioid crisis. All publicly funded THN programs offer naloxone free of charge to those at risk of opioid overdose, while the majority of these programs also target any person who self-identifies as being at risk of witnessing an opioid overdose (including friends or family of people who use drugs). All provinces offer kits with the injectable formulation of naloxone as part of their publicly-funded program, while three P/Ts (Ontario, Quebec, and the Northwest Territories) also offer the nasal naloxone spray. Nasal naloxone spray is also available to clients of Veterans Affairs Canada, and through the NonInsured Health Benefits (NIHB) Program (benefits for First Nations individuals who present a valid status card and personal health number to confirm their eligibility). In most P/Ts, naloxone is made available through a number of different sites and organisations, including community pharmacies, shelters, medical centres, and treatment service centres, although some jurisdictions are limited in their ability to distribute naloxone due to geographical considerations and regulations related to provincial drug scheduling. While population access to naloxone has improved substantially across the country, there remain some jurisdiction-specific operational, geographic, knowledge/evidence, and policy barriers to access. Importantly, there are several unanswered questions regarding the safety and effectiveness of different naloxone routes of administration, dosing, and the extent of training needed to effectively respond to an overdose and administer naloxone. Evidence regarding the benefit of distributing naloxone broadly (as opposed to only specific at-risk populations) is needed. There are also ethical considerations including how to collect robust health data while protecting low-barrier access environments and respecting patient anonymity, and whether it is appropriate to provide naloxone kits to minors. Additional considerations include identifying the most effective overdose response strategy more generally (outlining actions to take beyond administering naloxone, such as chest compressions, rescue breaths, calling 911, etc., and the order to take them in), as well as in the development of program evaluation practices and performance indicators. Consolidating existing evidence, suggesting areas for future research, and building consensus among stakeholders may help improve naloxone access and ensure equitable outcomes in Canada. Finally, there is continued recognition of the complex social, political, and legal solutions needed to address the state of the opioid crisis in Canada, as well as for the need to address continued stigma around drug use, integrate harm reduction practices, and support a holistic model of care in order to best confront the upstream factors leading to overdose, addiction, and substance use.
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