Pharmacists can be key supports in the opioid crisis

Canada is experiencing a disturbing surge in opioid-related deaths during the pandemic. Pharmacists are often among the first to experience their patients’ health problems. As the Canadian Pharmacists Association has stated:

Pharmacists across the country are on the front line of dealing with opioid misuse and are often the first health care providers to notice a prescription drug problem in a patient. The Canadian Pharmacists Association (CPhA) is deeply concerned about the growing crisis of opioid misuse in Canada and is committed to providing national leadership on this important issue. CPhA believes that tackling the opioid crisis will require a multipronged approach with engagement of a cross section of stakeholders, including pharmacy.  This includes a focus on:

• Addressing the root causes of opioid abuse
• Decreasing the inappropriate use of opioids
• Control and monitoring
• Supporting harm reduction strategies to assist those with addiction

Craig Plain Bsc.Phm. is a pharmacist who has experienced the opioid crisis first-hand.

As a pharmacist serving Vancouver’s Downtown Eastside community, I’ve seen first-hand the devastating impact of the opioid crisis and COVID-19 converging. The dire situation across many parts of the country is very real.

The B.C. Government has taken many positive steps – safe supply has made a difference.  Word of mouth among my patients has been that the illicit supply over the last several months is especially risky and I could see the relief in my patients when the program was implemented. The need for safe supply is not going away and I sincerely hope it continues after COVID-19.

Yet despite the steps provincial governments are taking, people are still dying at record rates during the pandemic. We can’t leave any solutions on the table.

Opioid poisonings can affect people in all communities. While there are major concerns with the illicit supply, especially right now, a significant number of opioid poisoning deaths involve prescription opioids. Pharmacists have a responsibility to co-dispense naloxone with all opioid prescriptions. It is hard to be sure if there is someone in a patient’s household who could consume the prescription or if they are obtaining additional opioids elsewhere.  When it comes to saving a life with naloxone it is important to play it safe. We must take the time to educate individuals on why they should have it on hand, whether they acknowledge the risk or not. We also need to ensure we’re offering training so they feel comfortable administering it properly.

Another solution not often discussed is increasing access to nasal spray naloxone, Narcan.  While the injectable form is widely available in pharmacy, the easy-to-use nasal spray form is not funded for the public in provinces like B.C. or Alberta where the opioid crisis is hitting hardest.  Nasal spray naloxone is available to certain groups in these provinces, like RCMP officers, and to First Nations and Inuit nationally through the non-insured health benefits (NIHB) program. And yet the broader public does not have access through pharmacy. The fact that nasal naloxone offers a more robust dose compared to injectable naloxone, means it’s especially important right now to help manage all the potent synthetics we are seeing.

A 2019 BC Centre for Disease Control (BCCDC) report acknowledged the injectable form is a barrier and I see it regularly. Many individuals are afraid of using a needle or take a long time struggling to administer it properly.  And with dangerous synthetics like fentanyl becoming more common it can take multiple injections to reverse an overdose. The BCCDC report recommended making nasal naloxone available to the public in pharmacy to improve the current B.C. Take Home Naloxone program. It also highlighted that 58 per cent of people who picked up a naloxone kit from a pharmacy did so for someone else, which speaks to the importance of family and friends having easy access to a kit to revive a loved one.

The City of Burnaby recently announced a pilot project to make the nasal spray available in libraries and community centres. It is time provincial governments like B.C. and Alberta fund it for all. Wider access means more lives saved.

Craig Plain Bsc.Phm., is pharmacy manager, Pier Health Resource Centre, Vancouver