45 www.rnca.ca Royal Newfoundland Constabulary Association NALOXONE continued Naloxone Nasal Spray On June 20, 2017, Health Canada announced that the Canadian authorized version of Narcan would transition onto the market by July 5, 2017. Narcan does not require a prescription and is indicated for emergency to reverse known or suspected opioid overdose. Cost to Patients Individuals who receive health coverage through First Nations Inuit Health under the Non-Insured Health Benefits (NIHB) Program are eligible to receive naloxone for free through pharmacies or other providers across Canada.Where pharmacies provide ancillary supplies to support safe naloxone administration and overdose management, providers can claim the cost of the naloxone and ancillary supplies as a naloxone kit. Pharmacies that participate in THN programs must distribute naloxone kits free of charge to patients, however, eligibility requirements apply to all THN programs. Where there is no public funding for naloxone, the cost to patients — either for injectable or inhaled format — varies greatly between provinces and pharmacies. News sources have described the nasal spray as costing as much as $125-$145 for two single-use doses. The injectable form is less expensive, with some sources reporting $5-$20 per dose or ampule, or $30-$70 for a complete naloxone kit. Naloxone Availably in Newfoundland and Labrador On August 22, 2016, Naloxone injection is moved to Schedule II status when indicated for emergency use for opioid overdose outside hospital settings. Naloxone becomes available in community pharmacies without a prescription. Publicly-fundedTake-Home Naloxone (THN) Program According to the Health Canada Joint Statement on Action toAddress Opioid Crisis, the Newfoundland and Labrador health authorities have committed to implementing a provincial THN kit program to increase capacity for opioid overdose response. As of January 2017, free naloxone kits are being distributed to target populations by the regional health authorities and the SafeWorks Access Program (SWAP). Purchasing Naloxone in Pharmacy Patients may purchase naloxone though retail pharmacies. Patient Assessment and Education Pharmacists should consider whether or not the sale of naloxone injection is appropriate based on a patient’s history of opioid use, past naloxone use, allergies and/or sensitivities, and pregnancy and lactation status. Pharmacists are expected to provide counselling prior to each and every sale of a naloxone kit.This interaction will allow the pharmacist to review important education and training points and allow the purchaser the opportunity to ask questions and discuss concerns. In the case of the naloxone injection, counselling should include the following: • a review of the contents of the naloxone injection kit; • how to identify an opioid overdose; • the importance of rescue breathing; • when to administer naloxone; • how to prepare the dose for administration by withdrawing the dose of naloxone from the ampoule/vial into the syringe; • how to landmark the thigh and administer an intra-muscular injection; • how to avoid and manage needle stick injuries; • when to use the second vial or ampoule of naloxone; • the importance of calling 911 immediately for medical assistance due to the short half-life of the drug; • the need to remain with the victim to provide supportive measures and assess the need for subsequent doses while waiting for emergency first responders to arrive: and • any other information the pharmacist deems relevant to the circumstances. www.pharmacists.ca continued
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