Impact of policy changes on the provision of naloxone by pharmacies in Ontario Canada: a population-based time series analysis

Background and Aims — In June 2016, the Ontario, Canada government implemented the Ontario Naloxone Program for Pharmacies (ONPP), authorizing pharmacists to provide injectable naloxone kits at no charge to all Ontario residents. In March 2018, the program was amended to include intranasal naloxone and remove the requirement to present a government health card to the dispensing pharmacist. We examined whether these changes increased naloxone dispensing through the ONPP.

Design — Population-based time-series analysis using interventional autoregressive integrated moving average models.

Setting — Ontario, Canada 

Participants — All Ontario residents between July 1, 2016 and March 31, 2020.

Measurements —Monthly rates of pharmacy naloxone dispensing.

Findings — Overall, 199,484 individuals were dispensed a naloxone kit over the study period. In the main analysis, the rate of pharmacy naloxone dispensing increased by 65.1% following program changes (55.6 to 91.8 kits per 100,000 population between February 2018 and May 2018; p = 0.010.01). In subgroup analyses, naloxone dispensing increased among individuals receiving opioid agonist therapy (OAT) (3,374.9 to 7,264.2. kits per 100,000 OAT recipients; p = 0.04), among individuals receiving other prescription opioids (192.8 to 381.8 kits per 100,000 population prescribed opioids; p < 0.01), among individuals with past opioid exposure (134.7 to 205.6 kits per 100,000 population with past opioid exposure; p < 0.01) and in urban centres (56.2 to 91.4 kits per 100,000 population; p < 0.01). We did not observe a clear impact on pharmacy-dispensed naloxone to individuals with no or unknown opioid exposure (34.4 to 39.3 kits per 100,000 population with no/unknown opioid exposure; p = 0.42) and in rural regions (50.4 to 97.2 kits per 100,000 population; p = 0.09).

Conclusions — Changes to the Ontario Naloxone Program for Pharmacies to add intranasal naloxone and remove the requirement to present a government health card appeared to increase pharmacy-based naloxone dispensing uptake in Ontario, Canada, particularly among individuals at high risk of inadvertent opioid overdose.