The Discovery Pharmacy at the University of Toronto’s Leslie Dan Faculty of Pharmacy is now piloting naloxone training for select offices and programs at the university.
A fast-acting and potentially life-saving medication, naloxone can be used to counter the effects of an opioid overdose the moment it is occurring. Much like an EpiPen is used to treat anaphylaxis, naloxone can be used by anyone with access to a kit and proper training.
“Providing naloxone kits and training is one way to help support the safety of our community and to help combat the effects of the ongoing opioid crisis,” said Jonathan Nhan, interim pharmacist lead at the Discovery Pharmacy.
In 2016, in response to the growing opioid crisis, naloxone kits became available without the need for a prescription nationally and free of charge in Ontario through the Ontario Naloxone Program and the Ontario Naloxone Program for Pharmacists. Since then, pharmacists have played a key role in dispensing take-home naloxone kits, a service that is coupled with one-on-one training and harm reduction counselling.
Maria Zhang, clinician educator at the Leslie Dan Faculty of Pharmacy and the Centre for Addiction and Mental Health (CAMH), has been working alongside Nhan to develop the Discovery Pharmacy naloxone program. The team of pharmacists and pharmacy students will be using resources originally developed by CAMH to deliver training at both the individual and group levels.
“We want to reduce the harms associated with drug use,” said Zhang, pointing out that many people can be exposed to opioids through different means. “Opioid poisoning can result from prescription opioid use as well as from taking recreational drugs that contain opioids – known or unknown – to the person taking them.”
Both Zhang and Nhan emphasize that maintaining individual privacy and reducing stigma associated with drug use are key to improving access to life-saving interventions. “Even if someone is interested in just learning more about the take-home kits, they can reach us at Discovery Pharmacy to ask questions,” said Nhan.
Stigma surrounding drug use can be a barrier to people accessing tools like naloxone – an issue the group training sessions aim to address.
The onset of the COVID-19 pandemic has exacerbated the opioid crisis. A September 2021 report from Ontario’s COVID-19 science advisory table outlined opioid overdose deaths increased by 60 per cent since the pandemic started in March 2020. Several subpopulations including men and individuals aged 20 to 49 are disproportionally impacted.
“We know that drug use can happen … and in isolation now more than ever. We want to contribute to the solutions addressing the opioid crisis with this service,” said Zhang.
In addition to the direct care delivery of providing naloxone kits and training, the Discovery Pharmacy program layers in the interprofessional education of health-care students, research and quality improvement.
“As an accredited pharmacy embedded in the U of T ecosystem, we aim to advance pharmacy practice and offer interprofessional care to our community,” said Zhang. “We also plan to interlay research and education and collaborate with other disciplines to see how we can better deliver our naloxone training, reach more people and destigmatize substance use so that those who require help don’t hesitate in getting it.”
Students and faculty from the Lawrence S. Bloomberg Faculty of Nursing will also play an active role in naloxone training and education through the Discovery Pharmacy. This provides a tangible opportunity for students to develop skills in interprofessional practice.
“For the most part, students across our health faculties learn within their respective fields. We talk about interprofessional practice in theory but often the first time a nursing student is exposed to it is when they are in hospital on clinical rotation,” said Sarah Ibrahim, assistant professor, teaching stream at the Lawrence S. Bloomberg Faculty of Nursing. “The more our students have the opportunity to gain interprofessional experience, the better equipped they will be once they are ready to enter practice.”
Nursing students will take initial training alongside pharmacy students and then will be paired up to provide peer-to-peer training. “This is a great way for students to come together to build that interprofessional partnership and rapport and carry this over as health-care providers,” said Ibrahim, who points out the need for health-care students to learn about harm reduction and the negative impact of stigma. “Stigma of drug use is a barrier for people accessing care and if, as a health-care provider, you don’t have the skills to provide care in this context, that’s also a barrier.”