Increased pharmacist support for outpatient clients that facilitates easier access to Naloxone kits and medication reviews
“We know that this is absolutely a crisis,” says Stephanie Carter, Clinical Director of the Ambulatory Services Acute Care Program. “We wanted to make sure we were providing the most up to date information.”
One key reason for the changes is because CAMH clinicians were starting to see a new category of client - those who were overdosing despite seemingly not using opioids at all. At least not knowingly. They would take a street drug like cocaine, only to learn after overdosing that the drugs were laced with Fentanyl. “The landscape has changed so much, so quickly,” says Advance Practice Clinical Leader (Pharmacist) Maria Zhang. “The advent of clandestine labs that manufacture very potent drugs that seem to come out of nowhere. The competition between dealers and suppliers to produce the next best thing, puts everyone at risk.”
“Anyone who is not obtaining their substances from the pharmacy or uses opioids, regardless of their source, is at risk,” says Advance Practice Clinical Leader (Nursing) Alison Watson.
To mitigate those risks, a key tool in overdose prevention, Naloxone, is being made more widely available and is a central plank in CAMH’s Opioid Overdose Prevention Strategy.
“We want to make Naloxone kits more easily available to anyone who wants it and proactively offer it to anyone who could benefit from one,” says Zhang. “We want to shift the tide because there are so many people who would benefit from having a Naloxone kit who don’t have one. The idea that Naloxone is just for quote unquote junkies is a message that needs to change.”
The goal is to make Naloxone as stigma-free as an Epipen, and a standard part of anyone’s first aid kit, whether they use street drugs or take prescription opioids as directed by their doctor.
In order to reduce the stigma around Naloxone, a dedicated CAMH pharmacist will distribute Naloxone kits directly to clients and family members at treatment groups and dedicated Naloxone Drop-In sessions, in addition to referring clients to the outpatient pharmacy. Zhang believes that making a pharmacist a core part of the overdose treatment team will improve outcomes.
“Traditionally I don’t think people perceived pharmacists as harm reduction experts or even practitioners. However, if you think of the most accessible health care provider in the community, it’s probably the pharmacist. This gives pharmacists the opportunity and responsibility to tackle the opioid epidemic through a variety of ways, including client and family education and the training and dispensing of naloxone kits.”
Another aspect of the team concept in overdose prevention – the non-judgmental support of family and friends.
“As much as we are focused on our clients, we very much want to reach out to family members and loved ones,” says Watson. “They are the ones who are going to be giving them the Naloxone. Tell someone that you are using. Tell someone where you are going to be. Don’t use alone. This is a relationship-building intervention between our clients, our therapists and the other people in their lives.”
This is the first of several phases of implementation, with plans to expand the strategy to other services which will include the Emergency Department in the months ahead.
Centre for Addiction and Mental Health
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