Physi­cian urges broader adop­tion of nalox­one

The Western Star - - Obituaries / Canada - BY CAS­SAN­DRA SZKLARSKI

A prom­i­nent drug safety ex­pert says some peo­ple de­pen­dent on high-dose pre­scrip­tion opi­oids should con­sider hav­ing an­other drug on hand at all times — a nalox­one kit in case of over­dose.

Dr. David Ju­urlink, head of clin­i­cal phar­ma­col­ogy and tox­i­col­ogy at Sun­ny­brook Health Sciences Cen­tre in Toronto, is urg­ing broader adop­tion of the life-sav­ing an­ti­dote more com­monly as­so­ci­ated with the fen­tanyl cri­sis.

“The idea that nalox­one is purely for peo­ple with ad­dic­tion I think is a se­ri­ously mis­guided one. If some­body is on fen­tanyl patches for chronic pain, most of those peo­ple you can make an ar­gu­ment that they should have nalox­one in the house­hold, even if they seem to be func­tion­ing well,” says Ju­urlink.

Even those who fol­low their doc­tor’s or­ders are at risk of be­ing harmed by their med­i­ca­tion, he says, es­pe­cially when the drug is com­bined with seda­tives, sleep­ing pills or anx­i­ety med­i­ca­tion.

“For a pa­tient who’s ever had any­thing re­sem­bling an over­dose or who is fall­ing asleep on their opi­oids or is on high-dose opi­oids, I think it’s a very good idea for that pa­tient and their fam­ily to be aware of the po­ten­tial util­ity of nalox­one and to know how to use it,” he says. “There’s no down­side to hav­ing nalox­one in the home.”

Long­time users of nar­cotics are typ­i­cally on high doses be­cause they’ve be­come tol­er­ant over time. And the higher the dose, the big­ger the risk, says Ju­urlink, adding that some­one pre­scribed just eight pills of Per­co­cet af­ter den­tal surgery prob­a­bly doesn’t need a nalox­one kit.

The life-sav­ing drug is avail­able as a nasal spray or in in­jectable form with­out a pre­scrip­tion. But Ju­urlink says most phar­ma­cies do not carry nalox­one and ac­cess varies across Canada, with con­cen­trated avail­abil­ity in ar­eas known for il­licit in­tra­venous drug use.

It’s tar­geted at peo­ple at risk of an opi­oid over­dose and peo­ple likely to wit­ness and re­spond to an over­dose, such as fam­ily and friends.

Bri­tish Columbia re­mains ground zero for Canada’s opi­oid epi­demic, with the coro­ners ser­vice record­ing 640 il­licit drug over­dose deaths dur­ing the first five months of the year.

Pro­vin­cial health of­fi­cer Dr. Perry Ken­dall says the prov­ince sees about 75 pre­scrip­tion over­dose deaths a year — mostly in­di­vid­u­als us­ing other sub­stances such as al­co­hol and an­tide­pres­sants. But pa­tients of­ten die in their sleep and it can then be dif­fi­cult to de­ter­mine whether over­dose was a fac­tor, Ken­dall adds.

He was cau­tious in call­ing for ex­panded dis­tri­bu­tion of nalox­one.

“These peo­ple are more at risk from (tak­ing mul­ti­ple pre­scrip­tion drugs) or some­times them­selves get­ting di­verted to ad­di­tional drugs or al­co­hol. Or they’re more at risk ... if they’re be­ing with­drawn too quickly,” he says. “The an­swer there is to look to bet­ter pre­scrib­ing.”

Guide­lines pub­lished in the Cana­dian Med­i­cal As­so­ci­a­tion Jour­nal in May say clin­i­cians may pro­vide nalox­one to those at risk of over­dose but that cur­rent “low qual­ity” ev­i­dence doesn’t back sug­ges­tions it would re­duce deaths.

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