Opioid Use Support
As medication experts and accessible care providers, pharmacists have a key role in managing opioid use. Pharmacists can ensure appropriate opioid therapies, support patients experiencing opioid-related harms, and help protect their communities.
What are Opioids?
Opioids are a class of medications that relieve pain. They can be made from the poppy plant or synthesized in a laboratory. Common opioids include morphine, hydromorphone, codeine, oxycodone, fentanyl, tramadol, buprenorphine, and methadone. These drugs may also be called by their brand names: Kadian, Dilaudid, OxyContin, Percocet, Tylenol #3, Vicodin, and the like. Opioids also have many unofficial names, sometimes referred to as “street names,” which vary by the context and specific drug.
When opioids are taken orally, smoked, or injected, they travel through the blood to reach the brain. Here, they are very effective at decreasing feelings of pain, making them an important treatment option for conditions like cancer pain, palliative care, surgical pain, and chronic pain. However, opioids also create feelings of pleasure in the brain, which may be sought as a type of intoxication or “high.” This pleasure may motivate people to misuse opioids.
Appropriate Opioid Use
Opioids are important medications for many Canadians living with pain. To ensure that prescribed opioid medicines are effective and used safely, it is important to follow the direction of your pharmacist and other health care professionals. Responsible opioid use includes:
- Taking opioids as prescribed—avoid taking extra doses, doses larger then intended, or using opioids for longer than intended
- Adding non-drug pain management techniques, like physical therapy, heat and cold therapy, mental health strategies, and massage
- Informing all your health care providers when you are taking opioids, especially if you receive a prescription from a new prescriber
- Telling your health care providers about other treatments and substances you use, including herbal supplements and cannabis
- Notifying health professionals if you are pregnant or planning to become pregnant
- Getting help from your friends, family, and health professionals
It is also important to remember the following:
- Do not stop taking opioids on your own—talk to your health care providers first
- Do not use recreational substances like alcohol when taking opioid medications
- Do not sell or give away prescribed opioids—return expired or unused medications to a pharmacy for safe disposal
Opioid Use Disorder
Opioid use disorder refers to a medical condition wherein individuals experience dependence and addiction to opioids. Individuals living with opioid use disorder continue to use opioids even though it causes harm to themselves or others. Opioid use disorder can involve the misuse of prescribed opioid medicines, the use of diverted opioid medicines, and the use of illicitly obtained, unregulated opioid substances.
Risk Factors for Opioid Use Disorder
The risk of developing an opioid use disorder is reduced by having adequate social and health supports. Risk factors for opioid misuse include:
- Personal or family history of substance misuse
- Poverty and unemployment
- Environmental influences, like substance use among peers
- Untreated mental health conditions, like depression and anxiety
- Stressful life circumstances
Developing a strong community support network is important for preventing opioid misuse; friends, family, and health care professionals have a key role. Your pharmacist can support appropriate opioid therapy to prevent and manage misuse.
Opioid Overdose
In addition to their pain relief and pleasurable effects, opioids also act on the part of the brain that controls breathing. If someone takes too much opioid, their breathing will slow down too much—which can be deadly. This is called opioid overdose. Signs of an opioid overdose include:
- Slow, weak, or no breathing
- Choking, gurgling, or snoring sounds
- Dizziness and confusion
- Difficulty walking, talking, or staying awake
- Inability to wake up, even when physically stimulated or shouted at
- Blue lips or fingertips
- Eyes that have very small pupils
- Cold and clammy skin
The risk of overdosing on opioids is higher when they are used with other substances, like alcohol and benzodiazepines. Illicit and unregulated substances may be contaminated with opioids, like fentanyl, which can also cause overdoses.
Remember, anyone taking high doses of opioids can experience an overdose—not just individuals with an opioid use disorder. For example, accidental ingestion of prescribed opioids by young children can cause an overdose.
Responding to an Opioid Overdose
To respond to an overdose, follow the SAVEME steps:
- Stimulate the individual. Can you wake them up? If they are unresponsive, call 911.
- Airway: make sure there is nothing blocking the airway or stopping the person from breathing. Remove anything that is blocking the airway.
- Ventilate: help them breath. Plug the individual’s nose, tilt back their head, and give one rescue breath every 5 seconds.
- Evaluate: has the person started to breathe on their own? If not, prepare the naloxone.
- Medication: administer one dose of naloxone. Continue to give breaths until the person is breathing on their own.
- Evaluate: is a second dose needed? If they do not respond after 3-5 minutes, give another dose of naloxone.
It is essential for you to stay with the person experiencing the overdose until help arrives. The Good Samaritan Drug Overdose Act protects you from simple drug possession charges when seeking help for an overdose. If the person must be left unattended at any time, put them into the recovery position.
For free training in responding to an opioid overdose and administering naloxone, visit Toward the Heart for a 15-25 minute interactive lesson.
What is Naloxone?
Naloxone is a fast-acting opioid antidote that is used to treat opioid overdose. It can restore breathing within 2 to 5 minutes and save the overdosing individual’s life. However, naloxone only works temporarily; the effects wear off after 20 to 90 minutes, so the overdose may return and cause the person to stop breathing again. It is essential to first call 911, give naloxone, and then remain with the person until help arrives. Depending on the type of opioid, how much opioid was taken, and how it was taken (for example: oral, injection, smoked), multiple doses of naloxone may be needed to reverse the overdose.
Naloxone is safe for all ages and only has an effect if opioids are in the person’s system. It has no effect on alcohol or non-opioid drugs. You cannot use naloxone improperly and it does not cause dependence or addiction.
In Canada, there are two types of naloxone: a nasal spray and injectable naloxone. Naloxone nasal spray is sprayed directly into the nose, where it is absorbed. Injectable naloxone is injected into any muscle, often in the arm or thigh. Both types of naloxone begin working in 2 to 3 minutes.
Accessing Naloxone
In Saskatchewan, naloxone is available without a prescription and may be purchased from pharmacies. The PAS Naloxone Registry lists the pharmacies in the province that carry naloxone for patient access. Naloxone is also available for free to the public through provincial and federal government programs:
Saskatchewan Take Home Naloxone Program
Saskatchewan residents who are at risk of an opioid overdose and/or might witness an opioid overdose, such as friends and family of people who use opioids, are eligible for free training and a free Take Home Naloxone kit. These naloxone kits contain the injectable type of naloxone. The included training covers overdose prevention, recognition, and response, including how to administer naloxone. Kits and training are available at participating pharmacies, clinics, and other sites. To locate a site in your area, visit the Take Home Naloxone Program webpage.
Federal Coverage for Clients with Non-Insured Health Benefits (NIHB)
The Federal government funds free naloxone access for individuals with NIHB coverage at community pharmacies. For the list of pharmacies that offer naloxone, access the PAS Naloxone Registry. Clients with NIHB coverage can visit one of these pharmacies to receive injection or nasal spray naloxone without charge. NIHB coverage supports:
- Naloxone 0.4mg/mL one mL injection
- Naloxone 1mg/mL one or two mL injection
- Naloxone injection kits
- Naloxone nasal spray
- Naloxone nasal spray kits
Who Should Receive a Naloxone Kit and Training?
Any Saskatchewan residents who are at risk of an opioid overdose themself or may witness an opioid overdose are eligible for free training and a free naloxone kit under the provincial Take Home Naloxone Kit Program. Such circumstances include:
- People using prescribed opioids for purposes like palliative care, cancer pain, surgical pain, and chronic pain management
- Those with a risk of accidental opioid ingestion—like children accessing medications of parents or other family members
- Instances of diversion and misuse of prescribed opioids—like young adults experimenting with medications in the household
- Individuals using illicit, unregulated substances—including opioids and substances which may be contaminated by opioids (like stimulants and hallucinogens)
- Friends and family of people taking opioids either recreationally or under medical supervision
- Community settings where substance use is common—like parties, sporting events, and concerts
Anyone interested in becoming trained in overdose response can visit Toward the Heart for free training. Like first aid, overdose response and naloxone training are important components of emergency preparedness.
Harm Reduction
Harm reduction describes practices that reduce the negative outcomes of high-risk behaviours, like substance use. Harm reduction services reduce the associated negative effects without requiring people to stop the risky behaviour completely. Examples of harm reduction for substance use include:
- Impaired driver prevention programs to raise awareness of the risks of driving under the influence of substances
- Take home naloxone kit programs
- Supervised consumption sites
- Drug checking programs for substance contamination
- Opioid agonist therapy (also called opioid replacement or substitution programs)
Harm reduction services have benefits to the individuals who use substances, their friends and families, and their communities:
- Increase referrals to support programs, health care, and social services
- Reduce sharing of substance use equipment
- Decrease transmission of hepatitis and HIV
- Reduce overdose deaths
Opioid Agonist Therapy
Opioid agonist therapy, also called opioid substitution or replacement therapy, is an effective treatment for opioid use disorder. It involves replacing the opioid an individual is currently using with a long-acting opioid agonist, either methadone or buprenorphine (Suboxone brand name). These medications work to prevent withdrawal and decrease cravings for opioids. Opioid agonist therapy can help individuals stabilize their lives and reduce the harms related to their substance use. Community pharmacies can dispense medications for opioid agonist therapy.
Resources
To learn more, explore the included resources below:
Toward the Heart
Quick Learn: Naloxone Administration and Overdose Response
Government of Saskatchewan
Take Home Naloxone Program Locations
Alcohol and Drug Services
National Overdose Response Service
Call or text 1-888-NORS (6677)
RxFiles
Questions about Opioids and the Answers that May Surprise You
Questions about Medication for Opioid Use Disorder and the Answers that May Surprise You
Centre for Addiction and Mental Health (CAMH)
Making the Choice, Making it Work: Treatment for Opioid Addiction