Allan Malek
Executive Vice President & Chief Pharmacy Officer, Ontario Pharmacist Association
Mark Barnes
Pharmacist, Ottawa Overdose Prevention & Response Task Force
When we picture an opioid overdose, the first image that comes to mind is often a young recreational user of street drugs. In truth, the highest rates of opioid poisoning hospitalizations in Canada are among those over the age of 65, with many being accidental overdoses of drugs legitimately prescribed for therapeutic use.
“Most Canadians think that opioid users are low-income or homeless people from the inner city or large urban environments,” says pharmacist Mark Barnes of the Ottawa Overdose Prevention and Response Task Force. “But overdoses can happen to anyone who uses or has access to an opioid.”
Allan Malek, Executive Vice President and Chief Pharmacy Officer of the Ontario Pharmacists Association, also attests that this epidemic affects Canadians of all ages and all walks of life. “Every pharmacist working on the front lines has to deal with the opioid crisis,” he says. “We deal with patients who are overdosing from opioids they were prescribed for pain as well as patients who are overdosing from recreational use. In both groups, we see people of all ages, from teenagers to seniors.”
Seniors are the cohort most likely to be prescribed opioids for chronic pain — but the factors that multiply their risk go far beyond that.
Many factors combine to put seniors at risk
Seniors are the cohort most likely to be prescribed opioids for chronic pain — but the factors that multiply their risk go far beyond that. “As we get older, we have more medical issues to deal with, which results in more medication,” says Malek. “As soon as you add opioids to the mix, there are a lot of risks of harmful interactions or other negative consequences. Also, as we get older, our livers and kidneys don’t function as well as they used to, and those organs are responsible for clearing these medications out of our system. So the opioids can build up in the systems until it reaches a point of crisis.”
The nasal spray that can reverse an overdose
To help mitigate this crisis, one of the most important tools available is naloxone, a life-saving drug that can lessen or avert the effects of an opioid overdose. “When we’re dealing with chronic pain and long-term opioid prescriptions, no patient should go home without a naloxone kit,” says Malek. “The big challenge, unfortunately, is convincing seniors to take the kit, because of the stigma. But the kits themselves are free* and the training is very simple, especially for the intranasal NARCAN spray. It’s pretty difficult to get it wrong.”
Though availability varies by province, NARCAN Nasal Spray is freely available at any Ontario pharmacy without a prescription and even without having to show your health card. “We’re thrilled to take an active role in the education of patients and their loved ones,” says Malek. “In many cases, it’s the loved ones who are vital. When someone is in the throes of an overdose, they’re often incapacitated, so it falls to someone else to administer the naloxone.”
The fundamental message, Malek says, is that we do have the tools to fight the opioid crisis, and particularly to stem the tide of preventable overdose deaths in all demographics — but only through education, engagement, and the erosion of stigma. “If we continue to leave this unaddressed, we’re sitting on a powder keg and will continue to see more and more cases of overdoses among seniors,” says Malek. “Seniors don’t necessarily need to be afraid of opioids, but they should talk to their pharmacists and their doctors about how to use them responsibly and know what to do when there’s a problem.”
*NARCAN Nasal Spray is accessible for free in pharmacies in Ontario and Quebec, and for Non-Insured Health Benefits (NIHB) Program clients, and Veterans Affairs Canada (VAC) clients across Canada.
This article was made possible with support from Adapt Pharma Canada Ltd.
