Let’s talk about prescription opioids: Starting the conversation with your patients

Sponsored content from Emergent BioSolutions Canada Pain takes many forms: it can be acute (e.g., due to surgical procedures), or chronic (e.g., associated with conditions requiring long-term therapy).1 When talking to your patients, since every patient is different, try to first understand how they are feeling so you can adapt your discourse to their situation:2-4 Some patients may feel uncomfortable or scared of the fact that opioids are being introduced into their treatment plan. Discuss the side effects but try to balance them with the benefits they will experience. Explain the risks of accidental poisoning, as well as the role of naloxone for emergency use to reverse a known or suspected opioid overdose.4-6 Ask open-ended questions that allow you to assess a patient’s responsiveness in a busy pharmacy environment: e.g., How do you feel about taking this medication? 3 Frame risks in a way that is understandable using analogies: e.g., Think of it like having a fire extinguisher in the kitchen. You hope you don’t need it, but you are prepared if you do.2,6,7 A study conducted in the United States showed that many patients were not aware their medication was an opioid.8 Ensure your patient understands their prescription; define, in patient-friendly language, what opioids do to the human body and their potential risks.4,5 Anticipate how to deal with a hostile response: e.g., I’m not an addict. Is that what you see me as after coming to your pharmacy for 5 years? Give me a break! 3 Put their worries to rest by reassuring them that it is a standard step in your pharmacy to offer a take-home naloxone kit to ALL patients receiving an opioid prescription.5 Explain that they always have a right to refuse.6 Communication is key! Keep in mind that some people may have been influenced by the negative connotations that media coverage has given to opioid use.9 Remind your patients that anyone using opioids may be at risk for an accidental poisoning.5 “What I often find, and what I am guilty of too, is just assuming that the doctor is covering it (risks of opioids), but I don't know that that's actually the case.” 8 —Community Pharmacist Your patients are counting on you! At the same time, they don’t know what they don’t know! Talk to them about accidental opioid overdose and offer NARCAN® Nasal Spray with every opioid prescription. Safety information10 Indications and clinical use: NARCAN® NASAL SPRAY is a pure opioid antagonist indicated for emergency use to reverse known or suspected opioid overdose, as manifested by respiratory and/or severe central nervous system depression. NARCAN® NASAL SPRAY can be administered by a bystander (non-health care professional) before emergency medical assistance becomes available, but it is not intended to be a substitute for professional medical care. Emergency medical assistance (calling 911) should be requested immediately when an opioid overdose is suspected, before administering naloxone. Contraindications: Patients who are hypersensitive to this drug or to any ingredient in the formulation or component of the container. Serious warnings and precautions: Call 911: Emergency medical assistance (calling 911) should be requested immediately when an opioid overdose is suspected, before using naloxone. Continued surveillance: Individuals with a satisfactory response to an initial dose of naloxone should be kept under continued surveillance. Aggressive reactions: Caregivers administering naloxone should be prepared to act in response to or assist the patient in cases of potential adverse reactions such as aggressive reactions, convulsions and vomiting. Special attention is warranted if naloxone is administered to a neonate or a pregnant woman. Other relevant warnings and precautions: In opioid dependent people, naloxone may trigger an acute opioid withdrawal syndrome; this may be life-threatening in opioid dependent neonates Preterm labour or fetal distress in opioid dependent pregnant women Rebound opioid toxicity, including respiratory depression, following the temporary reversal of the opioid overdose Ineffective against respiratory depression due to non-opioid drugs Cardiovascular risks including rare cases of cardiac arrest, tachycardia and ventricular fibrillation Post-operative considerations including hypotension, hypertension, ventricular tachycardia and fibrillation, dyspnea, pulmonary edema and rare cases of cardiac arrest. Death, coma, and encephalopathy have been reported as sequelae of these events Convulsions or seizures Irritability and aggressive behaviour Gastrointestinal reactions including diarrhea, nausea, vomiting and abdominal cramps Use in nursing women has not been established Higher systemic exposure in geriatrics For more information: Please consult the product monograph at http://narcannasalspray.ca/pdf/NARCAN%C2%AE-Nasal-Spray-product-monograph-Mar%2005-2021-red-plunger.pdf for important information relating to contraindications, adverse reactions, drug interactions, patient selection and dosing information. The product monograph is also available by calling 1-844-898-0657. Always direct patients to read and follow the directions on the label. References: 1. Health Canada. Canadian Pain Task Force, June 2019 Report - Chronic pain in Canada: Laying a foundation for action. Available at: https://www.canada.ca/content/dam/hc-sc/documents/corporate/about-health-canada/public-engagement/external-advisory-bodies/canadian-pain-task-force/report-2019/canadian-pain-task-force-June-2019-report-en.pdf. Accessed August 27, 2021. 2. Antoniou T, Pritlove C, Shearer D, et al. A qualitative study of a publicly funded pharmacy-dispensed naloxone program. International Journal of Drug Policy. 2021;92:103146. 3. Healthcare Providers Service Organization. Pharmacist Spotlight: Communication. Available at: https://www.hpso.com/getmedia/5d3ce92b-6fba-4d33-b237-8f090469ed48/pharmacist-spotlight-communication.pdf. Accessed July 27, 2021. 4. Canadian Medical Protective Association. Preventing the misuse of opioids. Available at: https://www.cmpa-acpm.ca/en/advice-publications/browse-articles/2015/preventing-the-misuse-of-opioids. Accessed July 27, 2021. 5. Tsuyuki R et al. Canadian national consensus guidelines for naloxone prescribing by pharmacists. Canadian Pharmacists Journal. 2020;153(6):347-351. 6. Ontario Pharmacists Association. Pharmacist clinical tool for initiating naloxone discussions. Available at: https://opatoday.com/wp-content/uploads/Practice/Tools/Naloxone/Pharmacist-Clinical-Tool-for-Initiating-Naloxone-Discussions.pdf. Accessed July 27, 2021. 7. Mueller SR et al. Attitudes toward naloxone prescribing in clinical settings: a qualitative study of patients prescribed high dose opioids for chronic non-cancer pain. Gen Intern Med. 2016;32(3):277-283. 8. Thakur T, Chewning B. Using role theory to explore pharmacist role conflict in opioid risks communication. Research in Social and Administrative Pharmacy. 2020;16(8):1121-1126. 9. Dassieu L, Heino A, Develay É, et al. “They think you’re trying to get the drug”: Qualitative investigation of chronic pain patients’ health care experiences during the opioid overdose epidemic in Canada. Canadian Journal of Pain. 2021;5(1):66-80. 10. NARCAN® Nasal Spray Product Monograph. Emergent BioSolutions Canada Ltd. March 5, 2021. PP-NAR4-CA-00089 10/2021

Let’s talk about prescription opioids: Starting the conversation with your patients

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