Ontario Naloxone Program for Pharmacies (ONPP) | Brandeis Opioid Resource Connector

A publicly funded program in Ontario, Canada to increase access to naloxone through community pharmacies

Beginning in June 2016 in the Ontario government made naloxone free to the public in participating pharmacies through the Ontario Naloxone Program for Pharmacies (ONPP). Using public funds, this program pays for participating pharmacies to distribute injectable and nasal spray naloxone kits to current opioid users, past opioid users at risk of relapse, and family members or friends of someone who is at risk of an opioid overdose.

Pharmacists may exercise their professional judgement on whether or not to provide naloxone kits to an eligible person. Pharmacy participation in the ONPP is voluntary. Pharmacists are required to complete an online course and must provide training on naloxone administration to those who receive a kit for the first time. More information on the program can be found here.

In March 2018, the program was amended to include intranasal naloxone at no cost and removed the requirement to present a government health card to the dispensing pharmacist. Empirical evidence shows that this policy change increased naloxone distribution, especially among those at high risk for an opioid overdose.

Naloxone dispensing increased considerably from 1.9 to 54.3 kits per 100,000 residents over the study period.

Continuum of Care

Harm Reduction

Type of Evidence

Peer-reviewed

Response Approach

Educational

Overdose prevention

Peer-reviewed Article

The uptake of the pharmacy-dispensed naloxone kit program in Ontario: A population-based study

Impact of policy changes on the provision of naloxone by pharmacies in Ontario, Canada: a population-based time–series analysis

Evidence of Program Effectiveness

“Naloxone dispensing through the ONPP increased considerably from 1.9 to 54.3 kits per 100,000 residents over the study period. In this time, 2,729 community pharmacies dispensed 91,069 kits to 67,910 unique individuals. Uptake was highest among prescription OAT recipients (40.7% of OAT recipients dispensed at least one kit), compared with 1.6% of prescription opioid recipients, 1.0% of those with past opioid exposure and 0.3% with no/unknown opioid exposure. Naloxone dispensing was highly clustered among pharmacies (Gini = 0.78), with 55.6% of Ontario pharmacies dispensing naloxone, and one-third (33.7%) of kits dispensed by the top 1.0% of naloxone-dispensing pharmacies.” (Choremis et al., 2019)

"The rate of pharmacy naloxone dispensing increased by 65.1% following program changes. In subgroup analyses, naloxone dispensing increased among individuals receiving opioid agonist therapy (OAT), among individuals receiving other prescription opioids, among individuals with past opioid exposure, and in urban centers...Changes to the Ontario Naloxone Program for Pharmacies to add intranasal naloxone and remove the requirement to present a government health card appeared to increase pharmacy-based naloxone dispensing uptake in Ontario, Canada, particularly among individuals at high risk of inadvertent opioid overdose." (Antoniou et al., 2021)