Why free naloxone is 'turning the medical model on its head'

The medical officer of health of London, a city embroiled in a deadly intravenous drug crisis, says the availability of free naloxone is saving lives by turning the traditional medical model on its head. 

New data obtained by CBC News shows the Ontario government paid for over 96,152 Naloxone kits distributed through pharmacies, jails, local health units and hospitals between Oct 2013 and Sept 2017 at a cost of over $5,007,000.

"Making sure that naloxone is in the hands of the people who are most likely to be there when the overdose occurs, that's the most proactive outreach model and it means this program is more and more likely to be saving lives," said Doctor Chris Mackie, the medical officer of health for the Middlesex London Health Unit. 

Mackie is the top doctor in a city that sometimes seems awash in dirty needles and used drug paraphenalia, where intravenous drug use has been blamed on a surge in London's HIV rate at a time when the spread of the disease is shrinking everywhere else in the province. 

Turning the medical model on its head

Mackie said it's also putting the power of medical decision-making in life or death situations into the hands of everyday people, including drug users themselves. 

"The medical model is you come to the doctor, you're forced to come into a clinic, diagnosis and treatment happens and you'll take the medication as prescribed," Mackie said.

"The provincial program to distribute naloxone has become much more permissive," Mackie said. "It used to have to funnel out of our harm reduction programs where somebody had to be, you know, an IV drug user to access the program."

"Now we're able to go out to a homeless shelter and train all the staff there and distribute the equipment that way," he said. "The total cost of this program, compared to the number of lives we're saving, I think it's very affordable."

'Basically there's no profit on this' 

The latest figures from the province also suggest Ontario pharmacies are making a profit through the distribution of the life-saving drug, with over 55,000 naloxone kits distributed through 2,010 participating pharmacies in 260 cities and towns throughout the province at a cost of $3.38 million since the launch of the Ontario Naloxone Program for Pharmacies in June 2016. 

Compare that to the 41,152 kits distributed through the province's jails, hospitals and local health units, which cost about $1.63 million from Oct 31, 2013 to Sept 2017.

The Ministry of Health says the $3.38 million cost borne by the province to distribute naloxone through pharmacies includes "drug cost, mark up and a dispensing fee." 

Something disputed by Allan Malek, the executive vice-president of the Ontario Pharmacy Association.

"There is no mark-up on it. In fact, it's actually a set funding formula," he said. 

"Very simply it's structured as a set fee for an initial kit," Malek said. "Then there's a separate fee for a kit that's being replaced." 

Malek said pharmacies get $70 for each naloxone kit they hand out initially, which includes the $35 cost of the naloxone kit itself, a $10 dispensing fee and a $25 training fee. 

Each kit thereafter Malek said the pharmacy receives $45, which includes the $35 cost of the kit and the $10 dispensing fee. 

"There's basically very little profit, if anything," he said. "Quite simply the dispensing fee covers the cost of the time it takes to enter the information of the patient into the pharmacy computer system." 

"So basically there's no profit on this," he said.  

Malek said pharmacies play a big role in helping people deal with the opioid crisis by providing convenient locations for people to not only pick up their free kits, but help the public understand how to use them. 

"Quite simply pharmacies are the most accessible health providers in the province," he said. "You can turn anywhere and find a pharmacy and speak to a health professional without the need of an appointment." 

"We're talking about life and death situations, you need quick access to these medications and making it available through a health professional is, I think, sound public health policy," said Malek.