Associate professor CHU Sainte-justine Montréal, Quebec, Canada
Background: In the past years, opioid overdose rates have been increasing significantly in the pediatric population, the highest increase being among adolescents aged 15 to 19 years. Naloxone is a cornerstone drug in preventing opioid overdoses and can safely be used at the same dose in children and adults. Although take-home naloxone kits are an efficient way to reverse opioid overdose regardless of the age, little is known about their dispense in the pediatric population. Community pharmacies are the cornerstone in preventing opioid overdoses as they freely dispense naloxone kits. Little is known about this preventive role in pediatrics. Objective: This study aimed to evaluate community pharmacists’ experiences, comfort levels, and specific information needs regarding naloxone dispense for pediatric patients across the province of Québec, Canada. Design/Methods: We conducted a descriptive, provincial survey, targeting the whole province of Quebec by randomly selecting one pharmacy per electoral region. The survey was pretested in 25 pharmacies. It assessed pharmacists' clinical experiences with naloxone, patient categories served, and comfort in pediatric and adult dispensation scenarios using Likert-scale responses and open-ended questions. Results: The survey included 121 community pharmacies. Almost all pharmacies (99%) offer take-home naloxone kits, with 58% dispensing pre-packaged kits, 52% of which containing naloxone nasal sprays. Experience with pediatric naloxone dispensation was generally poor as most pharmacies (88%) have only served take-home naloxone kits to adult patients. Nine percent have dispensed to 15-18 years old patients and only 1% to 11-14 years old patients. No surveyed pharmacies ever dispensed naloxone for a patient younger than 11 years of age. Only 30% of respondents felt comfortable dispensing an adult naloxone dose to a pediatric patient. The remaining 70% expressed the need for additional information regarding naloxone dose on an opioid prescription, specifically to be provided with documentation for administering standard adult doses to children. 75% of pharmacists requested information about the indication for naloxone on the outpatient prescription. Only 28% of pharmacists felt comfortable identifying naloxone indication uses in pediatrics, but 44% were ready to counsel pediatric patients and families on naloxone use.
Conclusion(s): To prevent opioid overdose in children, community pharmacists need pediatric specific guidelines and training for dispensing naloxone kits to children. These guidelines should include information such as dose-safety statements and indications.
