Medication overdose continues to be a major issue for patients. To save lives and reduce the high number of patients hospitalised due to medication-related overdose, healthcare professionals – including doctors, nurses and pharmacists – are committed to harm minimisation measures.
It is urgent that we find ways to address medication independence. As the Penington Institute’s Annual Overdose Report 2022 shows, more than 2,000 Australians lost their lives to overdose for the seventh year in a row.
As we acknowledge International Overdose Awareness Day, it is critical that more is done to prevent this tragic and entirely preventable loss of life,” says Penington Institute CEO John Ryan. “Unintentional death from overdose in Australia continues to outnumber the road toll and should be prioritised as the national health crisis that it is.”
Pharmacy 777 supports the Penington Institute’s International Overdose Awareness Day.
Pharmacy 777 Managing Director Kim Brotherson says, “Doctors and pharmacists play a vital role in addressing potential prescription medication dependence, particularly for those who unintentionally become dependent, ensuring treatment options are made available to those in need.
“As medication experts, pharmacists help to ensure the quality use of medicines. Patients are often confused regarding their medication regime and can unintentionally double-up on medications resulting in adverse reactions.
Pharmacy 777 pharmacists work with patients and their carers to prevent medication harm and address the challenges of medication dependence.
“As community pharmacists, we take our role in the community seriously,” Kim adds. “We are here to support our patients manage their medications safely and we encourage anyone with concerns about themselves or a loved one, to please talk to their 777 pharmacist today.”
Managing Covid-19 mental health challenges
The challenges with medication management have been compounded by the pandemic. Not surprisingly, COVID-19 impacted mental health and wellbeing with the introduction of social distancing measures, physical isolation, job loss for some and restrictions of movement and lockdowns from March 2020. There have been reports of stress, confusion, and anger due to the pandemic and, while many people may not experience any long-term issues, the pandemic contributed to or exacerbated mental illness.
ABS data released in November 2021 for the 2020 to 2021 period show 17.3% of people struggling with mental health issues needed to see a health professional. Yet, many experienced barriers, and of those seeking help, 34.3% delayed or did not see a doctor or allied health professional when needed.
Patient booking site HealthEngine shows the length of time between going online to book an appointment and seeing a doctor has increased, with many people waiting longer than usual to see a GP. In WA, average wait times have increased from 2.5 days in 2020, to 4 days in 2022.
“At times when anxiety and distress feel overwhelming, many may turn to substances that change the way they feel – a practice also referred to as self-medicating,” says Pharmacy 777 pharmacist Negar Almassi.
“There are many different ways of self-medicating, for example, with food, alcohol, prescribed medicines, or illicit substances,” she adds. “Any substance that numbs stress, anxiety or grief is called a depressant. These substances slow down the central nervous system, the messages between the brain and body, and the ability to respond to unexpected or stressful situations. In small doses, depressants can cause a person to feel more relaxed and less inhibited. In larger doses they can cause an overdose, starting with drowsiness, vomiting, or unconsciousness, potentially resulting in death.”
While there is a common belief that overdose is largely due to people taking illicit drugs, in fact alcohol and prescribed medications, including opioids, are the most commonly used depressants.
“There is no safe level of drug use when self-medicating with substances that have a depressant effect,” Negar says. “The increased number of hospital admissions due to adverse events from self-medicating is proof that these types of incidents occur way too often.”
This is where pharmacists are an invaluable part of a person’s care team. Community pharmacists work with patients and their doctors to provide solutions and advice during times of stress. Patients and their carers can speak with their pharmacist for help in developing medication safety plans and for advice to help prevent medication-related adverse events.
Addressing overdose risks with chronic pain patients
Another group of patients that have been adversely affected by the pandemic are the more than three million people living with chronic pain.
According to Pain Australia, many regular GP visits were cancelled over the past two years. With many healthcare professionals diverted to Covid-19-related activities, wait times are longer than usual, especially for conditions such as chronic pain, which many consider non-urgent. Longer wait times for reassessment or to refill prescriptions can result in worsening outcomes for patients. And while use of telehealth services increased, unfortunately not everyone has access to or is comfortable with digital technology.
Pain scientists have discovered that chronic pain symptoms are the result of a complex interaction between biological, psychological, and social factors.
“There’s a lot of evidence to say that in people with persisting pain, if they become more depressed or anxious, their pain usually gets worse,” says Professor Lorimer Moseley, pain scientist and chair of physiotherapy at the University of South Australia. “In the same way, if you’ve got persistent depression and you develop an injury, then the depression gets worse.”
Many people who live with chronic pain are prescribed opioids. Reduced access to treatment from healthcare professionals can increase rates of inappropriate use of opioids such as procurement of prescription or illicit opioids through illegal supply.
This can be life threatening, especially when combined with other substances such as sleeping medications or alcohol. This is why having an opioid safety plan is crucial.
“We can help patients or carers interpret directions and explain possible side effects or expected duration of therapy,” Negar says. “We encourage patients or carers to call with any concerns or questions about when or how to take their medicines. Asking questions and getting the best information can help reduce adverse events or complications that can occur from taking pain medicine for too long. Having these crucial conversations helps ensure the patient is referred to their GP to review the prescribed pain treatment.”
Opioid Safety Plans and Naloxone
In addition to the important support that pharmacists can provide, patients can get access to the lifesaving medication Naloxone through pharmacies. Naloxone reverses the effects of opioid overdose. It is easy to use as a nasal spray and requires little to no training to administer.
The Australian Government is now funding the supply of this vital medicine through pharmacies participating in the Take Home Naloxone Program. Pharmacy 777 supports the Take Home Naloxone Program, where naloxone is provided at no charge to people who are at risk of opioid overdose.
Talk to your community pharmacist and ask for a naloxone spray to include in your first aid kit. If you are at risk of overdose for any reason, keep naloxone on hand and speak to your pharmacist about an opioid safety plan. If you care for someone living with pain or anxiety, you can also speak to a pharmacist to learn how to assist during an opioid overdose and find out how you can reduce a patient’s risk of overdose.
“As pharmacists, it is always our hope that patients won’t need to use naloxone, but we know what an important resource it is for saving lives when a patient does experience an overdose,” Negar says.
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