The document provides information about take home naloxone (THN) training and dispensing for pharmacists, as well as an overview of coverage through Non-Insured Health Benefits (NIHB). It discusses who should receive THN training, how to counsel patients on THN, and NIHB pharmacy benefits including open benefits, limited use benefits, exceptions process, and pharmacist initiated treatments. The document also provides contact information for the regional NIHB pharmacist and notes some recent updates to the NIHB program.

1. Take Home Naloxone
for the Counselling Pharmacist
&
Non-Insured Health Benefits
KatyWindlBSP, CD
Saskatchewan Regional Pharmacist
Non-Insured Health Benefits Directorate
First Nations & Inuit Health Branch
Department of Indigenous Services
Canada/Government of Canada

2. Acknowledgment
2

3. Outline
1. Canada’s Opioid Crisis
2. Take Home Naloxone
o Who should receive THN?
o Opioid overdose recognition and response
o Counselling tips and resources
3. Non-Insured Health Benefits
o Pharmacy Benefits
o Pharmacist Initiated Treatment
o Coverage Appeals
o Program Updates

5. Opioid-related Harms

8. Take Home Naloxone Training
Any adult capable of learning basic life support can also
learn to recognize an opioid overdose, and administer
naloxone in time to save lives.
Who should receive the Training?
People likely to witness an opioid overdose in their
community, such as friends, family members, partners of
people who use drugs, and social workers.
(WHO 2014 guidelines)

9. Pharmacist Dispensing THN
Individuals who may benefit from a THN kit
include:
o All individuals who use opioids, both prescription and
non-prescription;
o Individuals identified by the above group as the person
most likely to be present if they were to overdose (e.g.
partners, family, friends, roommates); and
o Any person who knows an opioid user and would like
to be prepared in the event of an accidental overdose.
College of Pharmacists of Manitoba
http://www.cphm.ca/uploaded/web/Guidelines/Naloxone%20Guideline%20for%20Pharmacists%20June%2024%202016.pdf

10. Pharmacist Dispensing THN
“ Given the safe and effective nature of naloxone,
it is very unlikely that it would not be appropriate
to provide a THN kit to someone who requests it
for emergency use for opioid overdose.”
College of Pharmacists of Manitoba
http://www.cphm.ca/uploaded/web/Guidelines/Naloxone%20Guideline%20for%20Pharmacists%20June%2024%202016.pdf

11. Why is too much opioids dangerous?
• Lose the urge to breathe;
• Breathing slows down and
decreases oxygen to the
brain; and
• Risk of permanent brain
injury or death if untreated.

12. Recognizing Opioid OD
Key Features:
• Unresponsive
• Slow breathing
May also have:
• Small pupils
• Snoring or
gurgling
• Blue lips,
fingernails
• Cold clammy skin

13. What is naloxone (Narcan®)?
• Temporarily reverses the effects of opioids
including slowed breathing.
• Prescription Drug List (PDL) except when
indicated for emergency use for opioid
overdose outside hospital settings.
• Does NOT work for non-opioid ODs
– Can help if multiple substances involved

14. Naloxone has a higher affinity to opioid receptors than opioids, such as
heroin or oxycodone, knocking off the opioid from the receptor for a short
time (30-90 min)
How does naloxone work?

15. How long does naloxone work for?
3 hrs
4 hrs
4 hrs
4 hrs
4 hrs
24 hrs
0 4 8 12 16 20 24
Oxycodone
Codeine
Morphine
Hydrocodone
Heroin
Methadose
Time (Hours)
Minimum Opioid Half Life
Maximum Naloxone Half Life
Naloxone
An overdose can return!
A person’s high will return.

16. SAVE - ME
S – Stimulate
A – Airway
V – Ventilate
E – Evaluate
M – Medication
E – Evaluate

17. Naloxone Wakes You Up
Toward the Heart
• Online Training Module
• Online Training Videos
http://towardtheheart.com/naloxone

18. THN Training Video

19. Counselling 101
1. What is Naloxone used for?
o Naloxone reverses the effects of opioids, if someone has stopped breathing
because of too much opioids Naloxone is the antidote that reverses the effect and
allows them to breath on their own.
o What are opioids? Codeine, Morphine, Oxycodone, Hydromorphone, Fentanyl and
Heroine.
2. Who?
o Recognizing someone who is overdosing – At first someone feels sleepy, they
might have difficulty talking or walking. Eventually it looks like the person is just
sleeping they may make a snoring or gurgling sound and their breathing slows to
the point where they stop breathing and are non-responsive.
3. How?
o How to administer the injection or nasal spray.
o Watch the training video

20. Order Wallet Cards
• These cards are available free of charge.
• http://www.hc-publication-sc.hc-sc.gc.ca/paccb-dgapcc/cmcd-
dcmc/webpubs.nsf/Web1/170576?OpenDocument&lang=eng&

21. The Good Samaritan Drug
Overdose Act
Provides some legal protection for people who experience or
witness an overdose and call 9-1-1 for help.
The act can protect you if you are in breach of the following
conditions under section 4 (1) of the Controlled Drugs and
Substances Act:
o Parole;
o pre-trial release;
o probation orders;
o simple possession; and
o conditional sentences.
The Good Samaritan Drug Overdose Act applies to anyone seeking
emergency support during an overdose, including the person
experiencing an overdose.
The act became law on May 4, 2017.

22. Availability of THN in
Saskatchewan
Anyone may purchase a Take Home Naloxone Kit through their community
pharmacy.
Nasal Spray and Injection kits are covered under Non-Insured Health
Benefits (NIHB)
Saskatchewan’s publically-funded Take Home Naloxone (THN)
program will be expanding to provide free THN kits to people who may witness
an overdose, including friends and family members of those at risk.
In 15 communities across Saskatchewan, including Saskatoon,
Regina, North Battleford, Kamsack, Yorkton, Prince Albert, Moose
Jaw, Weyburn, Estevan, Kindersley, Buffalo Narrows, Swift Current,
Melfort, Nipawin and Tisdale.
To locate Addictions/Mental Health Services near you:
Visit www.saskatchewan.ca/addictions.

23. NIHB and THN
• Both injectable kits and Nasal spray are open benefits.
• It may be requested for your personal use, or to protect an at-risk person.
You don’t have to specify who it is for, however it must be billed to
NIHB under the name of the eligible client who is requesting it (even if it is
not for their personal use).
• Providers can bill the cost of the naloxone and ancillary
supplies as a “naloxone kit” under pseudo-DIN 09991460.
o 2 x one mL ampoules or vials of naloxone 0.4mg/ mL
o 2 alcohol swabs
o 2 safety syringes
o 1 rescue breathing mask
o 2 ampule breakers (if ampoules dispensed)
o 2 pairs of gloves

24. Non-Insured Health Benefits
General Program Pharmacy Benefits Overview
Saskatchewan Region
2018

25. NIHB Regional Pharmacist Responsibilities
• As the Senior Pharmacy Specialist in the region, provide professional
advice and guidance for First Nations and act as liaison for provincial
organizations;
• Provide guidance concerning the interpretation and application of
national and regional directives on pharmaceutical products,
pharmaceutical management and controlled substances;
• Provides evidence-based direction to program managers regarding
the development of policies and procedures related to the NIHB
pharmacy program;
• Educates on appropriate drug use;
• Assists First Nations organizations and communities to develop drug
use strategies; and
• Provides support and participates in community-based programs
(e.g. NNADP, Nursing, ADI) in the area of optimal drug use.
A Pharmacy Resource for First Nations!

26. What is Non-Insured Health Benefits?
• Health benefits for First Nations/Inuit beyond those
covered by the Canada Health Act, and insured
services provided by the provinces/territories or
other 3rd party plans
• In Saskatchewan, there are approximately 147,585
On & Off reserve First Nations people

27. Who is Eligible?
To be eligible to receive benefits under the Non-Insured
Health Benefits Program, a person must be:
1. A registered Indian according to the Indian Act; or
2. An Inuk recognized by one of the Inuit Land Claim
organizations; or
3. An infant up to 18 months of age of an eligible parent; and
4. Currently registered or eligible for registration, under a
provincial or territorial health insurance plan.

28. NIHB Benefits
• Pharmacy
• Medical Supplies and Equipment
• Dental
• Vision
• Crisis Mental Health
• Medical Transportation

29. Pharmacy (Drug) Benefits
• Prescribed by any regulated health professional within their
scope
• With the exception of OTC’s under Pharmacist Initiated
Treatments
• Must meet eligibility criteria
• No direct cost to the patient
• NIHB Program can be billed directly by the Pharmacy for
drug costs.

30. Three Types of Pharmacy Benefits
• Open Benefit - Includes most prescription drugs and
most over the counter drugs (OTC’s)
• Limited Use – medications that have value in specific
circumstances. i.e. Some antibiotics, Nicotine Replacement.
• Exceptions – require Prior approvals. Items not listed
on the drug benefit list but may be approved in special
circumstances.

31. Drug Benefit List
• Found online: https://www.canada.ca/en/health-
canada/services/publications/health-system-
services/non-insured-health-benefits-drug-benefit-
list.html
• Contains the formulary of drug
benefits and coverage criteria for
LUs.
• Special Formulary for Chronic Renal
Failure Patients
• Palliative Care Formulary
• Formulary for Adjunct Medications
Used During Active Cancer Treatment
Formulary (New)

32. Guide for Pharmacy
Benefits

33. Pharmacist Initiated
Treatment
The prescription was written within the context of one of the
scopes of practice detailed below, where allowed by the
relevant provincial and territorial legislation:
o prescribing in an emergency;
o renewing/extending prescriptions (may include emergency refills);
o changing drug dosage/formulation and/or making therapeutic substitutions;
o prescribing under a collaborative practice agreement; and
o prescribing a Schedule 1 drug within the pharmacist's scope of practice, as
defined by the relevant provincial and territorial regulations, and which are
benefits on NIHB's Drug Benefit List.
OR
o the treatment was initiated in accordance with the NIHB Pharmacist Initiated
Treatment Policy (see Section 3.13).

34. Pharmacist’s may recommend a
medication to treat these conditions
and bill directly to NIHB the drug cost
and dispensing fee.
The minor ailment fee can be billed to
the province as normal.
For the newer minor ailments that
have not yet been negotiated:
• Ensure that the patient knows that
they will be charged for the
cognitive service and that they can
go to a Physician or NP at no
charge for the service.
• Billing for cognitive services must
be separated from the drug cost
and dispensing fees.
Pharmacist Initiated Treatment

35. Info for Drug Appeal Process
• Required Documentation:
o Letter from recipient or parent/guardian
o Supporting information from the provider or prescriber
• Include the following:
o Condition for which the benefit is being requested
o Diagnosis and prognosis (including what alternatives
have been tried)
o Relevant Diagnostic Test Results
o Justification for the proposed treatment and any
additional supporting information
https://www.canada.ca/en/health-canada/services/non-insured-health-benefits-first-nations-
inuit/appealing-decision-under-non-insured-health-benefits.html

36. Express Scripts Canada (ESC)
Administer the Program;
processing and payment of Claims;
Provider registration;
Verification, audit and recovery where deemed appropriate.
NIHB HQ and Drug Exception Centre
Prior Approvals;
Drug Exceptions;
Appeals.
NIHB Regional Office (Toll free: 1-866-885-3933)
Coordination of Benefits (COB);
Medical Supplies and Equipment.
Regional Pharmacist
Administration of Pharmacy Benefits

37. What’s new in the NIHB program?
• NIHB Drug Exception Centre Now Taking Client Calls
o Effective March 13, 2018, the NIHB Drug Exception Centre (DEC) will
receive calls from clients related to medication benefit inquiries.
• Transition to Department of Indigenous Services
Canada
o On December 4, 2017, the Government of Canada created the new
department of Indigenous Services Canada. Programs and services
delivered by the First Nations and Inuit Health Branch (FNIHB), including
NIHB, have become part of Indigenous Services Canada.
• OAT Transportation
o Increased from 4 to 6 months in order to allow stabilization for carries.
Extensions with justification may be considered.
1-800-580-0950 ext. #3

38. What’s new in the NIHB program?
• NIHB-Eligible Infant Children extended coverage of
unregistered infants up to 18 months of age.
o Infants up to 12 months of age may access most types of NIHB benefits
under the identification number of their parent or guardian who is NIHB
eligible.
o After their first birthday, a child needs his or her own status or N number to
process NIHB benefits. If your child has reached the age of 1 and you
require additional time to register them, please call your NIHB Regional
Office.
• Expanded Coverage for Treatment of Hepatitis C
o NIHB has expanded coverage criteria so clients at any stage of the disease
are now eligible for coverage of these medications.
1-866-885-3933

39. Where can I find more information?
• For more information on NIHB benefits, including access to NIHB policy
frameworks, please visit:
http://hc-sc.gc.ca/fniah-spnia/nihb-ssna/index-eng.php
• For information on updates to the NIHB program please visit:
http://hc-sc.gc.ca/fniah-spnia/nihb-ssna/benefit-prestation/newsletter-bulletin-
eng.php
• Clients can contact the NIHB Regional Office for assistance
accessing benefits at 1-866-885-3933.
• Clients can contact the National Dental Pre-Determination centre
regarding dental claims or reimbursements at 1-855-618-6291.
• NIHB Drug Exception Centre 1-800-580-0950 ext. #3

40. Quarterly Benefit Updates
Updates to NIHB’s
program including
changes to the Drug
Benefit List (DBL) are
posted online:
https://www.canada.ca/en/health-
canada/services/first-nations-inuit-
health/non-insured-health-
benefits/benefits-information/non-insured-
health-benefits-program-update-first-
nations-inuit-health-canada.html

41. Katy’s Tips
• Documentation!
• Watch your Pack Size
• Itemize each item you are dispensing
o i.e. Do not use “renew / refill all meds” or “Diabetic Supplies”.
• Brand Name Dilaudid vs Generic

42. Contact: Katy Windl
katherine.windl@canada.ca
Saskatchewan Regional Pharmacist
Non-Insured Health Benefits Directorate
First Nations & Inuit Health Branch
Department of Indigenous Services
Government of Canada
NIHB Regional Office
1-866-885-3933