Ethos Ho, BSc Pharm Candidate
Mandatory Warning Labels and Information
With the rise of the opioid crisis, Health Canada has passed a new requirement regarding the dispensing of prescription opioid medications by pharmacists and other healthcare providers. Effective October 2, 2018, all prescription opioids, such as morphine, hydromorphone, and oxycodone, mandate mandatory warning stickers and patient handouts. These changes are being implemented to ensure that all patients receive consistent, relevant information regarding the risks associated with opioid use such as addiction, tolerance and overdose.1,2
Today’s article is going to discuss the practicalities associated with these upcoming changes, along with possible alternative solutions to ensure that the risks of opioid use are communicated effectively with all patients.
Disclaimer: Note that the views expressed in this article are the author’s own and do not necessarily represent represent the views of the Orbis Health Team or the pharmacy profession.
Is This A Practical and Effective Solution?
Although communication of the risks of opioid use is essential in ensuring safety and minimizing risks, is slapping a warning label on all prescription opioid vials and giving mandatory handouts an effective solution? Not only does this increase the cost and resources required for pharmacies, it’s also very easy for individuals to disregard the information on a small auxiliary label or printed handout.
Think about your own experience: how many individuals do you know who take the time to read the information on the handout or prescription vial? From my experience working in a pharmacy, most patients throw the handout into the recycling and never need it again after they have obtained the following information: what it is for, how to use it, side-effects, whether to take with or without food, when to take it, and potential drug interactions. Additionally, a lot of patients at my pharmacy believe that the information given to them by their pharmacist or prescriber is enough for them to feel confident in their ability to use their medication – meaning, they don’t need the handout.
Another argument against this strategy is: how many people start smoking or continue to smoke despite all the warning labels and pictures displayed on cigarette packs? The fact is, although the risks associated with smoking is well known and communicated extensively to the public, it’s clear that mandatory product labels and warnings are not enough to stop people from doing it.
An excellent argument made by Alberta College of Pharmacists Registrar, Greg Eberhart, during his interview is:
“What about the individual who is an addict? Who is taking methadone or opioid replacement therapy, receiving the medications under the supervision of a pharmacist every day? Does it really make sense to provide a label and a brochure to them every time [that they receive their medication]? Similarly, when we are dealing with individuals who are in palliative care…does it make sense that when a pharmacist dispenses medication to manage their pain, often on a daily basis, does it make sense to provide a sticker and a pamphlet along with it?”3
What Are the Alternative Solutions?
In my opinion, education regarding the risks associated with opioid use should occurs at the time of opioid prescribing. Making the communication more personal and individualized to each patient, which cannot be made from a simple sticker or brochure, will likely have a long lasting impact on the patient.
Additionally, prescribers should also discuss alternative non-opioid treatment options that are available in the market. For example, in my previous article about the effectiveness of over-the-counter codeine, studies showed that prescription strength codeine is comparable to regular analgesics. If there is an option available that doesn’t carry the risk of addiction or overdose, why not discuss this with the patient at the point of prescribing?
The Bottom Line
Although Health Canada’s strategy for ensuring consistent communication about the risks of opioid use makes sense, it lacks feasibility and practicality. The information presented on labels and information pamphlets is impersonal and lacks the connection that is built from education by a healthcare provider. Also, labels and brochures aren’t going to do much by itself to communicate information effectively as most patients get the most relevant information about their medication from a pharmacist or prescriber.
This is why the education at the point of prescribing is much more important to discuss about the risks and dangers of opioid use. So instead of making pharmacies solely responsible for dispensing this information, why not share this responsibility with all healthcare professionals involved in prescribing?
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