Colorado Pharmacists Cautious About Providing Naloxone

Naloxone expanded-access provisions that recently took effect in Colorado practically push pharmacists to provide the opioid overdose antidote to anyone requesting it, but many pharmacists in the state still have concerns about dispensing it.

Under standing orders from a physician, pharmacists, first responders, and harm-reduction organizations in Colorado are now able to dispense naloxone to any opioid users or third parties who request it. The chief medical officer and executive director of the Colorado Department of Public Health and Environment, Larry Wolk, MD, MSPH, even set up a blanket standing order under his license to cover pharmacies that lack a dedicated physician.

Nevertheless, Dan Scales, PharmD, owner and founder of Scales Pharmacy in Denver, told Pharmacy Times that some pharmacists are still hesitant to provide naloxone due to “lack of knowledge about the new laws” and “a misunderstanding of how harm reduction is effective.”

“The fear for some pharmacists and pharmacies around the state is the misconception that providing naloxone is encouraging drug abuse and facilitating dependence. This is not the case, but [it] has been the stigma associated with harm-reduction movements since they started,” he explained. “By providing education and training on [naloxone] safety in a stigma-free environment, [pharmacists] are actually promoting informed decision making…and providing a entrance point to care for those that want to seek it.”

Importantly, Dr. Scales said, the new law protects pharmacists from any criminal or civil liability for naloxone provided to patients in good faith.

“As pharmacists, we should be taking every opportunity to further our role in the communities we serve, and the new laws and state-created protocol allow us to do that,” he said. “Yes, there are concerns, but they are stigmatized misconceptions.”

Generally speaking, Larry Wolk, MD, MSPH, executive director and chief medical officer of the Colorado Department of Public Health and Environment, told Pharmacy Times in an exclusive interview that pharmacists’ “concerns have been around liability and education issues.”

“Pharmacists want to make sure they are complying with state and federal law, and also want to make certain that naloxone users are educated as to the short-term efficacy,” he explained. “I think those concerns remain but are easing as a result of the new law.”

A Kaiser Permanente Colorado study published last month found that clinicians are hesitant to prescribe naloxone because they do not want to offend patients by speaking with them about their risk of overdose. As a result of this and other concerns, only 3 of the 37 Colorado clinicians with prescribing authority had prescribed naloxone.