Breaking the Stigma Against Naloxone Communication, Distribution in the Pharmacy

To lead the change and create more patient-centric communication in the pharmacy regarding naloxone, it is essential to educate pharmacists and pharmacy technicians on their role in the process, according to a session at the American Pharmacists Association Annual Meeting and Exposition 2022.

Thomas Franko, PhD, associate professor of pharmacy practice at Wilkes University, discussed how the health care landscape is currently shifting from an opioid epidemic to a holistic substance use epidemic, which has caused an increase in stimulant use, such as cocaine and methamphetamine.

“The opioid epidemic still is part of it, but it’s more than that,” Franko said. “We also have to look at everything that is causing issues, from nicotine, to alcohol, to stimulants, and then take into fact all of the social determinants of health, such as housing insecurity, food insecurity, and financial issues.”

Franko added that the COVID-19 pandemic did not necessarily amplify this epidemic, but rather put a magnifying glass on the issues some of the patients are dealing with and made them more well known to the general population.

In terms of pharmacology, the onset of action with naloxone is approximately 2 to 15 minutes, which is injected in what Franko described as a “buddy system,” because it is safe to administer a second dose if there is no response after 3 minutes. Further, a half-life is 30 to 90 minutes, which may lead to another dose administration.

Franko advised of the adverse effects of using naloxone, such as anxiety, vomiting, and anger. He noted that regardless of whether naloxone is administered via a nasal spray/atomizer or injectable, it is crucial to know the benefits of using naloxone and the intensity of being in a situation of injecting it on someone else.

There are some tell-tale signs of opioid-induced respiratory depression, which can start with a sternum rub, slow breathing/respiratory arrest, or blue fingernails/lips. After identifying these signs, naloxone in a nasal spray should be administered in the user’s nostril with a tilted back head, following a call to 911. The person should also be placed in a recovery position, which involves laying them on their side with 1 arm up and the bottom arm laying across them. Their back leg should be extended behind them while the front leg is bent and crossed over, according to Franko.

Although more than 66,000 doses of naloxone have been administered by first responders, the dispensing rates from pharmacies have remained low. This treatment gap can be filled by using state laws/orders/protocols to increase offers of naloxone to high-risk populations who do not receive a prescription for it.

“If we want to continue to advance as a profession, we have to use every tool we have been given to make leverage and this is going to be one of them, since this should be a slam dunk for us,” Franko said.

The lack of confidence in discussing naloxone and lack of familiarity of the product has caused many pharmacists and pharmacy technicians to not be as communicative about the advantages of naloxone.

Decreasing the stigma is the next step for change in these roles, which includes using person-first language when speaking with patients to make naloxone sound more like a commonly used item, such as an EpiPen. Additionally, using open-ended questions, looking at patients holistically, and keeping the context simple for patients can help change the conversation surrounding opioids and naloxone.

Franko also mentioned how pharmacists should advertise treatment programs at their local pharmacy, provide takeback boxes in the pharmacy permitted under state law, and using a prescription drug monitoring program to identify patients as a part of the culture change surrounding substance abuse. Especially in a pharmacy technician role, who is the first person to communicate with each patient, it is important to engage in a proper conversation with the right language while making an initial assessment.

“The face of the whole system is the pharmacy technician,” Franko said. “Technicians are so important, and we all know that we would never make it in the practice without a pharmacy technician. We need to continue to empower technicians to make more assessments, more interactions with patients, and help pharmacists seal the deal with the case of naloxone.”

Naloxone is both safe and effective, and Franko emphasized that many myths surround its use and change is needed to break the stigma around it.

“As the most accessible health care provider, 90% of the US population lives within 5 miles of a pharmacy,” Franko said. “We are well positioned to get naloxone out to communities.”