Despite Increased Access, Naloxone Prescription Rates Low in Study

Naloxone, the opioid overdose reversal medication, can save lives, as reflected by a recently issued recommendation by US Surgeon General Jerome M. Adams, MD, MPH, that Americans carry and know how to use it.

Yet despite this recommendation and an increasing number of states enacting standing orders that make naloxone available without a prescription, California issued such a standing order on the matter on June 14, becoming the 41st state to do so. Many pharmacists had not actually dispensed the medication, an Indiana University study conducted in 2016 and published recently found.¹

Researchers examined the role of Indiana community pharmacies in naloxone access and noted that though 58% of pharmacies stocked naloxone and 48% of pharmacists were comfortable dispensing it, just 24% of pharmacists had actually dispensed the medication.

The study researchers noted that pharmacies with larger capacity, such as chain pharmacies; those with more than 1 full-time pharmacist' and those where pharmacists received naloxone continuing education in the past 2 years were more likely to stock naloxone. However, researchers were not able to predict factors that would indicate that pharmacists actually dispense the medication.

"The question moving forward, and what will be addressed in our future work, is what predicators indicate pharmacists actually dispensing naloxone," said Jon Agley, co-investigator and deputy director of the Institute for Research on Addictive Behavior. "That could be cost, stigma, or whether or not customers are looking for naloxone at pharmacies."

The Surgeon General Advisory encourages those at increased risk, their friends and family, and other potential witnesses, to be prepared to respond to an opioid overdose emergency, by obtaining naloxone.

Individuals at higher risk include those who are misusing licit or illicit opioids, those taking higher doses of opioid pain medicine, and those taking benzodiazepine sleeping aides and opioid pain medicine concurrently, according to a statement from ADAPT Pharma, the makers of Narcan, a widely used form of naloxone, ² The advisory also encourages health care providers to provide patients opioid risk education and to prescribe or dispense naloxone to those at increased risk of an opioid overdose. The advisory also notes that the CDC advises health care providers to consider offering naloxone to individuals when factors that increase risk for overdose or concurrent benzodiazepine use are present.

References

1. Meyerson BE, Agley JD, Davis A, et al. Predicting pharmacy naloxone stocking and dispensing following a statewide standing order, Indiana 2016. Drug Alcohol Depend. 2018:18; 187-192. doi: 10.1016/j.drugalcdep.2018.03.032.

2. ADAPT Pharma welcomes Surgeon General Naloxone Advisory strengthens partnerships to expand Narcan (naloxone HCl) nasal spray affordable access and awareness [news release]; April 5, 2018. adaptpharma.com/adapt_press_release/april-5-2018-adapt-pharma-welcomes-surgeon-general-naloxone-advisory/. Accessed June 19, 2018.