Expert: Availability of OTC Naloxone in Stores, Pharmacies Will Lead to Greater Uptake

In an interview with Pharmacy Times, Allison Burns, president and CEO of EMO Health, goes in-depth on the initiatives that can be taken to increase availability and uptake of OTC naloxone in retail stores and pharmacies. In addition, Burns discusses how pharmacists can prepare and educate themselves regarding OTC naloxone to better assist patients.

Pharmacy Times: How can pharmacists prepare for Narcan’s availability OTC and ensure that individuals know it’s available and are educated and informed regarding its use?

Allison Burns, president and CEO of EMO Health: This is a great question. Because it is going OTC, it is going to depend a lot on that pharmacist’s employer or wherever they are working out of. If you are at one retailer, they may have Narcan or naloxone being ordered through the pharmacy, or another retailer might have it being ordered through the front store. If you don't have the ability to put in orders for it, I would encourage pharmacists to work with, whether it's front store staff or whoever is doing the ordering, to make sure that it is in stock and available. Another thing that pharmacists can do is you could put, and again, this is going to come down to your employer and if they allow it, putting signs up in the pharmacy letting people know that it's OTC and what aisle to find it in; that's always helpful, to have visual aids. Have visual aids in different languages; not everyone speaks English as their first language. Anything where you can increase visibility around where to find it in the store and making sure that you are part of the solution in terms of, let's make sure this is stocked. Let's make sure that we regularly have it. If the distribution company that we're working with does not have it in stock, are there other options, other companies and vendors to work with? It will take us, because it goes from the pharmacy to OTC, which is more of like a front store area, it will take collaboration with those non-pharmacy staff.

PT: As for availability, what steps can be taken to improve access to OTC Narcan and make sure that it is widely available, especially in low-income communities?

Burns: This is another great question. We are seeing many pharmacies closed in low-income areas. For example, where I live in Boston, Massachusetts, we have a neighborhood called Roxbury, and the difference in life between Roxbury which is Black, brown, and African American and Back Bay, which is predominantly white and Caucasian individuals is a 20-year difference. All the retail pharmacies recently shut down in Roxbury; meaning those individuals may not have access, 1, to their prescription medications, but 2, to go in there and to get any type of OTC. Maybe they just need Band-Aids and Neosporin. Who knows? It’s hard for them because in these low-income areas, there might not be reliable public transportation and they might not be able to afford to get an Uber or ride sharing service. Maybe there isn't even ride sharing service where they are, because it's a rural area of the country. Improving access there, it's going to take, I would say, really, when they say it takes a village, it's going to take communities stepping up. Making sure now that it's OTC, it doesn't just have to be in pharmacies and in pharmacy retailers. It could be, you know, I know that you it can be ordered online now. But if you need it quickly, and not everybody can get certain packages delivered -- say you live in a big apartment building or condo complex. I know there's issues around access there. But I mean, it could be in gas stations, it could be in the supermarket, it could be in these other retail settings that are non-pharmacy. And that's going to be very important to make sure that the places that are low income or don't have access to a pharmacy have that, that they are in those, you know, non-pharmacy settings, I would say.

PT: How much does the location of Narcan in stores or pharmacies and where on shelves it is displayed have to do with the proliferation of the drug? Are certain places better for stocking Narcan than others?

Burns: So this is also something interesting. A lot of retailers may be questioning, “okay, well, where do we put this?” If you ask me, the best place to put it is someplace visible, where people can reach, whether you are, you know, in a wheelchair, so it's not so high that someone can't get it on a top shelf someplace that's, you know, eye level, accessible to everyone, closer to the front of the store where it can be seen. And if it's not closer to the front of the store, because you just simply don't have room there, that there's some sort of sign or visual aid to lead people where it is. Or, if it's not in a place that people would normally think -- a lot of people have told me “Well, I expect it to be, you know, in the first aid aisle,” somewhere in there, but it's over in like house goods, then you should probably have some type of signage in that aisle that says, “if you're looking for OTC naloxone, this is the aisle, find me here,” you know, something like that, where can you find it. I would say another barrier to this is there have been…and this is part of stigma, I don't know if we really have reliable data on, are OTC naloxone kits being stolen. So it doesn't really help, If you take an OTC product, you take it from behind the pharmacy counter, and you put it behind the front store register. That makes it stigmatized again, so I would recommend not doing that, although I do understand that that sometimes is just the only option that is getting. You're going to have to probably teach your employees how to be less stigmatizing about it if it is behind the front store counter, or if it's locked up and you need somebody to constantly be going and opening that box. Anytime where someone must ask for it, it becomes a challenge, a burden. That's where stigma, again, and embarrassment -- they might be embarrassed to ask -- plays a role. I would say if they can put it in a place that is visible, eye level, and if it's not in an intuitive location, that they put up some signage so people can easily find it, that would be best. And not locking it up and not putting it behind the counter would be ideal, although I do understand that those things do happen. I would argue that until you have really some data that's showing that loss is occurring, and theft is occurring, people should not assume that, because it's so expensive, and people can’t afford it, that they're going to steal it. We need to we need to work on that type of stigma there. Definitely,

PT: Can federal policy have an impact in making Narcan more widespread and available for individuals across the country?

Burns: I would say absolutely. It's actually because of federal and state policy makers that all the states are required to have a naloxone access law. All of them passed; eventually, it went from 1 state to all 50 states having some sort of mechanism where naloxone became available, either through a standing order or some other mechanism where you were able to get it without going to your personal doctor. We all know that doctors are hard to come by anyway, so you might not even have a PCP to go to. So those types of policies that then become regulation and statute are important because it's a way to make sure that every single state, and within those states the cities, towns, and counties, are standardizing their approach to getting this critical antidote out to the public and in the community, because we know this is where overdoses are happening. They're happening in the community. They're not happening in the hallway of the hospital, you know? So absolutely, I think more policies that can come out to help standardize how OTC naloxone will be rolled out, or even if it's not necessarily federal policy, but if they could come up with some sort of official guidance. People have questions, and they're probably trying to do their best, and their best sometimes isn't ideal. If there was, whether it's policy or again, some official guidance, that can help these retailers stores community, whether it's a community health center even, who knows any place that stocking naloxone. If it can help them on, what does it look to actually roll that out in your setting, I think that would be incredibly helpful.