Pharmacists Role in Providing Naloxone Is Expanding

Through overdose risk reduction education, proper medication management, and providing naloxone rescue kits to the community, pharmacists can play a vital role in helping fight the opioid epidemic, attendees of the American Pharmacists Association’s Annual Meeting & Exposition (APhA 2019) in Seattle, Washington, learned at a presentation on Sunday, March 23.

In the session “Naloxone to the Rescue: The Pharmacist’s Emerging Role in Preventing Opioid Overdose,” Lucas Hill, PharmD, BCPS, BCACP, clinical assistant professor at the University of Texas at Austin College of Pharmacy, and Anita Jacobson, PharmD, a clinical associate professor at the College of Pharmacy at the University of Rhode Island in Kingston, also discussed naloxone products, laws pertaining to naloxone, and the logistics of dispensing it.

“This is an issue that cuts across all counties, all states. We feel like we can do something about prescription overdoses, but what can we do about fentanyl and heroin?” Jacobson said.

“For a large percentage of us who have taken prescription opioids, it’s not a good experience,” but for people who have addictive personalities, it has been described as “slipping into a warm bath,” she said.

Jacobson shared a personal story with the audience, telling them that her partner of 6 years died of a heroin overdose in 2014. Just 39 years old, he had a history of alcohol abuse, and when he went to a detox clinic, he met people who introduced him to prescription opioids. After having withdrawal symptoms, he tried heroin for the first time, and it proved fatal.

It was at least a year until Jacobson was able to share her story, she said, but “if you don’t have someone in your life who’s struggling with opioid abuse, [this] can put a face to this.”

One way to stop these tragedies is for pharmacists to expand access to naloxone in their communities.

It is important for them to obtain medical histories and assess patients for overdose risk.

“Review their medications, understand what they are taking and what interactions might be present,” Hill said.

Screening tools and prescription monitoring can help pharmacists identify at-risk patients, though they are not always necessary, he said.

It is also important when offering naloxone to learn how to speak to patients who may be at risk or even ended up in emergency departments for what they might describe as an adverse effect.

Some patients do not think they have overdosed in those instances, and Jacobson said that calling the event a “breathing emergency,” can be less stigmatizing.

Naloxone is safe and effective, working in 2 to 3 minutes to reverse the effects of an overdose.

There are several formulations for use by laypeople that vary in cost, including a vial with a needle, intranasal, nasal spray, and auto-injector.

“Most of your decision-making is going to be based on which one can your patient use and what is covered by insurance. When it comes down to it, they all work,” Hill said.

It is important to offer naloxone to patients and try to destigmatize it, Jacobson said, perhaps likening it to a fire extinguisher.

“You might not need it, but it’s there if you have it,” she said.

One key thing to keep in mind is knowing the difference between a person who is high and one who is at risk of dying. Those who are in imminent danger may have shallow or slow breathing; feet, hands, and lips that are turning blue; be snoring deeply; unresponsive; or even unconscious.

Giving naloxone to a person who is high but not at immediate risk increases the chance that they will go into withdrawal and use more drugs, Hill said.

It is recommended that anyone who is in the presence of someone who overdoses administer naloxone; try to wake the person, even grinding their knuckles into their breastbone for 5 to 10 seconds, if necessary; administer CPR, if they know how; and then call 911. They should also stay with the person who has overdosed.

There are, of course, those who are afraid of calling 911 or staying with someone who has overdosed, because they risk facing criminal charges for possession of drugs and/or drug paraphernalia. Good Samaritan laws vary by state.

Pharmacist naloxone access also varies by state, with some states having standing orders, protocol orders, collaborative practice agreements, and pharmacist prescriptive authority.

The biggest barriers to offering naloxone are a lack of time in their jobs and insufficient knowledge, Hill and Jacobson said.

Reference

Hill L, Jacobson A. Naloxone to the Rescue: The Pharmacist’s Emerging Role in Preventing Opioid Overdoset. Presented at: APHA2019. Seattle, Washington; March 24, 2019.