Expand legislation — with new pharmacy-delivered naloxone legislation in many states, your patient counseling can save lives
- Overdoses from opioids are an epidemic, with 14,000 deaths from prescription drugs in 2014.
- Important for pharmacists to know: state laws are rapidly evolving to allow greater access to naloxone without a prescription. There are actions pharmacy owners may want to take.
- Private insurers and state Medicaid programs may cover naloxone as well as reimbursement for patient education.
The U.S. Department of Health and Human Services says it bluntly: “The United States is in the midst of a prescription opioid overdose epidemic.”1
Since 1999, deaths from prescription opioids have quadrupled, with 14,000 deaths in 2014 involving prescription drugs.2 Meanwhile, the number of heroin-related deaths has tripled since 2010.3
What can be done?
One of the actions being taken to fight this epidemic is expanding access to naloxone, a drug that can quickly block and reverse the effects of opioids, providing more time for treatment of an overdose.
Emergency responders such as paramedics have had access to the injectable form of this medication. But now auto-injectables and nasal sprays, such as Evzio and Narcan, provide forms of the drug that friends and family members can deliver in an emergency.
Trying to broaden access
In recent years, 42 states have passed some type of law expanding access to the medication.4 For example, this year North Dakota began allowing pharmacists to prescribe naloxone not only to patients at risk of an overdose, but also to others who may be able to take action to stop an overdose, including family members and friends of patients.5 Just last year, 14 states passed laws expanding access to naloxone.6
Here’s a map that highlights what states have legislation to provide naloxone:
Opioid antagonist access through community pharmacy7
However, many pharmacies may not be keeping up with and taking full advantage of those laws. Newspapers conducting surveys in Pennsylvania nine months after the state’s physician general issued a standing order expanding access to naloxone found that many pharmacies weren’t aware that customers no longer needed a prescription. More than half were not stocking it.8
Target risky drugs
New research suggests that providing naloxone prescriptions to patients taking opioids for long-term chronic pain can decrease the number of emergency department visits for opioid-related incidents by nearly two-thirds.9
A lead researcher on that study recommends prescribing naloxone for “risky drugs, not risky patients.”10 Addicts aren’t the only people at risk for an overdose. Other illnesses and medications can affect the impact of a prescription opioid dose, plus the risks include accidental overdose or someone else gaining access to the prescription opioid.
To ensure that patients who didn’t think of themselves at risk for an overdose would listen to the instructions for naloxone, providers in the study used the phrase “bad reaction” rather than “overdose.”
Suggestions for pharmacy owners
Pharmacists who want to provide access to naloxone should check their state laws and talk with prescribers about providing education as well as the medication to patients who are on opioids and their caregivers. Currently, Delaware law specifies prescribers have the right to administer naloxone; however, it is not clear if pharmacists have the same rights. For their 2016 agenda, The Iowa Pharmacy Association is making it a priority to ensure pharmacists have the right to access naloxone. Although Kansas and Wyoming are working toward access, the law, as of yet, does not specify the role of pharmacy.
(Note: Don’t have legislation in your state? See “Independent pharmacies take action to impact legislation” to learn how you can make a change.)
Public and private insurance coverage for naloxone and reimbursement for patient education varies, so check the programs that cover your patients.11 Educating patients to recognize an overdose (or a “bad reaction”), call 911, and administer naloxone can take as little as five minutes.
Community organizations involved in overdose prevention also may provide additional resources, such as bags or containers to hold the components of a “naloxone rescue kit” that your pharmacy could be providing.12
- The Naloxone Webpage, from the National Institute on Drug Abuse, provides information about the medication.
- Prescribe to Prevent offers information and resources for pharmacists and providers, including an online continuing education unit and patient education materials.
- LawAtlas has a map of state naloxone overdose prevention laws. The Network for Public Health Law provides background on the state laws and a chart.
1 “Opioids: The Prescription Drug & Heroin Overdose Epidemic,” U.S. Department of Health and Human Services, March 24, 2016. LINK
2 “Prescription Opioid Overuse Data,” Centers for Disease Control and Prevention, June 21, 2016. LINK
3 “Opioids: The Prescription Drug & Heroin Overdose Epidemic,” U.S. Department of Health and Human Services, March 24, 2016. LINK
4 “State Legislation: Overdose Prevention,” Drug Policy Alliance, January 2016. LINK
5 “Naloxone access expanded to North Dakota pharmacies,” Devils Lake Journal, June 28, 2106. LINK
6 “Naloxone Overdose Prevention Laws Map,” LawAtlas, Feb. 1, 2016. LINK
7 McKesson Corporation, State Public Affairs, “Utilizing Pharmacists to Increase Naxalone Access.”
8 “Some Lehigh Valley pharmacies don’t comply with state order for naloxone,” Matt Coughlin and Pamela Lehman, The Morning Call, June 17, 2016. LINK
9 “Co-prescribing naloxone in primary care settings may reduce ER visits,” National Institute on Drug Abuse, June 28, 2016. LINK
10 “Getting overdose antidote with painkillers may cut ER visits,” Lauran Neergaard, The Seattle Times, June 27, 2016. LINK
11 “Old drug, new life: Naloxone access expands to community pharmacies,” Diana Yap, Pharmacy Today, Aug. 1, 2015. LINK
12 “Pharmacy Basics,” Prescribe to Prevent, February 2015. LINK