MedicalResearch.com Interview with:
Talia Puzantian, PharmD, BCPP
Associate Professor of Clinical Sciences,
School of Pharmacy and Health Sciences
Keck Graduate Institute
MedicalResearch.com: What is the background for this study?
Response: Naloxone has been used in hospitals and emergency rooms since the early 1970s. Distribution to laypersons began in the mid-1990s with harm reduction programs such as clean needle exchange programs providing it, along with education, to mostly heroin users. In the years between 1996-2014, 152,000 naloxone kits were distributed in this way with more than 26,000 overdoses reversed (https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6423a2.htm).
We have data showing that counties in which there was greater naloxone distribution among laypeople, there were lower opioid death rates (Walley AY et al BMJ 2013). However, not all opioid users at risk for overdose will interface with harm reduction programs, particularly prescription opioid users, hence more recent efforts to increase access to laypersons through pharmacists. Naloxone access laws have been enacted in all 50 states but very little has been published about how they’ve been adopted by pharmacists thus far. One small study (264 pharmacies) from Indiana (Meyerson BE et al Drug Alcohol Depend 2018) showed that 58.1% of pharmacies stocked naloxone, only 23.6% provided it without prescription, and that large chain pharmacies were more likely to do so.
MedicalResearch.com: What are the main findings?
Response: Our findings, from a much larger state and with a larger sample size of pharmacies, are very similar: 23.5% of 1147 pharmacies in California (a sample representing 20% of the state’s pharmacies) responded in a survey that they could provide naloxone without a prescription but only about ½ had it in stock. Chain pharmacies were much more likely to provide and stock naloxone. We identified knowledge gaps (which formulation is appropriate to provide, whether insurance can be billed if pharmacist is providing) that need to be addressed in the training of pharmacists. In our other efforts training pharmacists on naloxone throughout California, we’ve identified lack of the State Board of Pharmacy’s training requirement as a significant barrier to furnishing naloxone. Hence, in collaboration with the California Board of Pharmacy, we’ve develop a free webinar meeting the training requirement and addressing the gaps found in this survey. This webinar launched at the end of October and can be found here:
MedicalResearch.com: What should readers take away from your report?
Response: Roughly 9 out of 10 Americans live within 5 miles of a community pharmacy. In metropolitan areas, the average distances is 1.83 miles. Many pharmacies are open 24/7. Not only are pharmacists accessible, but they are trusted and knowledgeable health professionals and drug experts who promote medication safety. Pharmacists have successfully implemented pharmacy based public health initiatives including immunization for their communities. Pharmacists are well poised because they have access to information to assess overdose risk potential (e.g., dosage of prescription opioid, concurrent medications which could increase risk for overdose, concurrent medical conditions which can increase risk). Patients may not consider themselves at risk for opioid overdose if they are using opioids prescribed by their physician but nearly half of opioid overdose deaths are due to prescription opioids. Pharmacists can help identify and educate patients about risk, prevention, recognition and they can provide naloxone. This survey study suggests we need to provide more education, resources and support to pharmacists to increase the practice of pharmacy-based naloxone distribution.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Future research should help identify barriers to pharmacist furnishing of naloxone. Identified barriers as well as knowledge gaps identified in this study (e.g., which naloxone formulations are appropriate to furnish, whether insurance can be billed for furnished naloxone) should be addressed in future efforts to train and prepare pharmacists to take a more active role in opioid overdose prevention. Independent pharmacies may need more education and resources in order to increase their ability to provide pharmacy-based naloxone. We may need to increase the public’s awareness of the role of pharmacists in opioid safety; increasing demand may increase provision of this service as well as stocking of naloxone. A similar follow up survey, conducted perhaps three years after implementation, may provide a perspective of trend and help inform on impact of efforts and time.
MedicalResearch.com: Is there anything else you would like to add?
Response: Opioid overdose occurs quickly, necessitating immediate response. Having first responders equipped with naloxone has saved countless lives. Any delay in response can be critical therefore those at risk for overdose should be equipped with naloxone. Some at-risk individuals may receive naloxone from a harm reduction program, others may receive a co-prescription of naloxone from their opioid prescribers, others may rely on a pharmacist to provide naloxone. The scope of opioid overdose deaths in this country suggests we need multiple avenues for the general public to access to naloxone. The US Surgeon General released a rare advisory in April 2018 that more people should carry naloxone and that there should be greater availability to this life saving drug: The more available naloxone is, the more likely it will save lives.
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