Study details how California pharmacies could expand naloxone access

“Naloxone saves lives,” says Andy Nguyen, PharmD. But to work, naloxone, a drug that reverses opioid overdoses, must be given on a moment's notice. That means getting the prescription drug into the hands of as many people who may encounter opioid users as possible.

In an effort to expand its usage and prevent some of the country’s 47,000 annual deaths from opioid overdoses, California passed AB-1535 in 2014, giving pharmacists the authority to provide naloxone to patients without a prescription from the doctor. But in 2017, Nguyen, who was pursuing his doctor of pharmacy (PharmD) degree at the UCSF School of Pharmacy, noticed that many pharmacies weren’t providing many, or even any, doses.

At the time, Nguyen was a pharmacy intern at Community Behavioral Health Service pharmacy under San Francisco Department of Public Health. The pharmacy was one of the few managing to give out a lot of naloxone.

After conversations with his advisor, Dorie Apollonio, PhD, MPP, as well as Thomas Kearney, PharmD, both faculty members in the Department of Clinical Pharmacy, Nguyen tracked down other pharmacies in California that had built naloxone into their work flows to find out why they were successful.

Pharmacies report that one of the biggest barriers to giving out naloxone is that the process takes extra time compared to filling regular prescriptions. Pharmacies that were successful with providing naloxone all had standardized policies that were clearly communicated to pharmacists and staff.

One pharmacy offered a to furnish naloxone to anyone who was filling an opioid prescription, and chain pharmacies in the study set regular goals for naloxone distribution, ensuring that the life-saving drug made its way into the hands that need it.

The study notes that there’s still a stigma surrounding the use of naloxone. Many pharmacies worry that naloxone attracts people with substance abuse disorders. While that population benefits the most from the drug, opioid overdoses can affect all types of patients, according to Apollonio.

Often times opioid patients are recovering from a medical condition or treatment and may be groggy or incapacitated. For the elderly, an opioid prescription can be one drug out of many they take every day, opening the door to accidentally taking the wrong dose.

For Nguyen, who is now a pharmacy resident at UC Davis Medical Center, there’s good news in the study: pharmacies in California that haven’t started providing naloxone can replicate what works in pharmacies that have, saving lives.

“What we really show is that some simple policy changes can get this drug to the people who need it,” Nguyen said.

More

Evaluation of naloxone furnishing community pharmacies in San Francisco (japha.org)