More Work to be Done to Expand Naloxone Availability in Pharmacies

One-third of pharmacies in a survey reported carrying naloxone nasal spray and many also required a physician’s prescription, according to a new study published in JAMA Network Open.

After a statewide standing order was enacted in 2015, Pennsylvania became one of the first states to allow pharmacists to dispense naloxone without a physician’s prescription. However, findings from a previous study suggested that pharmacist awareness of the statewide standing order is lacking, particularly in independent pharmacies.

The study authors examined the availability of naloxone nasal spray, with or without a prescription, at 418 pharmacies in Philadelphia, Pennsylvania through a telephone survey. The survey was conducted between February and August 2017.

Of the 418 pharmacies surveyed, 1 in 3 (34.2%) had naloxone nasal spray in stock and 61% of these said it was available without a prescription. However, the responses indicated that there were significant differences in availability by pharmacy type and neighborhood characteristics.

According to the survey, chain stores were more likely to have naloxone in stock and available without a prescription than independent stores. Additionally, naloxone was less likely to be available in pharmacies located in predominately minority neighborhoods compared with neighborhoods with a large proportion of white residents.

Although 90.6% of retail chains who did not have naloxone in stock reported being able to order it, only 60.6% of independents said they were able to do so. This disparity was also observed among pharmacies in predominately minority and low-income neighborhoods compared with other locations.

Notably, the findings showed that residents of communities with the highest rates of opioid overdose deaths are more likely to face barriers to accessing naloxone. Even in areas with elevated rates of overdose deaths, pharmacies were found to be less likely to carry naloxone compared with pharmacies in communities with lower overdose rates, according to the survey.

However, the researchers suggested that naloxone access laws that consist of a statewide standing order are not necessarily more effective in expanding naloxone availability. For example, in California, which does not have a statewide standing order for naloxone, more pharmacies stocked naloxone nasal spray in 2017 compared with the pharmacies in Philadelphia. 

“These findings underscore the importance of increasing pharmacy awareness of statewide standing order protocols and ensuring naloxone is available in their stores,” the authors wrote in the study.

Philadelphia recently introduced a bill that will require all pharmacies to stock naloxone and post a sign notifying the public of availability, the researchers noted.

They recommended policies that discourage pharmacies from imposing unnecessary dispensing restrictions, such as individual prescription or age requirements, especially in critical neighborhoods. Efforts to address the high cost of naloxone are also important, the researchers added. 

Reference

Guadamuz JS, Alexander GC, Chaudhri T, et al. Availability and cost of naloxone nasal spray at pharmacies in Philadelphia, Pennsylvania, 2017. JAMA Network Open. 2019. doi:10.1001/jamanetworkopen.2019.5388