Pharmacist prescribing of naloxone improves access to life-saving medication
The number of naloxone orders dispensed in Ohio surged by 2,328% after the Ohio General Assembly approved a law in 2015 allowing pharmacists to dispense naloxone without a prescription, according to a recent study in JAMA Network Open. With prior studies estimating a 14% reduction in death by opioid-related overdose in states where access to naloxone is increased, the findings are significant.
“Legal barriers needed to be removed to address this important public health crisis. Pharmacists positively impact the health of patients every day and work tirelessly to address the opioid epidemic. By providing naloxone, pharmacists save lives,” said lead study author Neha Gangal, a PhD candidate in pharmacy practice at the University of Cincinnati’s (UC) James L. Winkle College of Pharmacy, in a UC news release.
Gangal and colleagues compared 18 months of postpolicy to prepolicy data from Ohio’s Medicaid records and the database of Kroger Co.’s Ohio pharmacies, which includes prescriptions for patients with all types of insurance, not just Medicaid. Ohio’s Medicaid population is approximately 2.2 million, or 21% of the state’s population of 11.42 million.
Among Medicaid recipients, the total number of patients receiving naloxone increased from 183 patients in the prepolicy period to 3,847 patients in the postpolicy period. The analysis using the Kroger data confirmed an increase in the number of naloxone prescriptions dispensed for all types of insurance, including cash prescriptions.
In addition, low-employment counties had 18% more naloxone prescriptions dispensed per month compared with high employment counties. The researchers said the increase in low employment areas is most likely because the local pharmacy is often the sole health care contact for people living in these locations.
The team said they do not know whether the naloxone was for personal use, a family member, or a friend because the law was written to specifically allow access. Their study also did not seek to quantify the impact of increased naloxone distribution on the rate of opioid abuse or mortality from overdose.
“Overdoses are not a planned event, so during an emergency is not the time to try and access naloxone,” said study author Pam Heaton, a professor of pharmacy practice at UC’s Winkle College, in the UC news release. “The intent is for any adult to be able to go to a pharmacy and purchase naloxone for themselves or for anybody who might need it, so they are adequately prepared to administer a lifesaving medication.”
The majority of states now allow pharmacists to dispense naloxone without a prescription under varying guidelines. Between 2015 and 2017, Ohio had the second-highest number of opioid-related deaths. As of May 2019, approximately 75% of community pharmacies in Ohio were registered to dispense naloxone without a prescription.