Accessing Naloxone: Are New Laws Helpful or Confusing?

by Joy Rooney. Editing by Victoria Constant, James Lott (PharmD), and Maryiam Saifuddin.

A Pharmacist from the Good Care Pharmacy (Houston, TX) fills a prescription for Narcan.

If you have found your way to Naloxone Exchange, an online platform to legally order the medication, you may know what naloxone or Narcan is. Unfortunately, regardless of its life-saving capabilities, naloxone is not a household name, and many people don’t know what it is or what it’s used for.

Naloxone is the antidote to opioid overdoses caused by prescription drugs like OxyContin and Vicodin, as well as illicit drugs such as heroin and fentanyl. In the right dosage, naloxone can safely revive someone who has overdosed. Narcan is a brand-name version of the generic drug naloxone, which is administered intranasally via a patented nasal-spray atomizer. Narcan is far more user friendly, because it does not require knowledge of how to administer an injection.

NPR and IBM Watson Health recently surveyed 3,000 participants to determine how many people know about naloxone and how comfortable participants would be administering naloxone to someone who may have overdosed. Approximately 59% of respondents knew about naloxone. Although more than half of the respondents may be aware of naloxone, some do not appear to be familiar with existing laws in some states which facilitate access to and use of naloxone.

Most states have implemented at least one of the 3 following types of regulations to help increase access to and use of naloxone:

(1) Statewide standing orders which allow a licensed pharmacist to write a naloxone prescription on demand or to directly dispense naloxone;

(2) Legal permission for prescriptions for naloxone to be written for a patient, a loved one, or anyone who may be in contact with someone who may experience an overdose;

(3) Additional protections in some states’ “Good Samaritan Law,” which grants immunity (drug possession, drug paraphernalia, or other violations) to anyone who calls 911 as follow-up care after administering naloxone

Unfortunately, these laws are not consistent across all states. For example, many states have standing orders that allow pharmacists to dispense naloxone without a prescription from a doctor, but some states require pharmacies to register as a naloxone dispensing pharmacy, and others do not. In the State of New York, a Pharmacist Program Coordinator signs a dispensing protocol that requires quarterly reporting of naloxone units dispensed and renewal of the agreement every two years. While the State of Louisiana has a statewide standing order from the Secretary of the Louisiana Department of Health, the standing order must be attached to the invoice or record of sale. Do the above barriers for pharmacists prevent smaller pharmacies from using standing orders? With respect to Good Samaritan Laws, what kind of protection can people expect when they help someone who has overdosed?

Besides increasing public awareness, the data suggests that naloxone access has become increasingly confusing to the general public. The survey reports 35.5% indicated that respondents thought you need a prescription to receive it, 33.9% said you didn’t need a prescription, and 30.5% didn’t know or didn’t respond. Large pharmacies like CVS, Walgreens, Rite-Aid, and Kroger supply naloxone “with no prescription” in many, but not all, states. However, several states have implemented standing orders allowing pharmacists at participating pharmacies to write a prescription on demand, which appears similar to supplying naloxone without a prescription. Do people consider these methods the same? Or do they think that naloxone is still difficult to obtain unless they visit one of these stores?

Even with increasing efforts toward naloxone awareness and access, stigma remains an issue. If someone knows about naloxone and wants to buy it for a friend or family member, he or she may face the either perceived or real judgment. For someone in a small community with only one pharmacy that can dispense naloxone, stigma can be inhibiting. Although we hope to stop stigma, we know that it has prevented many from seeking treatment or helping their loved ones.

It is Fiduscript’s goal to address these issues so that we can help save lives. As we prepare for Naloxone Exchange’s launch in the state of Texas, we hope to continue to provide insight into the policies intended to address the opioid epidemic, to educate and train those interested in administering naloxone, and to fight the stigma that has plagued too many in our community.

Sources:

Hensley, Scott. “Poll: Most Americans Know About Opioid Antidote And Are Willing To Use It.” National Public Radio. August 2018. www.npr.org/sections/health-shots/2018/08/21/640195328/poll-most-american-know-about-opioid-antidote-and-are-willing-to-use-it Accessed November 8, 2018.

“Health Poll: Opioid Antidotes.” IBM Watson Health & NPR. June 2018.

https://truvenhealth.com/Portals/0/Assets/NPR-Truven-Health-Poll/NPR_Poll_Executive_Summary_Opioid_Antidote_FINALv3.pdf Accessed November 8, 2018.

Prescription Drug Abuse Policy System. (2018). Good Samaritan Overdose Prevention Laws [Data file]. Available from Prescription Drug Abuse Policy System Web site: http://pdaps.org/datasets/good-samaritan-overdose-laws-1501695153 Certificate for use: https://creativecommons.org/licenses/by/4.0/