From the Journals

Despite access laws, barriers to naloxone remain



Despite the adoption of naloxone access laws, new findings suggest that naloxone availability without a prescription still varies between states.

Two research letters published Nov. 13 in JAMA examined pharmacy availability of naloxone in California and Texas 24 and 32 months, respectively, after implementation of expanded access laws.

In California, just 23.5% of retail pharmacies were dispensing naloxone without a prescription 2 years later. In Texas, however, 83.7% of chain pharmacies with expanded access via standing order reported that they would dispense naloxone without prescription 32 months later.

In the first study, investigators conducted an anonymous telephone survey of a 20% representative sample of California pharmacies. Posing as potential customers, interviewers asked pharmacy staff whether naloxone was available at their pharmacy without a prescription. They also inquired about what formulations were available, price, and whether naloxone could be billed to insurance, wrote Talia Puzantian, PharmD, and James J. Gasper, PharmD.

Naloxone was available at 23.5% (95% confidence interval, 21.0%-26.0%) of the 1,147 pharmacies that provided data. Chain pharmacies were more likely to dispense naloxone (31.6%; 95% CI, 28.3%-35.1%) than were independent pharmacies (7.5%; 95% CI, 5.1%-10.6%; P less than .001). Of pharmacies dispensing naloxone, 50.6% had nasal naloxone in stock, and 59.9% correctly said that naloxone could be billed to insurance, reported Dr. Puzantian, of the Keck Graduate Institute School of Pharmacy in Claremont, Calif., and Dr. Gasper, of the department of family and community medicine at the University of California, San Francisco.

Reasons for low availability in California pharmacies might include lack of knowledge and training, stigma about substance use, and time, Dr. Puzantian and Dr. Gasper said.

“Whether naloxone will become more available with training of additional pharmacists and implementation of standardized policies by pharmacy chains needs to be studied,” the authors concluded.

The second study examined naloxone availability among Texas chain pharmacies with public implementation of standing orders, for a survey of 2,317 CVS, Walgreens, HEB, and Walmart pharmacies. Interviewers posed as potential overdose responders, and inquired about purchasing naloxone without a prescription, reported Kirk E. Evoy, PharmD, of the College of Pharmacy at the University of Texas at Austin, and his coauthors.

Of the pharmacies surveyed, 83.7% (95% CI, 82.2%-85.2%) said they would dispense naloxone without a prescription, and 76.4% (95% CI, 74.7%-78.1%) currently stocked naloxone.

In addition, 79.9% (95% CI, 78.3%-81.6%) would allow purchase of naloxone for someone else, though only 49.7% (95% CI, 47.8%-51.9%) would allow the purchase to be billed to a third-party buyer’s insurance, the authors noted.

Although this study found that most pharmacies would dispense naloxone without a prescription, the findings cannot be applied to independent pharmacies, Dr. Evoy and his colleagues noted.

“Consistent naloxone supply in all pharmacies, improved pharmacist understanding of naloxone standing orders, and ubiquitous insurance coverage for third-party purchasers may further improve access,” they wrote.

Dr. Puzantian and Dr. Gasper reported no disclosures. Dr. Evoy disclosed receiving grant funding from the Institute for Integration of Medicine and Science at the UT Health in San Antonio, the Kleberg Foundation, and Texas Health and Human Services. Other authors disclosed previous receipt of donations of branded formulations of naloxone from Kaléo Pharma and Adapt Pharma.

SOURCE: Puzantian T et al. and Evoy KE et al. JAMA 2018 Nov 13.320(18):1933-7.

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