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Should Pharmacists Universally Offer Naloxone with Opioid Prescriptions?

March 28th, 2017

BOSTON — While naloxone effectively blocks or reverses the effects of opioid overdoses, the challenge has been getting it to the people who need it.

A new study in the Journal of American Pharmacists Association suggests one answer is for pharmacies to proactively offer naloxone to patients taking opioid medications. Study authors, led by researchers from Boston Medical Center, urge the use of universal opt-out strategies as a way to better distribute the life-saving drug.

Background information in the article points out that education efforts and providing naloxone, marketed as Narcan, to people who are at risk of witnessing or experiencing an overdose leads to a 30% to 50% decline in opioid death rates.

The authors note that pharmacists in Massachusetts and Rhode Island currently can provide naloxone without a prescription. Barriers to greater dissemination of the drug, however, include reluctance on the part of patients to ask for it, as well as pharmacist concerns about offering it without such a request.

"There's this tension between patients who are afraid of the stigma associated with asking for naloxone, and pharmacists who worry about damaging relationships or breaking trust with patients by offering it," explained lead author Traci Green, PhD, MSc, epidemiologist and associate director of the Injury Prevention Center at BMC. "It's these fears that hold pharmacists back from offering naloxone to people who may need it for themselves or their family.”

To better understand the situation, Green and her colleagues conducted a series of eight focus groups in two states with more than 60 pharmacists, pain patients, current and former drug users, and family members of people who use opioids.

Results indicate widespread support for an "opt-out" model of offering naloxone in the pharmacy, rather than the current model that requires customers to request it at the pharmacy counter. With the opt-out model, researchers emphasize, naloxone is universally offered to those obtaining opioid prescriptions or those with identifiable medication-related risks, such as patients taking high doses of opioids for pain or for opioid use disorder, or those who are co-prescribed opioids and sleep aids or anxiety drugs.

Also targeted would be caregivers, friends, and family members who pick up opioid prescriptions for patients.

"Most overdoses occur at home or with a loved one close by,” Green pointed out. “With expanded naloxone access in the pharmacy setting, we have the opportunity to give people the choice to keep themselves and their family safe, and reduce the stigma of getting naloxone and of addiction. Our study suggests that by giving pharmacists the model and language to do so, they have the power to save a life with naloxone.”

The study is one of the results of a three-year project funded by the Agency for Healthcare Research & Quality to determine the best way to provide naloxone in the pharmacy setting.

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