Increasing Naloxone Access and Use to Prevent Opioid Overdose Death and Disability

Legislative Changes to Improve Naloxone Access

All 50 states allow medical providers to prescribe naloxone to patients at risk for opioid overdose. ⁵ However, this traditional process of prescribing and dispensing has been unable to meet the needs of the growing opioid crisis. There are a number of reasons this traditional model of prescription fails. For example, not all individuals at risk of overdose have a primary care provider they see regularly. Lack of insurance and transportation frequently serve as barriers to an office visit or trip to the pharmacy. And even those patients with established primary care providers and resources to acquire the medication may not discuss or request naloxone due to the stigma of addiction or fear of legal repercussions.

Legislative changes to increase access to naloxone vary by state but generally expand access through one of three strategies ⁶ :

Role of the Health Care Practitioner

Even with legislation in place expanding access to naloxone, the life-saving antidote is underutilized. A recent study in the American Journal of Emergency Medicine found that some opioid users are more likely than others to know about and use naloxone. ⁸ Patients presenting to the emergency department (for any reason) identified as opioid users were administered a 14-question survey about their opioid use and awareness, access to and use of naloxone. The study found that naloxone awareness and access was greater among patients with a history of injecting heroin. Specifically, 76% of injectable heroin users reported having heard of naloxone and 39% reported having access to naloxone while just 32% of those with no history of injecting heroin had heard of naloxone and only 2% reported having access to it.

These findings are concerning and suggest that current naloxone education and distribution efforts may not be reaching all types of opioid users. It is imperative that all health care providers are screening patients for factors that increase risk for opioid overdose. The Surgeon General lists the following criteria for elevated risk of opioid overdose ⁴ :

In the primary care setting, patients at risk for opioid overdose should receive counseling on the use of naloxone and should be provided a prescription for naloxone. Patients should also be encouraged to discuss the use of naloxone with their family members and friends and ensure these individuals are trained in identifying overdose symptoms and administering the medication, if necessary.

Prescribers should find out whether their state permits pharmacists to prescribe or dispense naloxone under a standing order or collaborative practice agreement and engage pharmacy partners to ensure greater community access to naloxone.

In the pharmacy setting, pharmacists should partner with prescribers to establish standing orders or collaborative practice agreements to ensure the ability to legally dispense naloxone to the public. Pharmacists should strive to make naloxone distribution without the need for a prescription standard practice, especially in rural areas where access to other providers and programming is limited. Naloxone should be prominently displayed behind the counter (similar to pseudoephedrine products currently) and naloxone availability should be marketed at the pharmacy so customers are aware of the ability and process to obtain it.

Pharmacists should ensure all patients who receive a naloxone prescription are trained in administering the medication and encourage the patient to refer family members and friends to the pharmacy for demonstration and training as well.

Health care providers should be aware of and advocate for legislation that expands access to naloxone in their state. Providers are also responsible for ensuring these legislative efforts are put to use within their practice.