Opioid Overdose Deaths Decline When Pharmacists Can Dispense Naloxone Without a Prescription

Opioid Overdose Deaths Decline When Pharmacists Can Dispense Naloxone Without a Prescription

Fewer fatal opioid overdoses occur in areas where naloxone is available without a prescription, says a new study by the RAND Corporation. Naloxone reverses the deadly effects of an opioid overdose, if administered promptly.

Based on data from 2005 through 2016, fatal overdoses dropped an average of 27 percent in the year following no-prescription legislation enacted in several states. It improved even more in the following years, cutting overdoses on average by at least 34 percent.

The study basically looked at what changes occurred in the total number of opioid related overdose deaths, and the volume of naloxone prescriptions, depending on the various dispensing policies adopted in each state.

As we reported three years ago, by the end of 2016, naloxone was available to the public without a prescription in roughly 35 states and D.C. Since then, according to a recent report in the Journal of the American Medical Association (JAMA), every state has passed some kind of legislation expanding access to naloxone.

However, only a few states gave pharmacists direct authority to dispense naloxone without a prescription. The majority of states approved only indirect authority, requiring certain conditions to first be met. For example, customers might have to prove enrollment in certain certified treatment programs. In the rest of the country, a doctor's prescription for naloxone is required.

Direct pharmacist authority wins

The RAND study discovered that major reductions in overdose deaths only occurred in the growing number of states that grant pharmacists direct authority to dispense the life-saving medication. Direct authority was also associated with increased ER visits for nonfatal overdoses, and vastly greater naloxone sales, than in states that limited pharmacist authority.

State laws that don't allow direct dispensing did little to reduce opioid-related overdose deaths and had little effect on naloxone sales.

"While previous research has examined associations between expanded naloxone use and opioid-related deaths, the RAND study is the first to look at the impact of giving pharmacists direct authority to prescribe the drug," the corporation said in a news release.

The study results only validated direct authority legislation, and cast doubt on the value of limiting the pharmacist authority.


"This is strong evidence that greater use of naloxone can help reduce opioid-related deaths," said David Powell, a senior RAND economist. "But how laws are structured to increase naloxone use is important. Weaker laws that do not give pharmacists direct dispensing authority did not curb opioid deaths."

Not all pharmacies on board

At least two recent studies have found that drug store chains like CVS and Walgreens are more likely to offer naloxone than independent pharmacies. Yet fewer than one-third of even the chain pharmacy branches say that they provide it.

Examples abound, however, of naloxone remaining a rare find in many states and jurisdictions. Many drug stores, if not most, still don't stock it.

For example, in California two years after the state authorized prescription free naloxone, only 269 of 1,147 pharmacies surveyed said they would provide naloxone. Out of those, only 136 had the favored, easier-to-use nasal naloxone applicators in stock.

Texas is an example of wider availability. Three quarters of pharmacies surveyed had naloxone available, and nearly 85 percent said they would provide naloxone without a prescription.

But more needs to be done

Last year, Surgeon General Jerome Adams urged friends and families of anyone at risk of an opioid overdose to obtain and carry naloxone at all times. In spite of Adams' heartfelt encouragement, such has not come to pass to the degree it was hoped. The gruesome statistics bear this out.

"Overdose deaths from both prescription and recreational opioid use far exceed those from any prior U.S. drug epidemic," the RAND report said. "The number of opioid-related deaths each year since 2014 has surpassed the number of deaths associated with the peak of the HIV epidemic of the 1980s, as well as surpassing the number of deaths caused by auto accidents or gun violence."

In a JAMA editorial on the subject, Dr. Michael Steinman of UC San Francisco, and Dr. Seth Landefeld of UA Birmingham, commented that "a sense of inertia" plagues America's health care system.

"Improved training of pharmacists may be needed to make naloxone universally available for the prevention of opioid-related deaths," they wrote. "Such efforts will require resources, investment, and organizational support."

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