Abstract
IntroductionExpanding naloxone availability is important to reduce opioid-related deaths. Recent data suggest low, variable urban naloxone availability. No reports describe naloxone availability at the point of sale (POSN). We characterize POSN without prescription across a Midwestern metropolitan area, via a unique poison center-based study.MethodsPharmacies were randomly sampled within a seven-county metropolitan area, geospatially mapped, and distributed among seven investigators, who visited pharmacies and asked, “May I purchase naloxone here without a prescription from my doctor?” Following “No,” investigators asked, “Are you aware of the state statute that allows you to dispense naloxone to the public under a standing order?” Materials describing statutory support for POSN were provided. Responses were uploaded to REDCap in real time. We excluded specialty (veterinary, mail order, or infusion) pharmacies a priori. POSN availability is presented as descriptive statistics; characteristics of individual sites associated with POSN availability are reported.ResultsIn total, 150 pharmacies were prospectively randomized, with 52 subsequently excluded or unavailable for survey. Thus, 98 were included in the final analysis. POSN was available at 71 (72.5%) of 98 pharmacies. POSN availability was more likely at chain than independent pharmacies (84.7% vs 38.5%, p<0.001); rural areas were more commonly served by independent than chain pharmacies (47.4% vs 21.5%, p = 0.022). Five chain and five independent pharmacies (18.5% each) were unaware of state statutory support for collaborative POSN agreements. Statutory awareness was similar between independent and chain pharmacies (68.8% vs 54.6%, p = 0.453). Rationale for no POSN varied.ConclusionPOSN is widely available in this metropolitan area. Variability exists between chain and independent pharmacies, and among pharmacies of the same chain; awareness of statutory guidance does not. Poison centers can act to define local POSN availability via direct inquiry in their communities.
Highlights
Expanding naloxone availability is important to reduce opioid-related deaths
point-of-sale naloxone (POSN) availability was more likely at chain than independent pharmacies (84.7% vs 38.5%, p
POSN is widely available in this metropolitan area
Summary
Expanding naloxone availability is important to reduce opioid-related deaths. Recent data suggest low, variable urban naloxone availability. Naloxone Availability to opioids in 2017, making them the second most commonly cited exposure category involved in overdose deaths.[2] The importance of efforts to decrease or eliminate morbidity and mortality attributed to opioid use, misuse, and overdose remains a public health priority, within which primary and secondary prevention efforts have been increasingly accompanied by efforts to broaden the distribution of the opioid reversal agent, naloxone.[2,3]. Naloxone distribution has been shown to be a cost-effective way to decrease overdose mortality,[8] and evidence modeling naloxone distribution at a time of increasing fentanyl adulteration suggests a survival benefit to naloxone distribution.[9] penetrance of naloxone prescribing varies,[10] the practical availability of point-of-sale naloxone (POSN) without a medical prescription remains ill-defined. In a manner analogous to previously controversial but widely accepted needle-exchange programs to prevent the spread of HIV and other communicable diseases,[11,12] expanded availability of POSN without a medical prescription offers the hope of increased access to a life-saving antidote with fewer acquisition barriers
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