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 The passage of laws that let pharmacists sell naloxone directly to
patients was associated with a nearly 30 percent drop in the number
of opioid overdose deaths compared to states without pharmacist
dispensing, researchers report in JAMA Internal Medicine.
"This is additional evidence that naloxone laws that focus on broad
access in distribution are effective in reducing opioid related
harm," said study coauthor Rosalie Liccardo Pacula, senior economist
and co-director of the Drug Policy Research Center at the RAND
Corporation in Santa Monica, California. "Pharmacies are everywhere
so they are easy access points."
One of the big advantages of allowing pharmacists to sell naloxone
without prescriptions is that they are the ones talking to patients
when fulfilling prescriptions for opioids, she noted.
"The pharmacists are interacting regularly with patients when they
are picking up opioids," Pacula said. "If it's a parent who is
picking up opioids for a child who is getting them because of a
surgery, the doctor may not have talked to the parent about the
risks of the drugs. This provides a window for the pharmacist to
raise the parents' awareness of the risks associated with opioids."
To look at the impact of naloxone-related laws, Pacula and her
colleagues turned to multiple databases, including 2010-2016 State
Drug Utilization Data, in which outpatient drug use information for
medications covered by state Medicaid agencies is recorded, and the
National Center for Health Statistics System for 2005-2016 for
opioid mortality figures.
When the researchers examined the laws involving naloxone
prescriptions, they found that few states had any form of
legislation before 2010. By 2016, 47 states had passed some sort of
law regarding the life-saving medication, but only nine had laws
giving authority to pharmacists to sell naloxone directly to
patients.
The rates of monthly fatal overdoses between 2005 and 2016 were
high, at 0.59 per 100,000 people, Pacula and her coauthors note. But
the quarterly rate of Medicaid prescriptions for naloxone were not
substantial: 0.046 per 100,000 beneficiaries between 2010 and 2016.
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When the researchers compared the 2016 average number of opioid
deaths in states that had not given direct authority to pharmacists
to dispense naloxone, to those that had, they found direct
dispensing was associated with a 27 percent lower rate of overdose
deaths.
The researchers also noted that in the states that had a decline in
death rates, there was an increase in visits to the emergency rooms
for non-fatal overdoses.
While the new study does show an association between direct
dispensing laws and lower rates of overdose deaths, it doesn't prove
that the laws caused the reduction in deaths, said Dr. Michael
Lynch, medical director of the Pittsburgh Poison Center at the
University of Pittsburgh Medical Center in Pennsylvania. But it is
suggestive, he said.
A big question, said Lynch, who wasn't involved in the study, is how
people who don't get their drugs from a prescription would realize
they can get naloxone from their pharmacist.
"Most overdose deaths from opioids lately are related to
nonprescription opioids," Lynch said. "What will prompt a pharmacist
to recommend that a patient get naloxone who doesn't have an opioid
prescription?"
As for the increase in emergency room visits, Lynch says that is a
good thing. While naloxone can reverse an overdose, patients still
need to be seen by a doctor. Further, this can be an opportunity to
suggest rehab to the patient, Lynch said.
SOURCE: https://bit.ly/2HaUF5W JAMA Internal Medicine, online May 6,
2019.
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