In communities around the country, health officials and lawmakers have expanded access to naloxone — the opioid overdose reversal medication — by making it available at pharmacies without a prescription. One problem: Not all pharmacies have gotten on board.

In California, less than one-quarter of pharmacies surveyed said that customers could pick up naloxone without a prescription, even though they have been legally allowed to do so since January 2016, according to one new study.

Only about half of the pharmacies that said they would give out the medication had any nasal naloxone in stock.

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And in Texas, according to a second new study, 1 in 4 pharmacies didn’t have it available. (Among all pharmacies surveyed in that state, however, 83.7 percent said they would dispense naloxone without a prescription.)

Both studies were published in the Journal of the American Medical Association on Tuesday.

In a separate editorial, Dr. Michael Steinman of University of California, San Francisco, and Dr. Seth Landefeld of University of Alabama at Birmingham wrote that the research reflected a sense of inertia in the 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.”

To combat rising opioid overdoses, some states and cities in recent years have changed their laws to allow pharmacists to dole out naloxone without requiring a prescription. Others have issued so-called standing orders, which act as blanket prescriptions for all residents. The goal is to reduce the obstacles people face in trying to get the lifesaving medication.

The research teams behind the two new papers embarked on “secret shopper” studies. Interviewers acted as potential customers and called around to pharmacies, asking if they would supply naloxone without a prescription and, if so, and if naloxone was available.

In California, researchers surveyed 1,147 pharmacies two years after state lawmakers authorized pharmacists to dispense naloxone without a prescription. Only 269 pharmacies said they would provide naloxone, and of those, only 136 had nasal naloxone on hand. (Some of the pharmacies may have had other formulations available.)

Chain pharmacies were more likely to offer naloxone than independent pharmacies, but still, fewer than one-third of chain pharmacy branches reported they would provide it.

“Patients may face a delay in access to the drug,” the study’s authors concluded.

For the Texas study, because the state does not have its own standing order, the researchers focused on chains — CVS, Walgreens, Walmart, and HEB — that have said they don’t require a prescription to distribute naloxone.

Interviewers called 2,317 pharmacies, 1,940 of which said they dispensed naloxone without a prescription. Of those, 1,771 had at least one formulation in stock.

The researchers highlighted several reasons for the slow rollout of accessible naloxone programs, including a lack of awareness of the policies, limited training for pharmacists, and stigma against people who use drugs.

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  • Even if it were immediately available, without prescription, in nasal spray form, hasn’t the cost increased geometrically to put it out of reach for the average consumer?
    Have I been misinformed?
    ~Cindy

    • Narcan Nasal Spray is $125 WAC for two units. Not a single price increase since it was launched 4 years ago.

  • All those years, the medical profession believes in evidence-based to benefit themselves. Now, a crisis of opioid, did they know the effect of these drugs they’ve been prescribing? Do they know fully the effect of any drug? Evidence-based, was there evidence? Where was the evidence? Are they blindly prescribing drugs they don’t fully understand?

  • As a pharmacist, I know first-hand that barriers outlined in the JAMA articles are real. I believe that classifying naloxone as an over-the-counter (OTC) measure needs to be a priority for the FDA for the following reasons:
    • OTC will help remove the stigma (real or perceived) that has been shown to impact whether a person will likely come into a pharmacy and buy naloxone or not. Simple example: more condoms sold if they are accessible on a shelf rather than behind the counter. Product placement and the removal of required interactions with pharmacy staff has been showed to improve access as this removes buyer stigma.
    • I have spoken to many patients that do not want the naloxone claim processed via their insurance for fear of how this could impact them later. Fear of information breach or how insurance carriers could view a naloxone purchase has yet to be looked or regulated.
    • OTC will allow for full pricing transparency. Manufactures often raise the cost of their products however since this rarely leads to changes in co-pay their actions go unnoticed/unchecked by the end user. A low tier placement or low co-pay by insurance carriers should never be misconstrued as access as the real costs are found in the claims which many never seen publicly.
    • Additionally, it is well documented that OTC equates to price stability and often even an overall price drop. OTC also decreases the cost to the healthcare system who are now covering (paying) naloxone.

    https://www.regulations.gov/docket?D=FDA-2018-P-3355

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