Pharmacist Naloxone Dispensing Law Associated with Increased Access

An Ohio law allowing pharmacists to dispense naloxone without a prescription was linked to a significant increase in naloxone dispensing rates, especially in low-employment areas, according to a new study published in JAMA Network Open.

In 2015, Ohio passed a law allowing pharmacists to dispense naloxone without a prescription in accordance with a physician-approved protocol.

For the study, the researchers analyzed naloxone dispensing rates after the implementation of the state law using Ohio Medicaid naloxone claims and Kroger Pharmacy naloxone claims for all counties in Ohio.

Any patients 18 years or older with at least 1 naloxone order dispensed through Ohio Medicaid or by a Kroger Pharmacy in Ohio during the study period of July 16, 2014 to January 15, 2017 were included.

Overall, in the Ohio Medicaid population, the number of naloxone orders dispensed in the post-policy period increased by 2328%, from 191 in the pre-policy period to 4637 in the post-policy period. Additionally, the number of orders dispensed by the 3 large chain community pharmacies increased by 3237%, from 59 in the pre-policy period to 1969 in the post-policy period, according to the study.

The results also showed that patients residing in a low-employment county were significantly more likely to receive naloxone in the post-policy period (11.5%) compared with the pre-policy period (3.8%; P=.001). Individuals in high-poverty counties were also significantly more likely to receive naloxone in the post-policy period (13.6%) compared with the pre-policy period (6%; P=.003).

Compared with high-employment counties, the naloxone dispensing rate in low-employment counties increased by 18%, according to the study.

A previous study by the US Department of Health and Human Services reported that unemployment rates were highly correlated with the magnitude of the opioid crisis, the study authors noted. Recognizing the significance of naloxone accessibility, the FDA is now considering allowing naloxone to be available over the counter.

“Pharmacists are in a strong position to support these strategies because they serve as patient educators, provide recommendations for the appropriate use of opioids and their adverse effects, and can advise patients and their family members about the availability of naloxone,” the authors wrote.

Moreover, the authors also noted that pharmacists are able to provide medication-assisted treatment and can work with the health care team to optimize pain treatment.  

Identifying and educating patients who might benefit from the protocol is key, they said. “The study suggested that a universal offer should be made to provide naloxone at pharmacies, and pharmacists should offer naloxone as a part of a universal opt-out strategy to all patients who are perceived as having a high risk of opioid misuse.”

References:

• Gangal NS, Hincapie AL, Jandarov R, et al. Association Between a State Law Allowing Pharmacists to Dispense Naloxone Without a Prescription and Naloxone Dispensing Rates. JAMA Network Open. 2020. Doi: 10.1001/jamanetworkopen.2019.20310