Significant Gaps Identified in Access to OTC Naloxone, Nonprescription Syringes
Researchers conducted a cross-sectional study to investigate the accessibility of over-the-counter naloxone and nonprescription syringes at community pharmacies.
Notable gaps were identified in the accessibility and affordability of over-the-counter naloxone and nonprescription syringes, according to data published in JAMA Network Open.1 Researchers suggested that better educating community pharmacy staff on the benefits of storing these products can address gaps and make a critical difference in the opioid use crisis.
“Community pharmacies can protect the health of people who use drugs (PWUD) by facilitating access to naloxone and syringes,” wrote authors of the study. “Approval of some formulations of naloxone for over-the-counter (OTC) sale has the potential to advance these efforts. Studies before the OTC transition indicated naloxone was not consistently accessible, and little is known about stocking following this change.”
The use of overdose-reversing agents and drugs to treat opioid use disorder (OUD) have come a long way since the initial approval of naloxone in 1971 for treating overdoses.2 Since then, OUD has garnered much more attention and further options have been introduced, such as the first OTC naloxone spray (Narcan) approved in March 2023.3
Since naloxone's approval in 1971, OUD has garnered much more attention and further options have been introduced to reverse overdoses. | image credit: oasisamuel / stock.adobe.com
While there are more treatment options and less stigma regarding OUD, research continues to show a significant lack of access to naloxone and pharmacy staff unwilling to sell nonprescription syringes.
READ MORE: Community Pharmacies Motivated to Adopt Opioid Overdose Prevention Practices
“Access to sterile injection equipment for injection drug users (IDUs) is necessary to reduce the spread of blood-borne diseases. Nonprescription syringe sales are legal in 45 states,” wrote authors of a study published in the Journal of Urban Health.4 In the current study, researchers included access and affordability of nonprescription syringes due to its lack of evidence similar to that of OTC naloxone.
“This cross-sectional study is reported per Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines and designed to evaluate the accessibility of OTC naloxone and nonprescription syringes in community pharmacies in Austin, Texas,” they wrote.1
As part of the study design, researchers sent 5 trained auditors to community pharmacies in Austin from February 10 to April 27, 2024. Auditors were told to visually observe OTC naloxone availability and request to purchase 1 bag of 10 syringes, as stated in a predetermined script given to auditors.
“Outcomes related to OTC naloxone included availability, cost, location in the pharmacy, and the presence of theft deterrent measures,” they continued.1 “Outcomes related to syringes included success of purchase attempts, cost, and reasons for unsuccessful attempts.”
A total of 5 auditors were sent to examine 125 different community pharmacies in Austin. For visual access to OTC naloxone, 69 pharmacies (55.2%) had a location for the product; all 69 of those pharmacies had a location for branded OTC naloxone but just 12 pharmacies (17.4%) had visual access to the generic product. Moreover, there was at least 1 box of branded and unbranded OTC naloxone available at 45 pharmacies (36%).
“In 3 pharmacies where there was not a place on the OTC shelves for naloxone, auditors noted that branded product was visible behind the pharmacy counter. However, they were not able to confidently ascertain either the available stock or price,” wrote the authors. Overall, the median cost of branded naloxone was just $5 more than the generic.
Finally, nonprescription syringe purchase attempts were successful at 58.4% of community pharmacies, with the median cost being $3.19. Many pharmacy staff asked questions during purchase that focused on clarification of why the auditor purchased syringes. Auditors were most often denied syringes due to no proof of injectable medication to use with the product, such as insulin.
Identifying a lack of access to both OTC products, only 20% of community pharmacies had at least 1 box of naloxone and would allow the purchase of nonprescription syringes.
Researchers’ findings highlight a significant gap in access and affordability for overdose-reversing medications. Despite their recent evolution within health care and society, as well as their evidence-based benefits, these products remain underutilized amidst an ongoing opioid use crisis.
“Substantial gaps in accessibility and affordability of both OTC naloxone and nonprescription syringes were identified,” they concluded.1 “Efforts to educate pharmacy staff and support their implementation of evidence-based harm reduction strategies to safeguard the health of PWUD will be critical to addressing this public health emergency.”
READ MORE: AMA Urges Policymakers to Act Despite Report of Improved Opioid Epidemic
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