Public health leaders know that the opioid overdose reversal medication naloxone (Narcan) saves lives. They would like to draw firmer conclusions on what would serve as the most effective access points to the drug for at-risk individuals in a community. A three-year, $1.3 million grant from the Agency for Healthcare Research and Quality (AHRQ) will allow healthcare leaders in Massachusetts and Rhode Island to evaluate the potential of wider pharmacy-based distribution of naloxone.
The project's principal investigator says that the two states already have been pacesetters nationally in making naloxone more widely available through pharmacies. Traci C. Green, PhD, MSc, deputy director of the Injury Prevention Center at Boston Medical Center, says the demonstration project will allow leaders to determine what components are needed for successful implementation of a pharmacy-based naloxone distribution program.
The questions that need to be answered are many, says Green, and include:
Should pharmacy-based distribution of naloxone be offered, for example, to all patients who receive a prescription for an opioid medication?
Would such widespread distribution be practical?
How would individuals in the community perceive the outreach and advice offered by a pharmacist?
Would signage at the pharmacy setting be a help or a hindrance to accessing naloxone?
Do pharmacy technicians as well as pharmacists need to be trained in naloxone distribution?
Green says the three-year project will seek answers to these questions and more. “We want to know how to reach individuals at risk who don't live in urban centers, where most of the available treatment and harm reduction services are,” says Green, who is an associate professor of emergency medicine at Brown University's Warren Alpert Medical School and who chairs the Rhode Island Drug Overdose Prevention and Rescue Coalition.
Green explains that Massachusetts and Rhode Island have taken somewhat different paths toward expanded access to naloxone. The Massachusetts Department of Public Health has been involved for some time in ensuring that naloxone kits are available via a number of community-based sites, with detox centers most prominent in this effort. In Rhode Island, progress has been made in making naloxone available to individuals who ask for it directly at local pharmacies, without a physician's involvement.
Naloxone for overdose prevention is rarely prescribed by a physician. In both Massachusetts and Rhode Island, naloxone can be obtained from pharmacies without a prescription.
Green indicates that pharmacists have tended to be quicker than physicians to embrace naloxone and their role in making it available to persons at risk of overdose. “They will say, 'Of course we see this as our charge,'” she says of pharmacists.
She adds that while pharmacy-based distribution of naloxone has occurred to a degree in several other states, Massachusetts and Rhode Island have been seen as leaders. Partners in the newly announced grant initiative with Boston Medical Center are Rhode Island Hospital, national pharmacy leader CVS Health, and a number of community pharmacies in the two states.
Leaders of the initiative hope that the same success that pharmacies have had in broadening communities' access to immunizations and clean needles will be demonstrated in the area of overdose prevention.
Green adds that this area is also fertile for community partnerships. “There are so many opportunities for addiction medicine and pharmacy to interact,” she says. “Overdose prevention is a great place to start.”
Green and several colleagues, including Jeffrey Bratberg, PharmD, of the University of Rhode Island College of Pharmacy, have developed protocols for pharmacies to supply and provide naloxone. Green credits Bratberg for adding momentum to the effort to determine how to maximize pharmacies' potential as an access point for naloxone in the community. “The question is not if it would work, but how to make it work,” Green says.
She says the grant will be used over the next three years to help demonstrate how naloxone distribution can best be integrated into the pharmacy setting, and then to manualize that knowledge so that efforts can be replicated nationally.