Examining Naloxone Availability at Rural Pharmacies

^{By Julie Gould} 

In a recent research letter published online in JAMA Network Open, a team of researchers observed rates of naloxone availability in rural Georgia pharmacies.

“This cross-sectional study evaluated the availability of naloxone, pharmacists’ awareness of the standing order, and the cost of the drug from chain and independent pharmacies in legislatively designated rural counties in Georgia 52 months after the standing order was signed into law,” explained lead study authors Jenn Nguyen, PhD, assistant professor, Mercer University College of Pharmacy, and colleagues.

To better understand the findings of the research and clinical implications, Pharmacy Learning Network spoke with Dr Nguyen.

Please introduce yourself, including your name, title, and affiliation. Please feel free to include details about your research background, too. 

I earned my PhD in Public Health from the University of Florida College of Public Health and Health Professions with postdoctoral training at the University of Florida College of Pharmacy and the National Cancer Institute. My research interests include behavioral science, public health promotion, and pharmacy practice.

What existing data led you and your co-investigators to conduct this research?

The alarmingly high rates of opioid abuse, misuse, and opioid-related deaths nationally and locally concerned our team. We learned that in response to these high mortality rates, all states have removed some legal barriers to increase access. 

Please briefly describe your study and its findings. Were any of the outcomes particularly surprising?

Even though legislative barriers were removed, it does not mandate access. We were interested whether or not naloxone was accessible in communities, especially vulnerable communities. We employed a secret shopper methodology and called all pharmacies located in legislatively designated rural counties in the state of Georgia (n=374). We were able to reach 364 pharmacies (97.3% response rate). Approximately 55% (n=199) of the pharmacies claimed to have the medication in stock. When asked if a prescription is required to obtain naloxone, only 47% (n=122) correctly stated that a prescription was not necessary. This result was surprising to us because it suggests that misinformation and supply chain were two of the biggest barriers that rural communities face in accessing naloxone. 

What are the possible real-world applications of these findings in clinical practice?

There are two big implications with regards to this finding. The first is that further education and training are necessary to ensure proper translation and execution of this particular mandate addressing a public health issue. The second is that the pharmacy, and pharmacists, serve as information and resource portals for their community. Even if their pharmacy did not stock naloxone, they can provide their patients with high-quality care. In this case, the pharmacist could refer the patient to another pharmacy and address any concerns regarding access.

Do you and your co-investigators intend to expand upon this research?

Yes, we do intend to expand upon this research. We are currently exploring ways to effectively address the misinformation, encourage pharmacies to have the drug in stock, and disseminate the information as widespread as possible in these rural communities. 

Is there anything else pertaining to your research and findings that you would like to add?

While policy changes have addressed some barriers, more efforts are necessary to ensure unrestricted access to this potentially life-saving drug, especially in vulnerable communities. Every health professional can play a vital role in lowering the alarming rates of opioid-related mortality of this public health crisis.

Reference:

Nguyen JL, Gilbert LR, Beasley L, et al. Availability of Naloxone at Rural Georgia Pharmacies, 2019. JAMA Netw Open. 2020;3(2):e1921227. Published 2020 Feb 5. doi:10.1001/jamanetworkopen.2019.21227