Opioid Overdose Deaths Decline When Pharmacists Can Dispense Naloxone

By Linda Carroll

(Reuters Health) - In states where pharmacists were allowed to sell the opioid antidote naloxone without a prescription, fewer people died from opioid overdoses, a new U.S. study finds.

The passage of laws that let pharmacists sell naloxone directly to patients was associated with a nearly 30 percent drop in the number of opioid overdose deaths compared to states without pharmacist dispensing, researchers report in JAMA Internal Medicine, May 6.

"This is additional evidence that naloxone laws that focus on broad access in distribution are effective in reducing opioid related harm," said study coauthor Rosalie Liccardo Pacula, senior economist and co-director of the Drug Policy Research Center at the RAND Corporation in Santa Monica, California. "Pharmacies are everywhere so they are easy access points."

One of the big advantages of allowing pharmacists to sell naloxone without prescriptions is that they are the ones talking to patients when fulfilling prescriptions for opioids, she noted.

"The pharmacists are interacting regularly with patients when they are picking up opioids," Pacula said. "If it's a parent who is picking up opioids for a child who is getting them because of a surgery, the doctor may not have talked to the parent about the risks of the drugs. This provides a window for the pharmacist to raise the parents' awareness of the risks associated with opioids."

To look at the impact of naloxone-related laws, Pacula and her colleagues turned to multiple databases, including 2010-2016 State Drug Utilization Data, in which outpatient drug use information for medications covered by state Medicaid agencies is recorded, and the National Center for Health Statistics System for 2005-2016 for opioid mortality figures.

When the researchers examined the laws involving naloxone prescriptions, they found that few states had any form of legislation before 2010. By 2016, 47 states had passed some sort of law regarding the life-saving medication, but only nine had laws giving authority to pharmacists to sell naloxone directly to patients.

The rates of monthly fatal overdoses between 2005 and 2016 were high, at 0.59 per 100,000 people, Pacula and her coauthors note. But the quarterly rate of Medicaid prescriptions for naloxone were not substantial: 0.046 per 100,000 beneficiaries between 2010 and 2016.

When the researchers compared the 2016 average number of opioid deaths in states that had not given direct authority to pharmacists to dispense naloxone, to those that had, they found direct dispensing was associated with a 27 percent lower rate of overdose deaths.

The researchers also noted that in the states that had a decline in death rates, there was an increase in visits to the emergency department for non-fatal overdoses.

While the new study does show an association between direct dispensing laws and lower rates of overdose deaths, it doesn't prove that the laws caused the reduction in deaths, said Dr. Michael Lynch, medical director of the Pittsburgh Poison Center at the University of Pittsburgh Medical Center in Pennsylvania. But it is suggestive, he said.

A big question, said Lynch, who wasn't involved in the study, is how people who don't get their drugs from a prescription would realize they can get naloxone from their pharmacist.

"Most overdose deaths from opioids lately are related to nonprescription opioids," Lynch said. "What will prompt a pharmacist to recommend that a patient get naloxone who doesn't have an opioid prescription?"

As for the increase in ED visits, Lynch says that is a good thing. While naloxone can reverse an overdose, patients still need to be seen by a doctor. Further, this can be an opportunity to suggest rehab to the patient, Lynch said.

SOURCE: https://bit.ly/2HaUF5W

JAMA Intern Med 2019.

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