ECU study finds naloxone available at more than half of retail pharmacies surveyed
Researchers at East Carolina University found 3 out of 5 North Carolina retail pharmacies have naloxone in stock for opioid overdoses as part of a statewide standing order. But some independent pharmacies or those in rural areas lack same-day availability or would not sell it without a prescription.
Naloxone, also known as Narcan, is a medication that reverses the effects of an opioid overdose by blocking receptors in the brain and restoring breathing. In 2016, North Carolina enacted a standing order allowing pharmacies to dispense naloxone without a prescription to increase access for people who need it.
ECU made naloxone available at the Student Health Services pharmacy on main campus on Feb. 17.
The ECU study, recently published online in the American Journal of Preventive Medicine, examined the implementation of the statewide standing order through a phone survey developed by Dr. Kathleen Egan and Dr. Joseph G.L. Lee in the Department of Health Education and Promotion in the College of Health and Human Performance.
The study is the first of its kind in North Carolina, Egan said.
“It’s important to understand if pharmacies are implementing the standing order and if there are variations in implementation by pharmacy type or neighborhood characteristics,” she said.
A random sampling of chain, independent and health department pharmacies from a list of 2,044 active pharmacies provided by the N.C. Pharmacy Board were surveyed. The state publishes a list of pharmacies participating in the standing order.
Using a mystery caller protocol, ECU undergraduate students Ashton Knudsen and Samantha Foster called 200 pharmacies across the state between April and June 2019. They asked whether naloxone was available without a prescription, whether they could get it that day, and how much it cost.
The study found an estimated 61.7% of North Carolina retail pharmacies had naloxone available without a prescription. All the pharmacies surveyed carried intranasal naloxone spray, and 4.1% carried intramuscular naloxone (injection). The average out-of-pocket cost was $123.24 and $33.82 respectively. Seventy-five percent of the pharmacies that would sell naloxone said Medicaid or other forms of health insurance could cover the cost.
The odds of naloxone availability were lower for independent pharmacies than chains. It also was lower in communities with higher percentages of residents with public health insurance, the research showed.
“Chains may have more streamlined protocols to roll out the standing order for naloxone,” Egan said. “There may not be an unwillingness to dispense naloxone without a prescription at the independent pharmacies, rather, they may not have all the information to do so. It could be a stocking issue.”
In 2018, nearly five North Carolinians died each day from an unintentional opioid overdose. From 1999-2018, more than 14,500 lost their lives to unintentional opioid overdose, according to the N.C. Department of Health and Human Services, which oversees the state’s opioid action plan.
Knudsen said she hopes that the research can help individuals who live in rural parts of North Carolina. “Our conclusions indicated a potential inequity in smaller, more rural neighborhoods, which can prevent someone who needs naloxone from having access to it,” she said. “I am hoping this study can also be used to influence future policy regarding the supervision of adherence to the standing order.”
As of January 2019, North Carolina was one of 12 states across the country that had implemented statewide standing orders for naloxone.
Four previous studies were conducted on naloxone availability at pharmacies in California, New Jersey, Minnesota and the city of Philadelphia. North Carolina has the highest percentage of pharmacy participation in states with a standing order in the studies conducted to date.
Efforts to identify the best practices for ensuring widespread implementation of statewide standing orders for naloxone are warranted, the ECU study concluded.
For more information on naloxone availability in North Carolina, visit the Naloxone Saves website.
###
ECU News Services
Howard House, 1001 E. Fifth Street
Greenville, NC 27858
ecunews@ecu.edu
Phone: 252-328-6481
news.ecu.edu
Contact: Kathleen L. Egan, assistant professor, eganka18@ecu.edu