Naloxone orders increase by 2328%


An Ohio law allowing pharmacists to dispense naloxone without a script saw the number of naloxone orders rise significantly… what results could we see in Australia?

A new study has found US state legislation allowing pharmacists to dispense naloxone without a prescription was associated with a significant increase in naloxone dispensing rates.

In July 2015, a new bill was passed in Ohio that further expanded access to naloxone by permitting pharmacists in the state to dispense naloxone without a script.

Naloxone could thus be dispensed to an individual where there is a reason to believe they are experiencing or at risk of experiencing an opioid-related overdose, and it could also be dispensed to a family member, friend, or other person in a position to assist an individual at risk of experiencing an opioid-related overdose.

As of May 2019, approximately 75% of community pharmacies in Ohio were registered to dispense naloxone without a prescription.

The recent study led by University of Cincinnati researchers looked at data of all patients 18 years and older with at least one naloxone order dispensed through Ohio Medicaid or by a Kroger Pharmacy during the study period of 16 July 2014 to 15 January 2017.

According to the results, published in JAMA Network Open, the number of naloxone orders dispensed after the policy was implemented increased by 2328% in the Ohio Medicaid population – from 191 in the pre-policy period to 4637 in the post-policy period.

The total number of patients receiving naloxone increased 2000%, from 183 in the pre-policy period to 3847 in the post-policy period.

Naloxone is a medicine that can reverse the side effects of an opioid overdose.

The number of orders dispensed by the three large chain community pharmacies increased by 3237%, from 59 in the pre-policy period to 1969 in the post-policy period.

The most commonly used naloxone delivery methods were intramuscular, which may have been used intranasally with an atomiser (i.e., off-label), and nasal (which was approved by the US FDA in November 2015).

No differences in sex, race, or geographic location were observed among patients in the pre-policy vs post-policy period.

However, patients residing in a low-employment county were significantly more likely to receive naloxone in the post-policy period (11.5%) compared with the pre-policy period (3.8%; P = 0.001).

Patients residing in a high-poverty county were also significantly more likely to receive naloxone in the post-policy period (13.6%) compared with the pre-policy period (6.0%; P = 0.003)

In Australia, naloxone was placed on Schedule 3 in February 2016, making it available over the counter with a private fee.

A naloxone pilot, currently running from 1 December 2019 through to 28 February 2021, is making the drug available free and without prescription to people who may experience, or witness, an opioid overdose.

A nasal spray form of naloxone was added to the PBS from 1 November 2019.

This pilot is being administered across three state: New South Wales, South Australia and Western Australia.

It is hoped the pilot will encourage pharmacists to supply naloxone and break barriers to access including prohibitive costs and lack of prescription by doctors.

PSA says it “wholeheartedly endorses” the need for naloxone to be more accessible for people who might find themselves at risk of opioid overdose, and supports the expansion of the trial.

“We want to see take home naloxone expanded, and we believe there is a need for greater support and awareness of the take home naloxone trials that are being conducted in SA, WA and NSW,” PSA national president Associate Professor Chris Freeman told AJP.

“Not only do patients need to be aware, but so do GPs and certainly pharmacists as well. There is a need for these pilots to allocate more resourcing to awareness of the program amongst the community, and we will certainly continue to make the case for this, and for expanded roll out.”

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