Orienting patients to greater opioid safety: models of community pharmacy-based naloxone

Abstract

The leading cause of adult injury death in the U.S.A. is drug overdose, the majority of which involves prescription opioid medications. Outside of the U.S.A., deaths by drug overdose are also on the rise, and overdose is a leading cause of death for drug users. Reducing overdose risk while maintaining access to prescription opioids when medically indicated requires careful consideration of how opioids are prescribed and dispensed, how patients use them, how they interact with other medications, and how they are safely stored. Pharmacists, highly trained professionals expert at detecting and managing medication errors and drug-drug interactions, safe dispensing, and patient counseling, are an under-utilized asset in addressing overdose in the U.S. and globally. Pharmacies provide a high-yield setting where patient and caregiver customers can access naloxone-an opioid antagonist that reverses opioid overdose-and overdose prevention counseling. This case study briefly describes and provides two US state-specific examples of innovative policy models of pharmacy-based naloxone, implemented to reduce overdose events and improve opioid safety: Collaborative Pharmacy Practice Agreements and Pharmacy Standing Orders.

Figure 1

Pharmacy Naloxone Access Models. Process flow as experienced by patient and pharmacist. Nlx Naloxone, Rx prescription, MD medical doctor, DO doctor of osteopathic medicine, NP nurse practitioner, PA physician assistant, CPA collaborative practice agreement, State abbreviations: WA Washington, RI Rhode Island, VA Virginia, GA Georgia, CA California, NV Nevada, NM New Mexico, ID Idaho

Figure 2

Overdose deaths and pharmacy-based naloxone prescriptions dispensed in Rhode Island, 2009 to 2015, by quarter. SOURCE: Rhode Island Department of Health, 2015