By Lisa Rapaport
Despite state laws expanding access to the opioid-overdose antidote naloxone without a prescription, a new study suggests that many pharmacies don't stock the drug or dispense it to young people who need it.
In the 10 U.S. states with the most opioid overdose deaths in 2016, roughly four in five drugstores stocked naloxone, a survey of 120 pharmacists found. But nearly half of these pharmacists incorrectly thought that they could only dispense the treatment to adults.
"Hindering access to naloxone to youth who are able to recognize the signs of an overdose and administer this life-saving medication undermines the effectiveness of these policies," said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen Children's Medical Center of New York in Lake Success and senior author of the study.
Overdoses of opioids like morphine or heroin can be deadly because these drugs slow breathing, thereby reducing the supply of oxygen to the body.
Naloxone blocks the ability of opioids to affect the nervous system, including the regulation of breathing. The trouble with any delays or roadblocks in access to naloxone is that it needs to be given quickly to be effective in countering the potentially fatal effects of an opioid overdose.
"If a pharmacy was not willing to provide naloxone to an adolescent, they could still obtain the medication through a prescription from their doctor, or, theoretically, if they were accompanied by a parent or other adult," said Kirk Evoy of the University of Texas at Austin College of Pharmacy and University Health System in San Antonio.
"I think the biggest concern would be teens who didn't feel comfortable disclosing opioid use to a doctor or parent, whether it be their own use or a friend's use, and thus decided to give up trying to obtain it after initially being turned away," Evoy, who wasn't involved in the study, said by email.
Most pharmacy employees surveyed correctly stated that no prescription was needed for naloxone, researchers report in the Journal of Adolescent Health, September 17. And most also understood that people were allowed to get naloxone to use for another individual who might be at risk for an overdose.
But only 52% of pharmacists correctly stated that there was no minimum age for purchasing naloxone.
Among chain drugstores in the survey, Walmart and Walgreens were more likely to stock naloxone than CVS.
Where drugstores did stock naloxone, 67% carried only the nasal spray form of the drug and 12% only dispensed injected versions.
The study wasn't a controlled experiment designed to prove whether or how drugstore availability of naloxone might directly impact teen access to the treatment or overdose deaths.
One limitation is that it only focused on 20 drugstores in each of the states examined, and it's possible survey results from this small sample of pharmacists might not reflect naloxone access nationwide.
It's also possible that some pharmacists incorrectly believe there are age restrictions for naloxone because there are other drugs with age restrictions like smoking cessation aids, said Talia Puzantian, a researcher at the Keck Graduate Institute School of Pharmacy and Health Sciences at the University of Southern California in Los Angeles.
"Without naloxone on hand, the risk for fatal overdose is significant," Puzantian, who wasn't involved in the study, said by email.
"Increasingly, adolescents are using and misusing both prescription opioids and illicit opioids," Puzantian said. "As prescription opioids become more difficult and costly to obtain, users are increasingly using the riskier illicitly manufactured pills or heroin which are increasingly adulterated with the more potent opioid fentanyl which is now driving the majority of opioid overdose deaths."
J Adolesc Health 2019.
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