The lack of actual availability, in addition to the lack of knowledge about naloxone and protocol for dispensing it, points to a failure of communication.
In 2015, New York City’s Mayor Bill de Blasio and his wife, Chirlane McCray kicked off a city-wide plan to prevent opioid-related deaths. According to the new initiative, New Yorkers would be able to get the overdose-reversing drug naloxone at participating pharmacies without a prescription. The city provided a list of locations that provide the medication.
That was three years ago. This year, The New York Times investigated how the initiative has actually impacted New York. The Times found that of the 720 pharmacies listed by the city as “carrying naloxone,” on only about a third of them actually had the medication on the shelf and would dispense it without a prescription.
What was wrong with the list? According to New York’s health department, part of the problem may be the criteria for being listed. If a pharmacy on the list did not have naloxone in stock, but merely offered to order it, they were considered eligible. Willingness, not having the medication on hand, was enough to meet the program’s guidelines. However, some pharmacies who met the first requirement failed on another: they offered naloxone, but required a prescription to dispense it.
According to The New York Times, “Some pharmacy workers inaccurately said that only the person in need of the drug could buy it, and then only with a prescription.”
Areas of the city that were heavily affected by the drug epidemic, such as the Bronx, did not have better, much-needed access to naloxone. More people died of opioid-related overdoses in the Bronx than in any other borough in 2016, yet, according to The Times’ investigation, only about a quarter of the more than 100 pharmacies on the list had naloxone and followed the protocol. When the medication was requested, pharmacists seemed “bewildered” and didn’t understand how to dispense it, or even what the medication was for.
The naloxone program was created with the idea that anyone, including minors, could walk into a participating pharmacy and leave with the medication. This was made possible under a standing order: “Pharmacists were to use the city health commissioner’s name, Dr. Mary T. Bassett, in place of a prescribing physician’s. They were to show the customer how to administer naloxone and bill their insurance.”
However, the lack of actual availability, in addition to the lack of knowledge about naloxone and protocol for dispensing it, points to a failure of communication. To remedy this, Dr. Bassett told The Times that “in addition to contacting stores on the list, the department would send workers to as many as 800 independent pharmacies in neighborhoods with high rates of overdose deaths.”
Naloxone has made headlines in recent weeks, as the United States surgeon general, Dr. Jerome M. Adams, issued a national advisory recommending that more Americans carry it and learn to use it. This was the first advisory from the Surgeon General in more than a decade.
Furthermore, local groups and government agencies are making an effort to provide naloxone and teach people how to use it. According to The Times, “Since last July, more than 70,000 naloxone kits have been distributed to the police, health care providers, homeless shelters and community-based organizations. When the mayor recently announced the city would spend an additional $22 million a year on anti-opioid initiatives, bringing annual funding for its HealingNYC program to $60 million, he said some of the extra funds would go toward increased training and distribution of naloxone.”
Focusing on overdose prevention in pharmacies, however, is still important. Many opioid users, including people with chronic pain, may need naloxone but not consider themselves to be at risk for an overdose. The stigma of syringe use, and of substance use disorder, may prevent people from accessing naloxone when they’re in need.
“People might go to pharmacies who would never go into a needle exchange,” said Van Asher, who runs daily operations and the syringe exchange at St. Ann’s Corner of Harm Reduction in the Bronx.
One of Facing Addiction’s partners, START, is helping educate people about naloxone, and taking on the drug epidemic. Dr. Lawrence S. Brown, the CEO of START, said, “Naloxone is one of the keys to any plan to address the opioid crisis head-on. At START, every new clinician is trained in naloxone administration and provided a naloxone emergency revival kit. For this life-saving medication to be so difficult to obtain is a grave issue, but we believe it can be and will be addressed. There is no other option. Until then, we will continue to strive to be a leader in keeping our most vulnerable New Yorkers safe at all times.”
An overdose can happen anytime, anywhere, to anyone using opioids. Our partners are stepping up to ensure that naloxone is everywhere an overdose might be.