Frozen at the pharmacy counter, Mary couldn’t find the words she needed. She was there to pick up a prescription for OxyContin. She understands the potent painkiller can be harmful and she tends to take more than she’s prescribed, so she wants to ask for the naloxone that’s legally offered to her. But she doesn’t want the pharmacist to assume she’s “just another addict” looking for an overdose antidote.
On the other hand.
The pharmacist was uncertain what to do. This was the third month in a row his customer, Mary, filled a prescription for high-dose painkillers. And last month, he had acquired approval from Mary’s doctor to fill the prescription three days early. Since OxyContin can be a dangerous if not taken correctly, he believed it might be good to provide his customer naloxone, just in case. But he didn’t want to upset her. Would Mary think he was accusing her of substance abuse? Should he jeopardize upsetting a good customer and losing her business?
He experienced a similar scenario the other day when someone picked up Suboxone, a medication used to manage opioid dependence. As a local pharmacist who cares about his customers, he isn’t sure what kind of technique to use. It ‘d be a lot simpler if there was a system in place to make the process easier. Something must change. Here’s the obvious problem: Patients who require naloxone don’t always get it.
Patients are either hesitant to ask for it or they aren’t aware it’s available, while pharmacists are reluctant to provide the medication without being asked for it for fear of the ramifications. So, analysts performed a study to offer some answers for people like Mary and her pharmacist, particularly looking at existing pharmacy practices in Massachusetts and Rhode Island regarding opioid prescriptions and naloxone. (In these states, pharmacists can offer naloxone without a prescription.).
We already know that informing people about naloxone and offering it to those at risk of overdose reduces opioid death rates by 30 to 50 percent. The US Department of Health and Human Services even positioned the expansion of naloxone access in the top three approaches to fight the opioid epidemic.
With these realities in mind, researchers combed over the results of their study and came to one final thought: the current model must improve.
The Opt-Out Model.
Rather than requiring patients to ask for naloxone or enabling pharmacists to offer it at the counter, researchers maintain an “opt-out” model. This would universally offer naloxone to anyone acquiring opioid prescriptions, or at least those who are recognized as “at-risk” for an overdose (those taking high doses of opioids, those taking medication for opioid addiction disorder, or those who are also taking sleep aids or anxiety medication). The option would also be offered for anyone picking up opiate prescriptions for family members.
Traci Green, PhD, MSc, who led the study, explains, “Most overdoses occur at home or with a loved one close by. With expanded naloxone access in the pharmacy setting, we have the opportunity to give people the choice to keep themselves and their family safe, and reduce the stigma of getting naloxone and of chemical dependency. Our study suggests that by giving pharmacists the model and language to do so, they have the power to save a life with naloxone.”.
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