Original Research

Assessment of Same-Day Naloxone Availability in New Mexico Pharmacies

Journal of Clinical Outcomes Management. 2021 November;28(6):268-271 | doi:10.12788/jcom.0070

References

1. Mason M, Welch SB, Arunkumar P, et al. Notes from the field: opioid overdose deaths before, during, and after an 11-week COVID-19 stay-at-home order—Cook County, Illinois, January 1, 2018–October 6, 2020. MMWR Morb Mortal Wkly Rep. 2021;70(10):362-363. doi:10.15585/mmwr.mm7010a3

2. Kaiser Family Foundation. Opioid overdose death rates and all drug overdose death rates per 100,000 population (age-adjusted). Accessed October 6, 2021. https://www.kff.org/other/state-indicator/opioid-overdose-death

3. Sohn M, Talbert JC, Huang Z, et al. Association of naloxone coprescription laws with naloxone prescription dispensing in the United States. JAMA Netw Open. 2019;2(6):e196215. doi:10.1001/jamanetworkopen.2019.6215

4. Smart R, Pardo B, Davis CS. Systematic review of the emerging literature on the effectiveness of naloxone access laws in the United States. Addiction. 2021;116(1):6-17. doi:10.1111/add.15163

5. Mueller SR, Koester S, Glanz JM, et al. Attitudes toward naloxone prescribing in clinical settings: a qualitative study of patients prescribed high dose opioids for chronic non-cancer pain. J Gen Intern Med. 2017;32(3):277-283. doi:10.1007/s11606-016-3895-8

6. Thornton JD, Lyvers E, Scott VGG, Dwibedi N. Pharmacists’ readiness to provide naloxone in community pharmacies in West Virginia. J Am Pharm Assoc (2003). 2017;57(2S):S12-S18.e4. doi:10.1016/j.japh.2016.12.070

7. Spivey C, Wilder A, Chisholm-Burns MA, et al. Evaluation of naloxone access, pricing, and barriers to dispensing in Tennessee retail community pharmacies. J Am Pharm Assoc (2003). 2020;60(5):694-701.e1. doi:10.1016/j.japh.2020.01.030

8. Nguyen JL, Gilbert LR, Beasley L, et al. Availability of naloxone at rural Georgia pharmacies, 2019. JAMA Netw Open. 2020;3(2):e1921227. doi:10.1001/jamanetworkopen.2019.21227

9. Guadamuz JS, Alexander GC, Chaudhri T, et al. Availability and cost of naloxone nasal spray at pharmacies in Philadelphia, Pennsylvania. JAMA Netw Open. 2019;2(6):e195388. doi:10.1001/jamanetworkopen.2019.5388

10. Edge K. Changes in drug overdose mortality in New Mexico. New Mexico Epidemiology. July 2020 (3). https://www.nmhealth.org/data/view/report/2402/

11. Senate Bill 221. 54th Legislature, State of New Mexico, First Session, 2019 (introduced by William P. Soules). Accessed October 6, 2021. https://nmlegis.gov/Sessions/19%20Regular/bills/senate/SB0221.pdf

12. GoodRx. Find pharmacies in New Mexico. Accessed October 6, 2021. https://www.goodrx.com/pharmacy-near-me/all/nm

13. U.S. Census Bureau. QuickFacts: New Mexico. Accessed October 6, 2021. https://www.census.gov/quickfacts/NM

14. Linas BP, Savinkina A, Madushani RWMA, et al. Projected estimates of opioid mortality after community-level interventions. JAMA Netw Open. 2021;4(2):e2037259. doi:10.1001/jamanetworkopen.2020.37259

15. You HS, Ha J, Kang CY, et al. Regional variation in states’ naloxone accessibility laws in association with opioid overdose death rates—observational study (STROBE compliant). Medicine (Baltimore). 2020;99(22):e20033. doi:10.1097/MD.0000000000020033

16. Pew Charitable Trusts. Expanded access to naloxone can curb opioid overdose deaths. October 20, 2020. Accessed October 6, 2021. https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2020/10/expanded-access-to-naloxone-can-curb-opioid-overdose-deaths

17. Centers for Disease Control and Prevention. Still not enough naloxone where it’s most needed. August 6, 2019. Accessed October 6, 2021. https://www.cdc.gov/media/releases/2019/p0806-naloxone.html

No personally identifiable information was obtained. This study was Institutional Review Board exempt.

Results

Responses were recorded from 183 pharmacies. Seventeen locations were eliminated from our analysis because their phone system was inoperable or the pharmacy was permanently closed. Of the pharmacies reached, 84.7% (155/183) reported they have naloxone available for pick up on the same day (Figure 1). Of the 15.3% (28) pharmacies that did not have same-day availability, 60.7% (17 pharmacies) reported availability in 1 to 2 days, 3.6% had availability in 3 to 4 days, 3.6% had availability in 1 week, and 32.1% were unsure of next availability (Figure 2). More than one-third of the state’s patients reside in municipalities where naloxone is immediately available in at least 72% of pharmacies (Table).¹³

Discussion

Increased access to naloxone at the state and community level is associated with reduced risk for death from overdose, and, consequently, widespread availability is recommended.^14-17 Statewide real-time pharmacy availability of naloxone—as patients would experience availability—has not been previously reported. These findings suggest unpredictable same-day availability that may affect experience and care outcomes. That other studies have found similar challenges in naloxone availability in other municipalities and regions suggests this barrier to access is widespread,^6-9 and likely affects patients throughout the country.

Many patients have misgivings about naloxone, and it places an undue burden on them to travel to multiple pharmacies or take repeated trips to fill prescriptions. Additionally, patients without reliable transportation may be unable to return at a later date. Although we found most pharmacies in New Mexico without immediate availability of naloxone reported they could have it within several days, such a delay may reduce the likelihood that patients will fill their prescription at all. It is also concerning that many pharmacies are unsure of when naloxone will be available, particularly when some of these may be the only pharmacy easily accessible to patients or the one where they regularly fill their prescriptions.

Barriers to naloxone availability requires further study due to possible negative consequences for patient safety and risks for exacerbating health disparities among vulnerable populations. Further research may focus on examining the effects on patients when naloxone dispensing is delayed or impossible, why there is variability in naloxone availability between different pharmacies and municipalities, the reasons for uncertainty when naloxone will be available, and effective solutions. Expanded naloxone distribution in community locations and in clinics offers one potential patient-centered solution that should be explored, but it is likely that more widespread and systemic solutions will require policy and regulatory changes at the state and national levels.

References

4. Smart R, Pardo B, Davis CS. Systematic review of the emerging literature on the effectiveness of naloxone access laws in the United States. Addiction. 2021;116(1):6-17. doi:10.1111/add.15163

8. Nguyen JL, Gilbert LR, Beasley L, et al. Availability of naloxone at rural Georgia pharmacies, 2019. JAMA Netw Open. 2020;3(2):e1921227. doi:10.1001/jamanetworkopen.2019.21227

10. Edge K. Changes in drug overdose mortality in New Mexico. New Mexico Epidemiology. July 2020 (3). https://www.nmhealth.org/data/view/report/2402/

12. GoodRx. Find pharmacies in New Mexico. Accessed October 6, 2021. https://www.goodrx.com/pharmacy-near-me/all/nm

13. U.S. Census Bureau. QuickFacts: New Mexico. Accessed October 6, 2021. https://www.census.gov/quickfacts/NM

Assessment of Same-Day Naloxone Availability in New Mexico Pharmacies

References

Results

Discussion

Pages

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