Laird Harrison

October 21, 2015

SAN FRANCISCO — More states are giving pharmacists the authority to identify patients at high risk for opioid overdose and to prescribe naloxone rescue kits.

"To potentially save a life is amazing. It gives me goosebumps because that's why I became a pharmacist," said Amy Bachyrycz, PharmD, from Walgreens and the University of New Mexico College of Pharmacy in Albuquerque.

The number of deaths from opioid analgesics has soared in recent decades. New Mexico has the second-highest rate of drug overdose in the United States, at 24.3 per 100,000 people, according to the Centers for Disease Control and Prevention and the New Mexico Department of Health.

In 2013, a protocol for naloxone, the potentially life-saving opioid antagonist, was developed in New Mexico, making it one of the first states to allow pharmacists to dispense the drug without a physician's prescription, Dr Bachyrycz reported.

Pharmacists were trained to use the kits and to counsel patients about them in 2014. "We use open body language and ask open-ended questions," she told Medscape Medical News.

By January 2015, they had dispensed 62.

The conversation sometimes begins when a patient brings in a prescription for an opioid medication. Dr Bachyrycz explained that she might offer the naloxone kit, and say something like, "I see you have had OxyContin prescriptions filled at two other pharmacies. Maybe you would like to have this on hand."

She presented an analysis of the program here at the American College of Clinical Pharmacy 2015 Global Conference.

Dr Bachyrycz and her colleagues asked pharmacists participating in the program to complete a brief report with details of each prescription. They received 190 competed forms by August 25, 2015.

Pharmacists in Bernalillo County, where Albuquerque is located, reported dispensing 161 kits, which is far more than those in other counties in the state. In fact, in 24 of New Mexico's 33 counties, pharmacists dispensed no kits.

For 71.2% of the kits dispensed, pharmacists wrote the prescription. And 87.0% of those prescriptions were new.

The most frequent reason cited for dispensing a kit was a request from a patient or from family or friends of a person suspected of abusing opioids. Dr Bachyrycz pointed out that sometimes more than one reason was cited.

Table. Reasons for Naloxone Prescription

Reason Percent
Prescription for high-dose opioid 27
Prescription for opioid with concurrent benzodiazepine use 10
Prescription for long-term opioid 20
Prescription with known or suspected alcohol use 3
Current polyopioid use 12
History of opioid abuse 17
Patient request 44
Other 19

 

The mean age of the patients was 41.8 years. About half were covered by Medicare, one-quarter had no insurance, and about 15% were covered by Medicaid.

Dr Bachyrycz said she would like to know why pharmacists in so many counties are not taking advantage of the program.

"The next step is a pharmacist perception survey," she reported. "They may think doing it encourages people to overdose, but there is no evidence of that."

 
There's a big pushback from some of the pharmacists who are not comfortable with it.
 

At the meeting, the poster describing the study attracted a steady stream of curious pharmacists. One Utah pharmacist said many colleagues have been reluctant to take advantage of their authority to prescribe naloxone in that state. "There's a big pushback from some of the pharmacists who are not comfortable with it," he said.

More and more states are giving pharmacists the authority to prescribe naloxone, said Joseph DiPiro, PharmD, from the Virginia Commonwealth University School of Pharmacy in Richmond. It's useful to see how pharmacists are using that authority, he said.

"This is one of the first reports I've seen," he told Medscape Medical News. "They are initial results, but it's something that needs to be done."

The study was funded by the University of New Mexico College of Pharmacy, the New Mexico Pharmacists Association, and the New Mexico Poison Center. Dr Bachyrycz and Dr DiPiro have disclosed no relevant financial relationships.

American College of Clinical Pharmacy (ACCP) 2015 Global Conference: Abstract 202. Presented October 19, 2015.

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