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Opioid analgesics

Pharmacists dispensing naloxone without prescription can cut opioid deaths, US study shows

Researchers found that laws encouraging naloxone distribution, but not direct dispensing by pharmacists, had little impact on reducing opioid-related overdose deaths.

Pharmacists who have legal permission to dispense opioid antidote naloxone without a prescription could cut fatal overdoses, study results suggest.

A study, published in JAMA Internal Medicine (6 May 2019), found that US states that adopted laws allowing pharmacists to prescribe naloxone without a prescription saw fatal opioid overdoses fall by an average of 27% during the second year since the law was passed, and 34% in subsequent years.

The researchers examined policies across all US states from 2005 to 2016, examining whether the adoption of different policies was associated with changes in opioid-related overdose deaths and the dispensing of naloxone.

They found that laws encouraging the distribution of naloxone, but stopping short of allowing direct dispensing by pharmacists, did little to reduce opioid-related overdose deaths.

“This is strong evidence that greater use of naloxone can help reduce opioid-related deaths,” said David Powell, a an author of the study and a senior economist at RAND Corporation, the non-profit research organisation that carried out the study.

“But how laws are structured to increase naloxone use is important. Weaker laws that do not give pharmacists direct dispensing authority did not curb opioid deaths.”

The research results also showed that direct dispensing laws were associated with increased visits to hospital emergency departments for non-fatal opioid overdoses. Researchers said it was not clear if the increase was caused by fewer patients dying from opioid overdoses or whether other factors triggered an increase.

The results also show that laws providing only indirect authority to pharmacists to dispense naloxone, such as to people enrolled in drug treatment programmes, had little effect on the dispensing rate. In contrast, states that adopted laws providing direct authority for pharmacists to dispense naloxone saw large increases in dispensing of the medication.

Since February 2019, pharmacies in the UK that provide drug services can provide naloxone without prescription.

 

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2019.20206520

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