You'll play a bigger role in expanding access to naloxone...to reduce opioid-overdose deaths.
All states have a way for pharmacists to provide naloxone directly to patients...by protocol, standing order, etc. And the U.S. Surgeon General advises the public to "Be prepared. Get naloxone. Save a life."
How can you help patients get naloxone? Clear up confusion if patients ask for naloxone as an "OTC." Ensure techs are familiar with your naloxone stock and procedures for filling these Rxs.
Consider preference and cost. Narcan nasal spray costs about $125 and Evzio auto-injector costs up to $4,100. These may be easy to use...but assembled IM or intranasal naloxone kits start at about $30.
Most payers cover at least one form of naloxone...and some local health depts may offer it at no charge if cost or co-pays are a barrier.
Be aware that many states have laws to protect those prescribing, dispensing, and giving naloxone from liability. Most states also allow naloxone Rxs to be dispensed to a "third party"...friends, family, etc.
Point out there's no proof naloxone encourages opioid misuse.
Who needs naloxone? Recommend it for patients on 50 mg/day or more of oral morphine or its equivalent...such as a fentanyl 25 mcg/hr patch.
And recommend it for opioid patients who also take benzos, have COPD or asthma, etc...or have a history of overdose or substance use disorder.
How should naloxone be offered? Make it a routine and automatic part of educating on opioid side effects, just as you do for constipation.
For example, say "naloxone's like a fire extinguisher, it's there to keep your family safe"...or "no matter how careful you are, any home with opioids has some risk of a breathing emergency for you or others."
How should people be trained? Educate about when and how to give naloxone...and have patients teach back, so they know how to train others.
Emphasize calling 911 and follow-up care. Explain naloxone can be repeated after 2 to 3 min if patients don't respond or symptoms return.
- MMWR Recomm Rep 2016;65(1):1-49
- JAMA Published online Apr 5, 2018; doi:10.1001/jama.2018.4867
- Medication pricing by Elsevier, accessed May 2018