ANaloxone and Buprenorphine...Access and Accessibility in America

Oct 16, 2018 3:25:41 PM by Jody Lutz

 

Naloxone is a medication approved by the Food and Drug Administration (FDA) to prevent overdose by opioids it is designed to rapidly reverse opioid overdose. Commercially, it has been available for almost 50 years and several formulations are available, produced by various manufacturers. 

It’s mechanism of action, blocks opioid receptor sites, reversing the toxic effects of the ingested opioid and in unscientific terms blocks the opioid’s effects. 

One of the greatest threats in an opioid overdose situation is respiratory depression, Naloxone can quickly restore normal respiration to a person whose breathing has slowed or stopped as a result of an opioid related overdose.

Naloxone Comparision

Source: https://www.uspharmacist.com/article/expanding-access-to-naloxone

A combination drug sold under the brand name Suboxone among others, is a combination medication that includes buprenorphine and naloxone. Suboxone is the 39th most highly prescribed drug in the United States, per drugs.com with sales totally in the tens of billions of dollars.

Suboxone costs

 

Source: https://www.washingtonpost.com/national/the-drug-industrys-answer-to-opioid-addiction-more-pills/2016/10/15/181a529c-8ae4-11e6-bff0-d53f592f176e_story.html?noredirect=on&utm_term=.95598ff04020

 

Naloxone Prescription....How can I get it?

There are two primary ways to obtain Naloxone. First, traditional methods - Naloxone is available by prescription from a licensed healthcare providers (MD, DO, NP or PA).

SAMSHA provides the following outline for Naloxone candidates:

A doctor can prescribe naloxone to patients who are in medication-assisted treatment (MAT), especially if the patient is taking medications used in MAT or considered a risk for opioid overdose. Candidates for naloxone are those who:

  • Take high doses of opioids for long-term management of chronic pain
  • Receive rotating opioid medication regimens
  • Have been discharged from emergency medical care following opioid poisoning or intoxication
  • Take certain extended-release or long-acting opioid medications
  • Are completing mandatory opioid detoxification or abstinence programs


In response to the opioid epidemic gripping the nation, Naloxone is increasingly available though out the United States by purchase directly from the pharmacist without a prescription from a physician, nurse practitioner or physicians assistant.

goodrx.com provides the following breakdown for national commercial pharmacy guidelines regarding Naloxone.

Where To Get Naloxone Without Prescription

At the present, you can go directly to select pharmacy counters and purchase naloxone without a prescription. Policies will vary depending on the pharmacy you visit:

  • CVS: According to CVS’s website, Naloxone is available without a prescription at most CVS pharmacies. Read here for the full list of applicable states.
  • Walmart & Sam’s Club: As part of a larger initiative to combat opioid abuse, Walmart and Sam’s Club will dispense naloxone without a prescription in all states where state law allows them to do so. In their press release, Walmart does not specify which states apply, so be sure to call your pharmacy to see if they honor this policy.
  • Kroger: Naloxone is available without a prescription in all Kroger stores.
  • Walgreens: Naloxone is available without a prescription in over 8,000 Walgreens pharmacies. Read the press release here for the full list of applicable states.
  • Rite Aid: Rite Aid offers naloxone without a prescription at all of its pharmacies in 19 states. See the press release here for the full list of applicable states.

State laws vary, but across the United States legislatures are pushing for access to Naloxone for patients prescribed opioids, their caregivers and first responders.

 

Naloxone Access in Communitites

Chart updated January 2018. Source: https://naspa.us/resource/naloxone-access-community-pharmacies/

What impact does Naloxone availability have in communities?

Drugabuse.gov sites the following study in response to that question. Overdose education and naloxone distribution (OEND) has been shown to increase the reversal of potentially fatal overdoses; one study showed opioid overdose death rates to be 27 to 46 percent lower in communities where OEND was implemented. Among 4,926 people who used substances and participated in OEND in Massachusetts, 373 (7.6 percent) reported administering naloxone during an overdose rescue, with few differences in behavior between trained and untrained overdose rescuers. A naloxone distribution study in San Francisco reported that 11 percent of participants used naloxone during an overdose; of 399 overdose events where naloxone was used, 89 percent were reversed. Brief education is sufficient to improve comfort and competence in recognizing and managing overdose.

Data from recent pilot programs demonstrate that in an opioid overdose situation, lay persons have consistent success in administering Naloxone and safely reversing the adverse effects of opioid overdose, thus in turn saving lives. In April of 2018, U.S. Surgeon General Jerome M. Adams, M.D., M.P.H., urged more Americans to carry the lifesaving medication that can reverse the effects of an opioid overdose.

“To manage opioid addiction and prevent future overdoses, increased naloxone availability must occur in conjunction with expanded access to evidence-based treatment for opioid use disorder,” the Surgeon General said. All states have passed laws to increase access to naloxone and, in most states, you can walk into a pharmacy and request naloxone even if you don’t already have a prescription. In addition, most states have laws designed to protect health care professionals for prescribing and dispensing naloxone from civil and criminal liabilities as well as Good Samaritan laws to protect people who administer naloxone or call for help during an opioid overdose emergency.

As the war on the opioid epidemic continues, Naloxone continues to play a front line role in saving lives from overdose. Initiatives and policies continue to expand to include training and access initiatives. Stay up to date on this ever evolving topic, subscribe to the AffirmHealth Blog:

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Additional Resources:

The Surgeon General's Spotlight on Opioids

SAMSHA Naloxone Access Laws Tool Kit

SAMSHA Medically Assisted Treatment Overview

Opioid Reversal Medication Tools

 

 

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