SALT LAKE CITY — An order given by the Utah Department of Health making it significantly easier for pharmacies to give out naloxone resulted in 4,275 doses of the rescue medication being dispensed in 2017, the department announced this week.
A standing order issued in December 2016 by Dr. Joseph Miner, executive director of the department, allowed pharmacists to dispense naloxone without a prescription.
“Every dose of naloxone we get out in our communities represents a potential life saved," Miner said in a statement. "I urge all pharmacies across the state to enroll in the standing order and help Utahns access this lifesaving medication.”
The order was made possible by a law passed by the Utah Legislature in 2016.
The order did not require all pharmacies to participate, but those that did submitted data to the state detailing how much naloxone was given out as part of the program, said Department of Health spokeswoman Jenny Johnson. A total of 165 pharmacies participated in the program in 2017.
Naloxone is a drug that can be used to reverse the effects of a serious opioid overdose and can be lifesaving in some instances. It can be administered with a needle injection or a nasal spray, depending on the kit it comes with. It is safe to use on a person even if it turns out they are not experiencing an overdose, and is not addictive, health officials have said.
While it isn't clear how many reversals may have resulted from the naloxone given out by pharmacies under the state's order, Johnson said that "there were 99 naloxone reversals in 2017 as a direct result of outreach efforts by the (department), local agencies and syringe exchange providers across the state," according to available data.
In addition, the Utah Naloxone Association, housed and supported by the University of Utah Department of Pediatrics, reports it has delivered 17,200 naloxone kits — equivalent to 34,400 doses — since July 2015.
Dr. Jennifer Plumb, medical director of the association and a professor of pediatrics at the U., said 2,056 overdose reversals have been attributed to the organization's kits during that time.
The naloxone prescription statistics are "a result of pharmacists starting conversations" with patients, said Angela Stander, prescription overdose coordinator for the Utah Department of Health.
"Pharmacists are taking an active role in this epidemic," she said. "They're that last chance before the opioid goes home with that patient … (to) intervene and do some education."
Stander said Miner issued the order in the first place because the department decided it "needed to get (naloxone) into the homes of those who had received (opioid) prescriptions from their physicians."
Large hospital systems such Intermountain Healthcare had already made it a protocol to allow its pharmacies to dispense naloxone without a doctor's prescription, according to Stander.
Because of that, it was rural, locally owned pharmacies that "benefitted the most from having a statewide standing order" lifting the requirement on having a prescription before getting naloxone, she said.
Participating rural pharmacies gave out 2,914 doses of naloxone, while 1,361 doses were dispensed by urban pharmacies, Johnson said.
Stander also hypothesized that a disproportionate amount of kits were handed out by rural pharmacies because some of the areas hit hardest by opioid overdoses, such as Carbon and Emery counties, have rural populations.
Stander said she hopes non-participating pharmacies, encouraged by the results of the standing order, will begin to get involved and further increase naloxone access for Utah patients.
Plumb said she would like to see the day when the co-prescribing of naloxone along with opioids becomes routine, "but we're not there yet."
Educating doctors and pharmacists to get in the habit of prescribing naloxone is one key to getting it into more patients' hands, but it is also key to get patients themselves to destigmatize the act of getting the substance as a simple precaution, Plumb said.
"People don't want to be judged as 'that kind of person,'" who could possibly need naloxone, she said, and so are sometimes hesitant to get it.
"I think there is definitely a lot of work to be done in our communities, talking about how substance use disorders are medical conditions … you could die from, and you need to be protected."
Stander said that even patients who take certain opioids as prescribed would be well-served to have naloxone in their home. Plumb compared the importance of keeping naloxone on hand to the wide availability of fire extinguishers, which are considered a common sense practicality despite being used infrequently.
Plumb said that while it's an important step to create better access to naloxone at pharmacies, doing so is only a small part of the strategy to make the substance as widely available as possible.
"A pharmacy as an access point to naloxone will continue to hopefully be an expanding area, and will become more comfortable for Utah residents, but we have to keep in mind … actual direct access and putting naloxine right in the hands of people who need (it)," she said.3 comments on this story
For example, Plumb said, the Utah Naloxone Association's strategy includes distributing kits to fire departments, police agencies, substance abuse disorder treatment providers, homelessness services providers and even networks of concerned parents, who then further pass out the kits as they see fit. The Utah Department of Health has used similar distribution tactics.
Although naloxone can currently be bought at many pharmacies without a physician's prescription, it is not sold over the counter, meaning a patient must obtain it directly from the pharmacist rather than getting it elsewhere inside a store.