In 2016, the Centers for Disease Control and Prevention (CDC) announced that the United States is in the midst of an opioid overdose epidemic. Opioids include both prescription drugs, such as Hydrocodone, Morphine, Percocet, and Oxycontin and illegal drugs such as Heroin. Both prescription opioids and heroin killed more than 33,000 people in 2015, which was more than any year on record. Although street-drugs are considered by the general public to be the root-cause of the epidemic, nearly half of all opioid overdose deaths involve a prescription opioid. Policy and law makers have begun to take notice; as a result, many pharmacists are becoming re-acquainted with an old drug, Naloxone.
Opioids work by attaching themselves to the body’s natural opioid receptors and numbing or reducing pain. However, opioids may also create a sense of euphoria that is highly addictive, with many people becoming addicted after only a few doses or even when taking opioids exactly as prescribed. Naloxone is an “opioid antagonist,” used to counter the effects of opioid overdose, whether from prescription or illegal opioids. It is a non-scheduled, non-addictive prescription medication used to counteract life-threatening depression of the central nervous system and respiratory system, thus allowing an overdose victim to breathe normally. It has been used successfully by providers in the emergency medical community for decades.
In order to curtail the opioid overdose epidemic, New Jersey has aimed to make Naloxone more accessible in the community. To that end, New Jersey has passed laws permitting pharmacies to dispense Naloxone without the need for a patient-specific prescription. The new legislation does not make Naloxone an over-the-counter (OTC) medication, as it still requires a prescriber’s authorization (whether pursuant to a patient-specific order or a non-patient specific standing order) before dispensing; however, it empowers pharmacists to act quickly to intervene where Naloxone counseling and/or dispensing is warranted. Until recently, large chain drugstores with physicians on staff easily obtained standing orders, while independent pharmacies had to work with local physicians to obtain standing orders. However, Governor Christie signed a law in early June that allows a Department of Health physician to issue Naloxone standing orders to independent pharmacies, thus enabling an independent pharmacy to dispense Naloxone to at-risk patients, their caregivers or any person seeking to help another person at risk for opioid overdose without having to obtain a separate patient specific prescription authorization from the patient’s physician. This is an important development, as time is often of the essence for an at-risk patient. The pharmacist dispensing Naloxone, at a minimum, should counsel the patient or caregiver on how Naloxone is administered, the proper dosage, side effects, potential contraindications, steps to be taken after administration and steps to be taken if the patient is not breathing and has no pulse due to an opioid overdose.
A pharmacist must counsel a patient or caregiver to whom Naloxone is being dispensed, but because any patient who receives an opioid prescription could be at risk for overdose, the evolving standard of care may require a pharmacist to counsel all patients who are receiving opioids about the availability and proper use of Naloxone. If you would like to integrate Naloxone dispensing pursuant to a standing order in your pharmacy and would like assistance in drafting a compliant Naloxone dispensing policies and procedures or have any questions regarding operationalizing Naloxone dispensing in your pharmacy, contact Frier Levitt today.
