54% of pharmacies in Michigan offer naloxone without a prescription, according to a recent study by University of Michigan researchers. This study, published in The American Journal of Drug and Alcohol Abuse, surveyed pharmacies in eight counties across Michigan to study naloxone availability.
Naloxone, also known as Narcan, is a drug that can be used to reverse an opioid overdose. Common signs that an individual might be experiencing an overdose include small pupils, slow breathing, limp body and losing consciousness. In situations when it is unclear if someone is experiencing an overdose, naloxone can be administered as a nasal spray or an injectable without risk.
In 2016, the state of Michigan passed a standing order that allows any pharmacist to dispense naloxone without a prescription. This policy permits concerned family, friends or community members to obtain naloxone preventatively, but not all pharmacies participate.
Derek Frasure, Rackham student and policy director of Students for Sensible Drug Policy, spoke with The Michigan Daily about the importance of increasing the number of pharmacies dispensing naloxone. As of 2017, approximately 34% of Michigan pharmacies are registered to dispense naloxone under the standing order.
“The idea is that we want as many people to have naloxone as possible so that whenever an overdose occurs, somebody is around in order to reverse it,” Frasure said.
Dr. Chin Hwa (Gina) Dahlem, a clinical associate professor at the U-M School of Nursing and a family nurse practitioner at the Delonis Center, shared her ideas as to why the percentage of pharmacies in Michigan offering naloxone may be so low.
“One piece could be the lack of awareness, but also there is a cost for pharmacies to stock medications,” Dahlem said. “So if there is a financial cost for the pharmacy to stock the medication, but no one is accessing or requesting the medication, they are eating up the cost. That could be a possible financial barrier.”
Dahlem also said finances can be a barrier for patients to obtain naloxone.
“The way it works is that once you go to the pharmacy, they will bill your insurance to obtain naloxone, and whatever your copay is for that medication is what you pay for naloxone,” Dahlem said. “Depending on the insurance and their copays, there could still be a barrier, especially with the copay, which I have seen ranging from zero to $149. However, if you do have Medicaid, it is free.”
In addition to the low percentage of Michigan pharmacies offering naloxone, patients may face other non-financial barriers when trying to obtain the drug. Dr. Keith Kocher, an emergency physician at Michigan Medicine, said the stigma around naloxone can play a large role in limiting access.
“How we decide to care for these kinds of patients at risk of overdose is layered with a lot of stigma,” Kocher said. “We make assumptions about them, oftentimes really terrible assumptions. And that ends up deprioritizing the kinds of medical care and decisions that we should be offering for patients.”
Dahlem also commented on the stigma patients may face when attempting to obtain naloxone, whether it be for themselves or someone they care about.
“If you do obtain naloxone through the pharmacy, it will show up on your prescription list,” Dahlem said. “When this came out in 2016, I tested it out myself and it does indicate that I have naloxone. I haven’t had a problem, but that could be a concern for patients because this is already a highly stigmatized population where they experience a lot of stigma when trying to access care for their addiction. You don’t need to have a disease of addiction to access naloxone. You could be in a position to help respond to an overdose situation.”
Beyond pharmacies, naloxone can be accessed through certain community groups or through online services that maintain anonymity. Free training is also available for those interested in being able to administer naloxone in situations where signs of an opioid overdose are present, and the Ann Arbor District Library houses a free naloxone vending machine.
Dahlem emphasized the importance of being knowledgeable about naloxone and its administration.
“I think it’ll be important for all of us to know how to reverse overdoses,” Dahlem said. “We have our online training, or contact your local community naloxone distribution programs or survey service providers to receive the training and learn how to save a life.”
Daily News Contributor Maanasa Bommineni can be reached at maanasab@umich.edu.