OTC Naloxone Part 3: How Policymakers Can Improve Access to Naloxone in Communities

about 5 mins One person dies from a drug overdose in the United States. largely Fifty percent of these deaths are due to opioids, and public access to opioid antagonists is improving. Naloxone It is a vital tool to save lives. To this end, in 2023 the U.S. Food and Drug Administration Approved Some Intranasal Make naloxone products available at retail over the counter (OTC). This move could reduce stigma, lower costs, and improve low-barrier access to the life-saving medication. But as we saw in previous parts of this series, retail access, while important, is imperfect. Even as competition lowers costs, high prices remain a barrier for many people who use drugs, and real-world availability is not enough to meet the need.

We focus on several policies that, when operated in a complementary manner to OTC sales, can optimize naloxone saturation in the community.

Naloxone Access Laws and Liability Protection

Legislation to lower barriers to purchasing naloxone over the counter, particularly legislation allowing pharmacists to distribute the drug. “Without a patient-specific prescription.”These laws are commonly associated with improving public access to naloxone. By providing a route to access prescription naloxone products without a prescription, these laws reduce out-of-pocket costs for insured individuals and ensure access to a wider variety of formulations, including injectables.

In addition to having access to naloxone, many states also have Liability Protection For those who prescribe, sell, and administer naloxone. Such laws complement laws on access to naloxone and are intended to encourage people to obtain and use the drug.

Since 2017, every state and Washington, D.C., has implemented some form of Naloxone Access ActIt is important that legislators ensure that this low-barrier over-the-counter access is not revoked simply because intranasal products are available on the market. Moreover, in some states, these laws Need Extensive paperwork and identification are barriers to people seeking naloxone at pharmacies. States can ensure continued low access to a wide range of naloxone products by taking a comprehensive approach, including improving existing laws to make access as difficult as possible, permanently renewing or implementing standing orders, allowing pharmacists to prescribe, allowing third parties to dispense or prescribe medications, and expanding liability protections.

Public health insurance coverage for over-the-counter naloxone

Over-the-counter naloxone has increased competition and lowered drug prices, price Although things have gotten a little better, cost remains a major barrier for people who use drugs and for those who care for those who use drugs. Medicaid and Medicare It would cover the cost of prescription-only naloxone products, making them much more affordable for consumers. By extending this coverage to OTC products, insurers would effectively remove one of the biggest barriers to accessing naloxone, though purchases would likely have to be processed at a pharmacy, undermining some of the privacy benefits of OTC status. Still, at least Medicaid programs in six states Blue Cross Blue Shield of Massachusetts has already announced plans to cover OTC naloxone, giving consumers the option to use their insurance.

Governments as bulk purchasers and/or primary distributors

While pharmacies (both over-the-counter and prescription) undoubtedly provide an important route to obtain naloxone, retail sales account for a relatively small proportion. ratio About 2.64 million of the more than 10 million vaccine doses will be delivered to communities in 2021. Rather, community-based organizations, e.g. Bulk Purchaseremains the primary distribution channel for this life-saving drug.

Bulk purchases of naloxone are being made through nonprofit organizations such as Remedy Alliance/For the People, but state governments are also actively participating in the effort. State opioid response Grants and Opioid Settlement Fund.

Combating the overdose crisis requires a multifaceted approach that includes expanding access to evidence-based treatment and a range of harm reduction interventions, but states should not neglect purchasing naloxone now that some formulations are available over the counter. Additionally, states need to turn to people who use drugs and the organizations that serve them, including harm reduction organizations, to support them. Decision Regarding which prescription to prioritize.

Immunity Associated with Naloxone Leave Programs for Emergency Medical Technicians

Medical professionals such as emergency medical technicians (EMTs) and firefighters resource Efforts to prevent overdose deaths are underutilized in most states. Medical personnel, who are often the first lay people to arrive on the scene, are already trained and equipped to administer naloxone. But as important as professional first aiders are, they are the ones most often used to rescue overdoses. People who use drugstheir friends, and families.

So allowing paramedics, firefighters, and other emergency personnel to not only administer but also dispense naloxone is an effective way to leverage existing roles and get more of the drug into the hands of those who need it most. And research shows that programs that paramedics leave behind success various environment: High absorption rate (Over 85 percent Studies have shown it can reduce overdose deaths and increase recovery and help-seeking behavior.

Public Naloxone

Most overdose deaths, whether witnessed or not, At home or other private locationsThat's why we encourage people who use drugs to Do not use alone,and Equip They, as well as their friends and family, should be treated with naloxone. However, public overdoses are a serious problem in many areas. For example, a Massachusetts study found that: one third 70% of fatal overdoses occur in public places. In recent years, some areas have seen an increase in the proportion of overdose deaths that occur in public places. For example, in New York City, the proportion of overdose deaths is “Outbreaks in public outdoor locations increased from 10.6% to 16.0%.” Between 2019 and 2022.

This supports both over-the-counter sales of naloxone (which most people should carry even if they don't use drugs or think they know someone who does, unless there is a supply shortage) and the strategic placement of the drug in public places. Over 30 states already allow and support the stockpiling and administration of naloxone. Educational field.for example, ArizonaMaking naloxone available over the counter would reduce red tape for grassroots harm reductionists to make the drug available in places like fraternity houses. And some efforts go beyond that. In December 2023, the Biden-Harris Administration will guidance Install naloxone at secure stations on the grounds of all federal facilities by July 2024. American Medical Association He called for more naloxone kits to be installed in public places that already have defibrillators, from stadiums to subway stations.

Conclusion

Making naloxone available over the counter at pharmacies, grocery stores, and other outlets is one important step to increase community penetration. But policymakers shouldn't overlook other ways to increase naloxone availability. From optimizing naloxone access to authorizing paramedic leave-behind programs to promoting naloxone stations in public places, governments can have the most impact on the overdose crisis by taking a comprehensive approach.

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