The opioid epidemic in the United States continues to take the lives of many individuals, with overdoses continuing to rise every year. Naloxone is an opioid antagonist that is efficacious in temporarily reversing opioid overdoses. Pharmacists play an important role in the accessibility and education of naloxone in both the community and health system settings. Recent efforts, such as co-dispensing naloxone with opioid prescriptions, naloxone training programs, and approval of naloxone to be over-the-counter, have been implemented in hopes to better control the opioid epidemic. Despite the efforts to make naloxone more accessible, there are still some barriers to overcome such as lack of training, cost, stigma, and patient refusal. This review aims to explore the contributions pharmacists have made thus far and define the barriers that still have to be resolved.
References
[1]
Bachyrycz, A., Shrestha, S., Bleske, B.E., Tinker, D. and Bakhireva, L.N. (2017) Opioid Overdose Prevention through Pharmacy-Based Naloxone Prescription Program: Innovations in Health Care Delivery. Substance Use & Addiction Journal, 38, 55-60. https://pubmed.ncbi.nlm.nih.gov/27164192/
https://doi.org/10.1080/08897077.2016.1184739
[2]
Buzancic, I., Kummer, I., Drzaic, M. and Ortner Hadziabdic, M. (2022) Community-Based Pharmacists’ Role in Deprescribing: A Systematic Review. British Journal of Clinical Pharmacology, 88, 452-463. https://pubmed.ncbi.nlm.nih.gov/34155673/
https://doi.org/10.1111/bcp.14947
[3]
Finley, E.P., Garcia, A., Rosen, K., McGeary, D., Pugh, M.J. and Potter, J.S. (2017) Evaluating the Impact of Prescription Drug Monitoring Program Implementation: A Scoping Review. BMC Health Services Research, 17, Article No. 420.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5477729/
https://doi.org/10.1186/s12913-017-2354-5
[4]
Deprescribing.org. (2023) What Is Deprescribing?
https://deprescribing.org/what-is-deprescribing/
[5]
Rawal, S., Osae, S.P., Cobran, E.K., Albert, A. and Young, H.N. (2023) Pharmacists’ Naloxone Services beyond Community Pharmacy Settings: A Systematic Review. Research in Social and Administrative Pharmacy, 19, 243-265.
https://pubmed.ncbi.nlm.nih.gov/36156267/
https://doi.org/10.1016/j.sapharm.2022.09.002
[6]
Cid, A., Daskalakis, G., Grindrod, K. and Beazely, M.A. (2021) What Is Known about Community Pharmacy-Based Take-Home Naloxone Programs and Program Interventions? A Scoping Review. Pharmacy, 9, Article 30.
https://pubmed.ncbi.nlm.nih.gov/33540676/
https://doi.org/10.3390/pharmacy9010030
[7]
Advisory Board (2020) Fatal Drug Overdoses Hit a Record High Last Year. Covid-19 Is Making the Problem Worse.
https://www.advisory.com/daily-briefing/2020/07/17/overdose
[8]
Leppla, I.E. and Gross, M.S. (2020) Optimizing Medication Treatment of Opioid Use Disorder during COVID-19 (SARS-CoV-2). Journal of Addiction Medicine, 14, e1-e3. https://pubmed.ncbi.nlm.nih.gov/32412931/
https://doi.org/10.1097/ADM.0000000000000678
[9]
Blue, H., Hawthorne, A.N., Melgaard, K., Dahly, A., Lunos, S. and Palombi, L. (2020) Pharmacist Involvement in Combating the Opioid Crisis: A Mixed-Methods Approach Revealing Conflicting Perceptions. Journal of the American College of Clinical Pharmacy, 3, 21-29. https://doi.org/10.1002/jac5.1124
https://accpjournals.onlinelibrary.wiley.com/doi/full/10.1002/jac5.1124
[10]
Bratberg, J.P., Smothers, Z.P., Collins, K., Erstad, B., Ruiz Veve, J. and Muzyk, A.J. (2020) Pharmacists and the Opioid Crisis: A Narrative Review of Pharmacists’ Practice Roles. Journal of the American College of Clinical Pharmacy, 3, 478-484.
https://accpjournals.onlinelibrary.wiley.com/doi/full/10.1002/jac5.1171
https://doi.org/10.1002/jac5.1171
[11]
College of Psychiatric and Neurologic Pharmacists (2015) Naloxone Access: A Practice Guideline for Pharmacists.
http://prescribetoprevent.org/wp2015/wp-content/uploads/naloxone-access.pdf
[12]
Bailey, A.M. and Wermeling, D.P. (2014) Naloxone for Opioid Overdose Prevention: Pharmacists’ Role in Community-Based Practice Settings. Annals of Pharmacotherapy, 48, 601-606. https://pubmed.ncbi.nlm.nih.gov/24523396/
https://doi.org/10.1177/1060028014523730
[13]
Lim, J.K., Bratberg, J.P., Davis, C.S., Green, T.C. and Walley, A.Y. (2016) Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists. Journal of Addiction Medicine, 10, 300-308.
https://pubmed.ncbi.nlm.nih.gov/27261669/
https://doi.org/10.1097/ADM.0000000000000223
[14]
United States Department of Veterans Affairs (2019) Opioid Overdose.
https://www.mentalhealth.va.gov/substance-use/overdose.asp?utm_source=google&utm_medium=cpc&utm_campaign=search_va_sud_harm&utm_term=broad-match&utm_content=overdose+symptoms&gclid=CjwKCAiA-vOsBhAAEiwAIWR0TfCdXfYC0MqlIpFVIP6g6cXyx7IXgiX1ByLDHwyZul9jPqPFwQW03xoCIxwQAvD_BwE
[15]
Kerr, D., Kelly, A.M., Dietze, P., Jolley, D. and Barger, B. (2009) Randomized Controlled Trial Comparing the Effectiveness and Safety of Intranasal and Intramuscular Naloxone for the Treatment of Suspected Heroin Overdose. Addiction, 104, 2067-2074. https://pubmed.ncbi.nlm.nih.gov/19922572/
https://doi.org/10.1111/j.1360-0443.2009.02724.x
[16]
Kelly, A.M., Kerr, D., Dietze, P., Patrick, I., Walker, T. and Koutsogiannis, Z. (2005) Randomised Trial of Intranasal versus Intramuscular Naloxone in Prehospital Treatment for Suspected Opioid Overdose. Medical Journal of Australia, 182, 24-27.
https://pubmed.ncbi.nlm.nih.gov/15651944/
https://doi.org/10.5694/j.1326-5377.2005.tb06550.x
[17]
Jimenez, D.E., Singer, M.R. and Adesman, A. (2019) Availability of Naloxone in Pharmacies and Knowledge of Pharmacy Staff Regarding Dispensing Naloxone to Younger Adolescents. Journal of Adolescent Health, 65, 698-701.
https://www.sciencedirect.com/science/article/pii/S1054139X1930374X?via%3Dihub
https://doi.org/10.1016/j.jadohealth.2019.07.009
[18]
The Comprehensive Addiction and Recovery Act (CARA).
https://www.cadca.org/cara/
[19]
United States Food and Drug Administration: FDA Approves First Generic Naloxone Nasal Spray to Treat Opioid Overdose.
https://www.fda.gov/news-events/press-announcements/fda-approves-first-generic-naloxone-nasal-spray-treat-opioid-overdose
[20]
Guy Jr., G.P., Haegerich, T.M., Evans, M.E., Losby, J.L., Young, R. and Jones, C.M. (2019) Vital Signs: Pharmacy-Based Naloxone Dispensing—United States, 2012-2018. Morbidity and Mortality Weekly Report, 68, 679-686.
https://pubmed.ncbi.nlm.nih.gov/31393863/
https://doi.org/10.15585/mmwr.mm6831e1
[21]
Wu, L.T., Ghitza, U.E., Burns, A.L. and Mannelli, P. (2017) The Opioid Overdose Epidemic: Opportunities for Pharmacists. Substance Abuse and Rehabilitation, 8, 53-55. https://www.tandfonline.com/doi/full/10.2147/SAR.S144268
https://doi.org/10.2147/SAR.S144268
[22]
Candidates for Naloxone: What the Data Tell Us.
https://www.fda.gov/media/121184/download
[23]
Sohn, M., Talbert, J.C., Huang, Z., Lofwall, M.R. and Freeman, P.R. (2019) Association of Naloxone Coprescription Laws with Naloxone Prescription Dispensing in the United States. JAMA Network Open, 2, e196215.
https://pubmed.ncbi.nlm.nih.gov/31225895/
https://doi.org/10.1001/jamanetworkopen.2019.6215
[24]
Luchen, G.G., Prohaska, E.S., Ruisinger, J.F. and Melton, B.L. (2019) Impact of Community Pharmacist Intervention on Concurrent Benzodiazepine and Opioid Prescribing Patterns. Journal of the American Pharmacists Association, 59, 238-242.
https://pubmed.ncbi.nlm.nih.gov/30552053/
https://doi.org/10.1016/j.japh.2018.10.010
[25]
Centers for Disease Control and Prevention (2017) Creating Community-Clinical Linkages between Community Pharmacists and Physicians. CDC, U.S. Department of Health and Human Services.
https://www.cdc.gov/dhdsp/pubs/docs/ccl-pharmacy-guide-high-res.pdf
[26]
Hill, M.V., McMahon, M.L., Stucke, R.S. and Barth Jr., R.J. (2017) Wide Variation and Excessive Dosage of Opioid Prescriptions for Common General Surgical Procedures. Annals of Surgery, 265, 709-714.
https://journals.lww.com/annalsofsurgery/Fulltext/2017/04000/Wide_Variation_and_Excessive_Dosage_of_Opioid.15.aspx.%202017
https://doi.org/10.1097/SLA.0000000000001993
[27]
Walley, A.Y., Xuan, Z., Hackman, H.H., Quinn, E., Doe-Simkins, M., Sorensen-Alawad, A., Ruiz, S. and Ozonoff, A. (2013) Opioid Overdose Rates and Implementation of Overdose Education and Nasal Naloxone Distribution in Massachusetts: Interrupted Time Series Analysis. BMJ, 346, f174.
https://doi.org/10.1136/bmj.f174
[28]
Wheeler, E., Jones, T.S., Gilbert, M.K., Davidson, P.J. and Centers for Disease Control and Prevention (CDC) (2015) Opioid Overdose Prevention Programs Providing Naloxone to Laypersons—United States, 2014. Morbidity and Mortality Weekly Report, 64, 631-635.
[29]
Doe-Simkins, M., Walley, A.Y., Epstein, A. and Moyer, P. (2009) Saved by the Nose: Bystander-Administered Intranasal Naloxone Hydrochloride for Opioid Overdose. American Journal of Public Health, 99, 788-791.
https://doi.org/10.2105/AJPH.2008.146647
[30]
Clark, A.K., Wilder, C.M. and Winstanley, E.L. (2014) A Systematic Review of Community Opioid Overdose Prevention and Naloxone Distribution Programs. Journal of Addiction Medicine, 8, 153-163.
https://doi.org/10.1097/ADM.0000000000000034
[31]
Maxwell, S., Bigg, D., Stanczykiewicz, K. and Carlberg-Racich, S. (2006) Prescribing Naloxone to Actively Injecting Heroin Users: A Program to Reduce Heroin Overdose Deaths. Journal of Addictive Diseases, 25, 89-96.
https://doi.org/10.1300/J069v25n03_11
[32]
McDonald, R. and Strang, J. (2016) Are Take-Home Naloxone Programmes Effective? Systematic Review Utilizing Application of the Bradford Hill Criteria. Addiction, 111, 1177-1187. https://doi.org/10.1111/add.13326
[33]
Salwan, A., Hagemeier, N.E., Tudiver, F., Dowling-McClay, K., Foster, K.N., Arnold, J., Alamian, A. and Pack, R.P. (2020) Community Pharmacist Engagement in Opioid Use Disorder Prevention and Treatment Behaviors: A Descriptive Analysis. Journal of the American Pharmacists Association, 60, e173-e178.
https://pubmed.ncbi.nlm.nih.gov/32669219/
https://doi.org/10.1016/j.japh.2020.06.008
[34]
Miller, S., Williams, L. and Thompson, A.N. (2020) The Prescribing and Education of Naloxone in a Large Academic Medical Center. Pharmacy, 8, Article 31.
https://pubmed.ncbi.nlm.nih.gov/32151017/
https://doi.org/10.3390/pharmacy8010031
[35]
Thakur, T., Frey, M. and Chewning, B. (2020) Pharmacist Roles, Training, and Perceived Barriers in Naloxone Dispensing: A Systematic Review. Journal of the American Pharmacists Association, 60, 178-194.
https://pubmed.ncbi.nlm.nih.gov/31371179/
https://doi.org/10.1016/j.japh.2019.06.016
