Assessing pharmacy-based naloxone access using an innovative purchase trial methodology.

Area of Science:

• Public Health
• Pharmacology
• Addiction Medicine

Background:

• Massachusetts pioneered standing orders for pharmacy-based naloxone to combat opioid overdose deaths.
• Assessing naloxone accessibility for individuals who use illicit opioids (PWUIO) is crucial for targeted interventions.

Purpose of the Study:

• To evaluate the accessibility of pharmacy-based naloxone through a purchase trial in Massachusetts.
• To compare naloxone accessibility between PWUIO and bystanders purchasing naloxone from pharmacies.

Main Methods:

• A purchase trial involving 200 chain and independent pharmacies across Massachusetts.
• Two purchase attempts per pharmacy: one by a PWUIO and one by a bystander.
• Outcome measures included successful purchase, naloxone type, cost, counseling received, and reasons for failed purchase.

Main Results:

• Overall naloxone purchase success rate was 81%, with no significant difference between PWUIO and bystanders.
• Nasal naloxone (Narcan) was acquired in 93% of successful purchases at a median cost of $133.38.
• PWUIO received counseling less frequently (30%) than bystanders (51%); common barriers included stockouts (47%) and high prices (25%).
• Chain pharmacies demonstrated significantly higher naloxone sales (86%) compared to independent pharmacies (53%).

Conclusions:

• Massachusetts pharmacies demonstrate high naloxone accessibility for both PWUIO and bystanders.
• Independent pharmacies require enhanced efforts to improve naloxone availability.
• Proactive pharmacy-based naloxone provision to high-risk individuals should be prioritized.