One of the states hardest-hit by the U.S. opiate epidemic has been Kentucky, which recorded more than 1,400 fatal overdoses in 2016, according to the Kentucky Office of Drug Control Policy.
Earlier this year, Kentucky became the first state to develop an online registry that enables patients to locate pharmacies that supply naloxone without a patient-specific prescription. Patients can view a map showing locations that dispense naloxone; they can search by city, county, or zip code. The ODCP plans to continue updating the site, as more pharmacies are beginning to stock the medication for at-risk patients across the state, officials said.
Under the Kentucky Board of Pharmacy program, anyone with a history of opioid poisoning or opioid abuse, an opioid naïve person receiving a first-time methadone prescription or a person on a high-dose opioid prescription can receive a naloxone kit. Additionally, any person or agency can voluntarily request a kit. Pharmacists will train recipients on procedures for safe administration.
As of June, 421 pharmacies in 90 counties had signed up to participate, according to Trish R. Freeman, clinical associate professor and director of the Center for the Advancement of Pharmacy Practice at the University of Kentucky College of Pharmacy. There are pharmacies in 119 of Kentucky’s 120 counties. By the end of this year, the KPA’s goal is to have naloxone available without a prescription in all 119 counties, Freeman told The Influence.
“We are focused on having naloxone accessible; our goal is at least one pharmacy in every county,” Freeman says. “We are also trying to raise public awareness that it is available. Insurance will often pay for it, and we are trying to get that word out,” Freeman says.
The website, which also provides information about naloxone and an overdose response guide, is maintained by the state’s Office of Drug Control Policy (ODCP) in partnership with the Kentucky Board of Pharmacy, the Kentucky Agency for Substance Abuse Policy, and Advancing Pharmacy Practice in Kentucky Coalition (APPKC).
APPKC, a unit of the University of Kentucky College of Pharmacy, continues to work to locate pharmacies to add to the registry that employ pharmacists who are naloxone-certified and have an approved protocol in place with a physician for dispensing. There is also a tab for contacting the ODCP, where patients or concerned family members and friends can provide contact information and comments, and a treatment center locator.
The online registry was made possible by Kentucky’s naloxone legislation, enacted in 2015 as Kentucky Senate Bill 192. The bill allows pharmacists to dispense naloxone pursuant to a specific protocol that provides pharmacists with such information as who is eligible to receive naloxone prescriptions, and guidelines they must meet for patient education.
The guidelines require explaining risk factors for opioid overdose, developing strategies for prevention, and certain administrative procedures. Before dispensing naloxone, pharmacists must attend a 1.5-hour training session that addresses aspects of the new legislation, including the criteria necessary to meet the requirements of the protocol and the documentation they must complete after dispensing the medication.
As of June, 1,700 pharmacists had applied, received training and been certified. Freeman says the pharmacists’ response has been “phenomenal, which really shows their willingness to be part of the solution in trying to address the crisis.”
Freeman says it’s difficult to get an accurate count on how much naloxone has been dispensed. “We have asked folks to voluntarily report” when they receive it, but that usually won’t happen unless it is mandated, she notes. She is writing a research grant for funds to purchase dispensing data from across the country, to better understand what is happening as laws change and more pharmacies begin to dispense it across the country.
Freeman says the agencies conducted a survey to gauge perceptions and used the survey information to help us design their education program “so we were able to address any issues. I’m not saying there weren’t some attitudinal barriers, but we haven’t seen global attitudinal barriers.”
KPHA has also partnered with the Kentucky Department of Public Health to implement a naloxone-dispensing mobile pharmacy. Freeman says officials hope the mobile van program will yield some information on how the program is working and the impact of the law.
Freeman says that about 18 months ago, Kentucky was dealing with a shortage of naloxone, before the new Narcan nasal spray was approved for use. “But now we have no supply issues.”
How much does naloxone cost? The coalition’s cost to buy a carton of Narcan nasal spray with two units is $121. Retail pharmacies may mark that up. In Kentucky, the Department of Public Health and first responders can buy the same carton for $75. Agencies do not set a limit on how many times one person can be given naloxone to prevent overdoses, Freeman says.