Laws Allowing Pharmacists to Directly Distribute Naloxone May Reduce Fatal Opioid Overdoses

However, states that enact these laws may also experience an increase in emergency department visits for nonfatal opioid overdoses.

Distribution of naloxone to patients at risk for opioid overdose (as well as their friends and family) has become increasingly accepted (NEJM JW Emerg Med Dec 2016 and Ann Emerg Med 2017; 69:340). However, strategies for distribution vary from state to state. Researchers compared opioid overdoses from 2005 to 2016 in states that have adopted three different legislative strategies for naloxone distribution (direct authority given to pharmacists to dispense without a prescription; indirect authority given to pharmacists through a standing order; other).

The overall rate of fatal opioid overdose between 2005 and 2016 was 0.59 per 100,000 people per month. States that granted direct dispensing authority to pharmacists had significant reductions in fatal opioid overdoses (decrease of 0.39 per 100,000 people per year ≥3 years after adoption of the laws) but also had significant increases in emergency department (ED) visits for nonfatal opioid overdoses (increase of 45 per 100,000 people per quarter ≥3 years after adoption). States with other types of laws had no significant change in fatal or nonfatal opioid overdoses.

Comment

Increasing access to naloxone is essential to the prevention of opioid overdoses fatalities. While we work on increasing access to treatment for patients with opioid use disorder (NEJM JW Emerg Med Jun 2019 and CJEM 2019 Apr 22; 1; [e-pub]), we also need to make it easier to mitigate the severity of overdoses in patients not yet treated. We can do this by giving out naloxone in the ED, by having non-ED clinicians emphasize the role of naloxone, and by allowing pharmacists to distribute naloxone without having to ask permission to do so. We may see more nonfatal overdoses in the ED when patients are given naloxone by family or friends, but I'd much rather see these patients in my ED than in the morgue.

Reviewing Author

Ali S. Raja, MD, MBA, MPH

Disclosures

Leadership Positions in Professional SocietiesSociety for Academic Emergency Medicine (Board Member); American College of Healthcare Executives – Massachusetts (Board Member)