Naloxone: Pharmacists aid in the fight

By: Unknown on 7:29:00 AM

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Almost 70% of all drug and poison related deaths were attributable to opioids from 2007 to 2013, according to the Virginia Department of Health Professions. Heroin related deaths have been on the rise: in the first half of 2015 alone, there were over 100 overdose-related deaths in the state of Virginia. In the face of involvement by law enforcement and various agencies, pharmacists have been deemed into a position to help curb these fatalities.

The REVIVE! program for Opioid Overdose and Naloxone Education was created in 2013 for the State of Virginia, led by the Virginia Department of Behavioral Health and Developmental Services (DBHDS). The REVIVE! program provides educational materials to professionals and other stakeholders on how to recognize and respond to an opioid overdose situation by administering the opioid antidote Narcan(naloxone). Since June of 2015, REVIVE! has been expanding from a pilot project to a statewide program, thanks to the patronage of Del. John O’Bannon (R-73). Virginia HB-1458 was passed, which authorized pharmacists to dispense naloxone pursuant to an oral, written, or standing order in accordance with protocol approved by the Board of Pharmacy. With this program, pharmacies may wholesale distribute naloxone via invoice to law enforcement or fire fighters who have completed training programs as required by law.

In speaking to a few practicing pharmacists, I became aware that some practitioners did not know these educational programs and laws had been created. These types of programs, where they exist, differ due to the varying prominence of opiate overdose and the fact that these bills are only passed at the state level. This makes HB-1458 and the REVIVE! program only relevant through the Commonwealth of Virginia.

To get more insight into the topic, I held a brief interview with Caroline Juran, Executive Director of the Virginia Board of Pharmacy. She has been providing assistance to the legislators during the General Assembly session and the Board of Pharmacy as it adopted a protocol for pharmacists to dispense naloxone pursuant to a standing order. Her work centered on trying to increase awareness of the new law when speaking at pharmacy professional association meetings. Fortunately, she had not seen much resistance to the newly passed laws, but she still believes,” that there is a need for increased education and awareness of the law, including the civil liability protections, and how to implement a standing order for dispensing naloxone.” It is imperative that we raise awareness of educational programs and laws formed around opioid overdoses.

At this point, the pharmacists that are dispensing Naloxone pursuant to a standing order are not mandated to report to the board, so no statistics related to the prevention overdose-related fatalities can be identified yet. In a memorandum by President Obama in October 2015, he stated improving access to treatment was specifically noted as one of the largest actions in the Nation Drug Control strategy. The press release unveiled plans for naloxone use and training programs for pharmacies like CVS Health and Rite Aid. Also noted were increased efforts by the American Pharmacists Association, the National Community Pharmacists Association, American Society of Health System-Pharmacists and The National Association of Boards of Pharmacy.

"Pharmacists can play an integral role in protecting patients from opioid overdose," stated Caroline Juran. What does this entail? It includes identifying high-risk patients, encouraging responsible naloxone use by both patients and care givers, and providing training on the proper administration of the drug. 

This is what our role is shifting towards due to this epidemic: comment below on your thoughts. Is this intervention truly our responsibility? Does this level of intervention and assistance require more training than basic CE's can provide? How can pharmacy technicians help us reach these patients?