Many U.S. drugstores fail to provide naloxone for opioid overdoses

(Reuters Health) - Despite state laws expanding access to the opioid-overdose antidote naloxone without a prescription, two U.S. studies suggest many pharmacies don’t stock the drug or make it easily available to people who need it.

In California, where pharmacists have been able to dispense naloxone without a prescription since 2016, fewer than one in four drugstores in a survey gave the drug to people without a prescription, one of the studies found. When pharmacists were willing to give naloxone without a prescription, in theory, only about half of the drugstores had it in stock.

In Texas, naloxone can also be dispensed without a prescription. Here, 84 percent of drugstores in a survey said they would give the drug to customers without a prescription, but only 69 percent of the stores had it in stock.

“There is still significant room for improvement with regards to making this potentially life-saving medication available to patients who need it,” said Kirk Evoy of the University of Texas at Austin College of Pharmacy and University Health System in San Antonio, who led the Texas study.

Overdoses of opioids like morphine or heroin can be deadly because these drugs slow breathing, thereby reducing the supply of oxygen to the body.

Naloxone blocks the ability of opioids to impact breathing.

The trouble with any delays or roadblocks in access to naloxone is that it needs to be given quickly to be effective in countering the potentially fatal effects of an opioid overdose, Evoy said by email.

“Being able to administer naloxone immediately, while waiting for emergency medical services to arrive, greatly increases the chances of survival and reduces the risk of long-term negative health consequences, because the body cannot last long without oxygen,” Evoy added.

For the Texas survey, researchers examined responses from one pharmacist from each of the 2,317 CVS, Walgreens, HEB and Walmart pharmacies in the state in 2018. In Texas, pharmacies can dispense naloxone if they have so-called standing orders from a prescriber.

Trained interviewers called the pharmacies posing as a potential overdose responder who wanted to buy naloxone to have on hand in the case of an overdose. Most of the pharmacists said they would dispense to a customer who wanted to use naloxone for somebody else. Only half, however, would bill the purchaser’s insurance for the medication.

With insurance, some patients might get Narcan (naloxone) Nasal Spray without any co-pay at all. Without insurance, one box with two Narcan doses may cost around $130 to $140, according to the retail drug price tracker

For the California study, trained interviewers posing as customers called a random sample of about 1,200 drugstores, or about 20 percent of pharmacies in the state in 2018. They found that slightly more than half of chain pharmacies that were willing to dispense naloxone without a prescription had it in stock, compared with only 31 percent of independent pharmacies.

Both studies were published in the Journal of the American Medical Association.

“When someone is in an overdose, they will not be able to go to a doctor or emergency room,” said Talia Puzantian of the Keck Graduate Institute School of Pharmacy and Health Sciences in Claremont, California.

“They are at the mercy of those around them: friends, family, strangers to respond either by administering naloxone or by calling 911 and having first responder hopefully administer naloxone,” Puzantian, co-author of the California study, said by email.

When an overdose is suspected, using naloxone immediately is crucial, Puzantian added. Signs of an overdose can include slow or shallow breathing, gasping for air while sleeping, pale or clammy bluish skin or fingernails, slowed heartbeat, or inability to wake or respond when shaken.

More naloxone in the hands of family and friends of opioid users can save lives, Dr. Seth Landefeld of the University of Alabama at Birmingham writes in an editorial accompanying the studies.

Last year, 72,000 Americans died from drug overdoses, most from opioids and most before patients ever reached a hospital, Landefeld said by email.

“I do not know how many of these people overdosed alone,” Landefeld added, “But ready availability of naloxone would undoubtedly have saved many lives.”

SOURCE:, and JAMA, online November 13, 2018.