A drug that is central to the push to reduce Pennsylvania’s soaring opioid overdose deaths isn’t on the shelves of many pharmacies, and numerous drug stores Tuesday showed confusion about a state order meant to put naloxone in the hands of any resident who could witness an overdose.

The Pittsburgh Post-Gazette called 32 area pharmacies, including chains and independent stores in Pittsburgh and outlying towns and counties on Tuesday morning, and found that 16 did not have Narcan, the most consumer-friendly version of naloxone.

The Philadelphia Inquirer found similar results in the southeastern part of the state. Of 14 pharmacies called by reporters within the city of Philadelphia, five said they had it in stock and no prescription was required. Another five said they had it, but needed a doctor’s script. The rest said they couldn’t get it. One independent store told a caller to go to a chain store.

Just six of 14 Montgomery County pharmacies contacted had the drug in stock; two said they required a prescription.

In October of last year, Physician General Rachel Levine signed the standing order explicitly allowing anyone in Pennsylvanian to get the overdose-reversing, life-saving drug naloxone in a nasal spray or injection. Additionally, Allegheny County has had a standing order since May 2015.

Dr. Levine acknowledged that some pharmacists haven’t gotten the message, despite the state’s efforts.

“We would want pharmacies, and the pharmacists, to know about the standing order, and more and more do,” she said. “I think it would be great … that they have it in stock.”

She said the administration has written to every pharmacist in the state and referenced the standing order at events and “countless press conferences.” Next month she will go before the Board of Pharmacy and urge them to echo the call.

Of the 16 pharmacies in the Pittsburgh area that did not stock the drug, staff members at eight said they did not know where it could be found. Others suggested other pharmacies, or referred callers to the Allegheny County Health Department.

Some pharmacy staff seemed unaware of, or confused about, the state order making the drug available without a doctor’s prescription.

Staff at two Oakland pharmacies first said that they would need to see a prescription to supply the drug. One of them backtracked on that point when told of the standing order. A Westwood pharmacy employee insisted on a prescription, and then told the caller to contact the Allegheny County Health Department when told of the order.

In nearby Elliott, a pharmacy employee said no prescription was needed, but that a buyer would have to provide a name, phone number and date of birth. When the caller hesitated, the employee said if someone is in trouble, call 911.

At a Monessen pharmacy, a pharmacy employee said the store did not stock it and would not order it.

A Brentwood pharmacy’s employee said their store doesn’t carry Narcan, but could order it with a prescription. When the caller mentioned the order, the employee said that it only applies to certain pharmacies on a specific list, and they aren’t one of those pharmacies. The employee then directed the caller to the county Health Department.

Pharmacy staff at Rite Aids in the Cultural District, the North Side and Beaver said they don’t have the drug. One referred the caller to the Rite Aid in Market Square, Downtown, which has the nasal version — but charges $187.99 for a single dose of it. A Rite Aid spokeswoman said that the chain has “strategically placed naloxone in areas where there has been a demand or need observed” and stores that don’t have it refer customers to locations that do. She declined comment on the price quoted, but said that cash prices for some formulations range from $33 to $97.

Other pharmacies quoted prices around $50 for the nasal product, and the three which had the intra-muscular injection product provided prices ranging from $45 to $60.

This confusion and uneven availability of the drug is a problem familiar to Alice Bell, overdose prevention project coordinator for Prevention Point Pittsburgh.

“There are lots and lots of pharmacies that don’t have naloxone,” she said. “We get calls from people who say, ‘I called my local pharmacy. They don’t have it. They don’t know anything about it.’”

“Something we’re seeing is that there’s a lot of variability in participating in that standing order. It depends on the branch you go to, on the person who’s working, and then we see people… who may have a co-pay, and that becomes a barrier, as well,” said Prevention Point Pittsburgh Director of Operations Aaron Arnold. 

As to why the statewide standing order hasn’t translated to full availability at every pharmacy, Ms. Bell has a few theories. Any new policy takes time to figure out, pharmacists must learn more about the issue, and there is perhaps a lack of understanding or stigma that this is somehow wrong or enabling people to use drugs.

Part of the confusion could be because standing orders are very rare, said Pat Epple, CEO of the 2,300-member Pennsylvania Pharmacists Association.

“That is really unusual. The rarity of this is what is catching people off guard,” she said. Even more unusual is a standing order like this one, that allows for a third party to purchase the drug that will not be used on themselves (because the drug is administered not by the person who is overdosing, but someone nearby). Additionally, not every pharmacy will stock naloxone, likely due to its cost, she said.

The association has been communicating with members about the order, she said, and she believes word is getting out and availability is improving.

“I’m pretty confident that we are getting to the point where within certain [areas], there is someone who will stock it,” she said.

Allegheny County Health Department Director Dr. Karen Hacker said her agency has heard similar complaints about naloxone availability, and said more outreach should be done to work with pharmacists. She also noted the standing order is not a mandate to carry naloxone.

“The policies are in place. Now we have to get it to filter down to folks on the front lines,” she said.

Post-Gazette staff writers Rich Lord and Maia R. Silber and Philadelphia Inquirer staff writers Sam Wood, Marie McCullough and Don Sapatkin contributed. Rich Lord: rlord@post-gazette.com or 412-263-1542. Maia R. Silber: msilber@post-gazette.com. Sam Wood: samwood@phillynews.com, 215-854-2796 @samwoodiii. Marie McCullough: mmccullough@phillynews.com or 215-854-2720 or @repopter. Don Sapadtkin: dsapatkin@phillynews.com or 215-854-2617 or @DonSapatkin

Kate Giammarise: kgiammarise@post-gazette.com or 412-263-3909 or on Twitter @KateGiammarise.