Few are buying non-prescription naloxone at pharmacies
Eighteen Richland County pharmacies started selling naloxone without a prescription this year, but few residents apparently are purchasing the opioid overdose-reversal medication.
In fact, at the five local pharmacies willing to discuss the specifics of their naloxone sales, no doses of the drug have been sold over the counter without a prescription.
Pharmacists and public health officials say a combination of a lack of awareness, the stigma surrounding drug addiction, the high cost for consumers without insurance and the preventative nature of the drug account for the lack of sales.
Naloxone, sold under the brand names Narcan and Evzio, blocks the effects of prescription opioids, heroin and fentanyl on the brain and reverses an overdose. It has become the primary tool in fighting the epidemic of opiate overdoses.
Jay Fordyce, a pharmacist with Discount Drug Mart in Shelby, said he believes the lack of sales could be due to a lack of awareness, with the public not realizing they now can walk into a pharmacy and purchase the drug without a prescription.
“I don’t know if people are afraid to come up to the pharmacy and ask for naloxone or what,” he said. “I think people just don’t know about it.”
The Shelby store keeps one box of the drug in stock, containing two nasal pumps.
Chris Peshek, a regional pharmacy supervisor with Discount Drug Mart, said the Discount Drug Mart stores on Briggs Drive in Mansfield and Mansfield Avenue in Shelby have not sold any doses of naloxone since the chain started doing so in April.
He said it could be related to the sense of shame that can surround drug addiction.
“It keeps coming back to that stigma of not wanting to admit you have a problem or not wanting to get help for the problem because you’re afraid that somebody’s going to find out,” he said. “Because of that really strong stigma associated with drug addiction, people don’t want to be seen walking into a drugstore to buy naloxone.”
Three-quarters of the 24 pharmacies in Richland County sell naloxone — four CVS pharmacies, two Discount Drug Mart pharmacies, three Kroger pharmacies, one Meijer pharmacy, five Rite Aid pharmacies and three Walgreens pharmacies.
Map of drug stores selling naloxone
Twelve of the pharmacies are in Mansfield, three are in Ontario, two are in Shelby and one is in Lexington.
CVS, Meijer, Rite Aid and Walgreens declined to share their sales numbers, citing corporate privacy policies.
Similar to Discount Drug Mart’s lack of sales, the three local Kroger pharmacies have not sold any naloxone doses, according to Jennifer Jarrell, a Kroger media relations representative. The Kroger pharmacies on Park Avenue West, Ashland Road and Lexington Avenue, all in Mansfield, have been selling naloxone over the counter since February.
Costs range from $40-$145 a dose
Cost could be another prohibitive factor for buying naloxone at pharmacies.
A two-pack dose sells for about $40 at Meijer and $136 at Walgreens. A single dose of the drug is $45 at Kroger and up to $140 at Rite Aid and $145 at CVS. When it’s bought as a preventative measure, it can be difficult to rationalize spending that much money on it, pharmacists say.
Fordyce has customers come in interested in purchasing naloxone, but no one’s bought any from him yet.
“I guess he decided he didn’t need it that bad,” Fordyce said of a man who came in to buy naloxone but who walked away when he found it it was $75 to $80 per single dose at Discount Drug Mart.
But patients with insurance usually pay a maximum of about $10 out-of-pocket, Peshek said.
Fordyce said the pharmacy bills the insurance of the person buying the drug, not the person who uses it.
“I would encourage people first thing to the call their prescription insurance and ask if they cover (naloxone) and what their co-pay would be,” Fordyce said.
The nature of naloxone’s preventative nature also could be a prohibitive factor. People who can stop an overdose have to prepare in advance to help a loved one who overdoses in the future.
“You have to be thinking way ahead,” Peshek said. “You need it right away, so you’re just going to go to the hospital or ER.”
Fordyce emphasized people who are overdosing still need medical attention, even if they get a dose of naloxone.
The effects of opioids can last between six and 12 hours, but naloxone wears off in 20 to 30 minutes.
“This is just the first step if there’s an overdose,” he said. “You should still call 911 or go to the hospital. Odds are, they’re going to need more (naloxone).”
Legislature passed bill unanimously
Ohio Gov. John Kasich signed House Bill 4 into law in July 2015 to allow pharmacists to dispense naloxone without a prescription to at-risk opioid users and those who can intervene during overdoses, such as family members, friends or roommates. The bill had passed both the Ohio House and Senate unanimously.
“For friends and family members, pharmacies play a unique role,” said Cameron McNamee, director of policy and communications for the State of Ohio Board of Pharmacy. “If you have an active opioid user in your family and they feel like they’re not ready to get help yet, getting naloxone from a pharmacy is one of the best things you can do to get a little bit of peace of mind.”
Previously, pharmacies could not sell the drug without a prescription from a doctor.
Nearly 1,400 pharmacies, or 65 percent of all Ohio retail pharmacies, in 84 of Ohio’s 88 counties sell naloxone without a prescription as of the end of November.
Holmes, Morgan, Noble and Vinton counties do not have any pharmacies selling naloxone.
Not many other alternatives
Currently, the only other way to receive naloxone is from first responders or high-risk agencies, such as hospitals or mental health agencies.
Richland Public Health started providing naloxone kits to first responders and their high-risk contacts in February with funding from the Ohio Department of Health.
The kits, known as Project DAWN kits, come with two pocket masks, two atomizers, two two-milliliter syringes and two milligrams of naloxone.
Project DAWN, which stands for “deaths avoided with naloxone,” is an Ohio community-based overdose education and naloxone distribution program.
The first site was created in Portsmouth in 2012.
First responders administer naloxone if they believe someone has overdosed or if they observe symptoms such as blue or gray skin, sweating, unresponsiveness, absent or shallow breathing, absent or shallow pulse or pinpoint pupils, said Keith Evans, public health nursing supervisor with Richland Public Health.
It can be administered via intravenous (through the veins), intraosseous (into the bone marrow) or intranasal (in the nose) methods, Evans said.
Richland Public Health has provided 30 to 40 kits to first responders since January.
But the organization started discussions with the Ohio Department of Health in October to receive shipments of naloxone kits available to the public.
“Like any disease, if you get rid of that disease, then you can start the healing process,” Evans said. “Easier said than done to eliminate the product from the community.”
There are more than 50 Project DAWN naloxone distribution and training sites across Ohio, where members of the public can receive naloxone kits and training on how to administer the drug, but there are none in Richland County.
“When I see things like that where the county has a drug problem and then I also see that same county doesn’t have a Project DAWN, it always kind of makes me scratch my head,” Peshek said.
55 overdose deaths in 2016
So far in 2016, there have been 55 drug overdose deaths in Richland County, according to the Richland County Opiate Board’s Keith Porch, who is assistant police chief with the Mansfield Police Department.
Richland County has seen an increase in the number of overdose deaths since 2012, when there were seven overdose deaths.
In 2013, there were 22 deaths, in 2014, there were 25 deaths and in 2015, there were 42 deaths.
ejmills@mansfieldnewsjournal.com
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Filed under: General Problems
I am not surprised to find that addicts aren’t spending their drug money to save their own lives. I am a little surprised their loved ones aren’t buying it though.