Journal
DRUG AND ALCOHOL DEPENDENCE
Volume 230, Issue -, Pages -Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.drugalcdep.2021.109190
Keywords
Naloxone; Pharmacy; Standing orders; Harm reduction; Analgesics; opioid
Categories
Funding
- National Institute on Drug Abuse [R01DA040807, R01DA046527, P30DA040500, R01DA045745]
- National Institute of General Medical Sciences [P20GM125507-01]
- National Center for Injury Prevention and Control [R01CE002999]
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The study found that the quantity and coverage of naloxone dispensed under NSO increased annually, but communities with higher percentages of Hispanic populations and rural characteristics were less likely to dispense naloxone under NSO.
Background: Naloxone is a prescription medication that reverses opioid overdoses. Allowing naloxone to be dispensed directly by a pharmacist without an individual prescription under a naloxone standing order (NSO) can expand access. The community-level factors associated with naloxone dispensed under NSO are unknown. Methods: Using a dataset comprised of pharmacy reports of naloxone dispensed under NSO from 70% of Massachusetts retail pharmacies, we examined relationships between community-level demographics, rurality, measures of treatment for opioid use disorder, and overdose deaths with naloxone dispensed under NSO per ZIP Code-quarter from 2014 until 2018. We used a multi-variable zero-inflated negative binomial model, assessing odds of any naloxone dispensed under NSO, as well as a multi-variable negative binomial model assessing quantities of naloxone dispensed under NSO. Results: From 2014-2018, quantities of naloxone dispensed under NSO and the number of pharmacies dispensing any naloxone under NSO increased over time. However, communities with greater percentages of people with Hispanic ethnicity (aOR 0.91, 95% CI 0.86-0.96 per 5% increase), and rural communities compared to urban communities (aOR 0.81, 95% CI 0.73-0.90) were less likely to dispense any naloxone by NSO. Communities with more individuals treated with buprenorphine dispensed more naloxone under NSO, as did communities with more opioid-related overdose deaths. Conclusion: Naloxone dispensing has substantially increased, in part driven by standing orders. A lower likelihood of naloxone being dispensed under NSO in communities with larger Hispanic populations and in more rural communities suggests the need for more equitable access to, and uptake of, lifesaving medications like naloxone.
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