Pharmacies juggle state regulations for non-prescription naloxone

Pharmacies around the country are making extra efforts to ensure that naloxone is as accessible as possible, including dispensing it without a prescription in multiple delivery methods. For national chains like Walgreens and CVS, that entails working closely with state regulators to ensure compliance and collaborating with prescribers to implement standing order agreements.

Walgreens currently dispenses the drug without an individual prescription at more than 1,500 pharmacies throughout nine states (Alabama, Indiana, Massachusetts, New Jersey, New Mexico, New York, Ohio, Pennsylvania and Rhode Island) and will be soon be expanding its initiative to the other 26 states where regulations allow it.

“We follow regulations and requirements in each state, and in those states where a prescription is required, Walgreens is eager to work with regulators to help update their rules to allow for dispensing of naloxone without requiring a prescription,” according to Walgreens spokesman Phil Caruso.

When the initiative is fully implemented, naloxone will be available without a prescription in more than two-thirds of Walgreens’ 8,200 stores across the country.

CVS Pharmacy takes a similar approach with state regulators and uses a collaborative practice agreement (or standing order agreement) with a physician prescriber in each state to ensure patients can access naloxone without a doctor’s order, according to Erin Britt, the company’s director of corporate communications.

“As such, the patient does not need to present an individual prescription for naloxone at our pharmacies in the state,” she says. “These are similar to the agreements we have in place that allow pharmacists to provide flu shots to pharmacy patients without the need for an individual prescription.”

The fine line

Although it varies by location, Walgreens and CVS Pharmacy offer naloxone in both the injectable and twist-on nasal spray versions. In states where it’s available without a prescription, the individual simply walks up to the pharmacy counter, where the naloxone would be dispensed just like any other medication. From beginning to end, the process takes only about 15 minutes.

Some of the states that allow the dispensing of naloxone under a physician’s standing order have reporting requirements, including notifying the physician and having the person obtaining the medication acknowledge that they have received training on its proper administration.  

There were more than 16,000 deaths related to prescription opioid use in 2013, and 8,000 more involving heroin. Naloxone has saved lives, which adds urgency to programs that make it more accessible. However, it can cause problems when not administered correctly, so pharmacies are doing what they can to ensure patients are informed and know how to get medical help.

“Whenever naloxone is dispensed with or without a prescription, instructions are provided on how to properly administer the medication, which includes calling 9-1-1,” Caruso says. “Naloxone is not a substitute for medical care, and anyone who is administered the medication should seek immediate medical attention.”

That advice is important not just for the patient, but caregivers as well. According to Britt, CVS pharmacists who dispense naloxone also counsel patients and caregivers on a number of important points including:

• How to identify signs of an overdose;
• The importance of calling 9-1-1;
• Giving rescue breaths;
• Administering naloxone; and
• Remaining with the patient until help arrives.

Costs vary by pharmacy and state, but naloxone generally costs between $30 and $60 without a prescription.