My daughter Zoey had to do 25 hours of volunteer time for her school so I hooked her up with the local harm reduction drop in center, where she helped put together safe drug use kits as well as naloxone rescue kits. Some days she sat outside the bathroom door and monitored the three-minute clock to make certain the person in the bathroom was okay and not overdosed. A great experience for a high school student and it led to many interesting conversations. We talked about naloxone and how it was now available in pharmacies. We went to a few local pharmacies to view their naloxone placement and found that while naloxone was available over the counter, it was more often than not only available behind the counter. So we decided to survey all the pharmacies in the city of Hartford and write a report about it as part of her volunteer project. We surveyed the stores for signs advertising naloxone’s availability, whether the naloxone was in the store (on the shelves, behind the counter, in tamper-resistant packages, etc.), whether or not the pharmacist would write a prescription (legal in Connecticut) so a person with insurance would not have to pay the full over-the counter price (usually $44.95). When we presented the report to the Hartford Health Department, one of their consultants suggested we get more volunteers and survey the state. He helped create a secret shopper survey monkey with instructions so people could evaluate each store by the same criteria. Eventually, we worked with the Statewide Harm Reduction Partnership (SHArP). Using over 20 volunteers, we surveyed 162 pharmacies across the state, including at least 10 from each of Connecticut’s 8 counties.
Last Thursday we had a media day that started at the state capitol where state senator Saud Anwar spoke about the importance of naloxone availability. A mother who’s lost her son spoke as well as a man I work with who’s life was saved by naloxone. I spoke on the topic from the perspective of a rescuer and a man who led one of the treatment programs in the state spoke of the harm reduction. Later we visited three pharmacies in the state and presented awards to them for their service. They were chosen for making naloxone easily available and for treating customers without stigma. It was a wonderful day. The pharmacists were great. They are often unrecognized and they were truly touched to be thanked for their efforts, to be noticed. We are hopeful that working with the state pharmacy association many of our recommendations will be followed by more pharmacies.
Here are some of the results of our state-wide survey as well as the recommendations we had for pharmacies followed by the recommendations for consumers.
Naloxone Survey
Signs-Did the store have signs displaying naloxone availability?
Yes-21% No-79%
Naloxone Cost
Narcan generally retailed for $44.99. Walgreens sold a generic Naloxone for $34.99. Seven pharmacies quoted prices over $60. One supermarket pharmacy quoted $125.
Location
On shelf -30%
On shelf easily available – 18%
On aisle shelf with theft deterrent such as locked container or redeemable coupon – 12%
Behind general checkout counter – 31%
Only behind pharmacy counter – 39%
Was the pharmacy unable to prescribe for naloxone due to lack of trained provider or authorization
Yes- 19% No-81%
Was pharmacist able or willing to write a prescription for naloxone
Yes-52% No-48%
Did you perceive the pharmacist was sensitive with the use of language (i.e. stigma free)?
Yes-84% No-16%
Was clerk knowledgeable/helpful in where and how naloxone was sold in store?
Yes-52% No-48%
Syringes
We also surveyed the pharmacies to see how many were willing to sell syringes 10 or fewer syringes to a person without a prescription as allowed by state law.
Syringes- Would pharmacy sell 10 or fewer syringes without prescription
Yes-35% No-65%
Over the Counter Naloxone – Best Practices for Pharmacies
Connecticut pharmacies have been instrumental in expanding access to naloxone across the state. Based on findings from a statewide survey, these recommendations outline the best practices to enhance naloxone visibility, accessibility, affordability, and community impact.
Visibility and Accessibility
- Placement:
o Place naloxone in visible, accessible locations such as aisle shelves or near the front counter.
o If naloxone must remain behind the pharmacy counter, ensure signage directs customers on how to request it.
o Ensure naloxone is available during all store hours, including times when the pharmacy is closed. - Signage:
o Use clear, visible signs throughout the store indicating naloxone availability.
o Include information on naloxone’s purpose, how to request it, and whether a trained pharmacist is available to write prescriptions for insured customers. - Displays:
o Avoid storing naloxone in locked glass cabinets whenever possible.
o Highlight naloxone availability with displays near the pharmacy counter or a visible shelf location.
Affordability
- Product Options:
o Stock both brand name naloxone (e.g., Narcan) and generic alternatives to provide affordable options.
o Offer lower-cost options for uninsured customers to increase access. - Insurance Awareness:
o Encourage pharmacists to inform customers with insurance about the benefits of having naloxone prescribed, which can significantly reduce costs through copay or deductible coverage.
Training
- State-Mandated Training Compliance:
o Ensure all pharmacy staff, especially in grocery store pharmacies, complete state-mandated naloxone training to improve service delivery. - Customer Interaction:
o Train staff to proactively discuss naloxone with customers, including guidance on storage, administration, and expiration date monitoring.
o Encourage staff to provide printed materials or verbal instructions on administering naloxone and responding to opioid overdoses.
Community Partnerships
- Partner with harm reduction groups and public health agencies to distribute educational materials.
o Host informational events or collaborate with health departments to increase community awareness about naloxone. - Educational Materials:
o Provide takeaway handouts that explain:
What naloxone is and how it works.
How to administer naloxone during an overdose.
Storage guidelines, expiration date monitoring, and care instructions. - Harm Reduction Information:
o Consider offering harm reduction resources or information on local assistance programs alongside naloxone displays.
Pharmacies play a critical role in making naloxone accessible and affordable to those who need it most. By implementing these best practices, pharmacies can save lives and support their communities in combating the opioid crisis.
Over the Counter (OTC) Naloxone – Recommendations for Consumers
Naloxone (brand name Narcan) is a life-saving medication that reverses opioid overdose. With FDA approval for over the counter (OTC) sales in March 2023, naloxone is now widely available at pharmacies, community organizations, and online retailers.
What You Need to Know
Where to Find Naloxone
• Most pharmacies in Connecticut stock naloxone, including CVS, Walgreens, Walmart, Target, Costco, and many independent pharmacies.
• Naloxone may not be prominently displayed and is often kept behind the pharmacy counter, only accessible during pharmacy hours.
• Some pharmacies use theft deterrents like locked cabinets or cards requiring customers to ask staff.
Accessing Naloxone
• Call Ahead: Confirm availability, hours of operation, and whether a trained pharmacist can write a prescription if needed.
• Online Options: Naloxone can also be ordered by mail from manufacturers or online retailers like Amazon.
Lowering Costs
Over-the-Counter Pricing:
•Typical over the counter prices for naloxone are:
o Narcan nasal spray: $44.99
o Generic version (Walgreens): $34.99
Using Insurance
• If you have insurance (private, Medicare, or Medicaid), ask your doctor or pharmacist for a prescription.
• Prescriptions often reduce the cost to your insurance copay or deductible, making it more affordable than the OTC price.
Pharmacist Prescriptions
• Connecticut pharmacists who complete special training can write naloxone prescriptions.
• Call ahead to ensure a trained pharmacist will be available at your preferred store.
Free Naloxone Options
• Harm reduction organizations, community health agencies, and local health departments often distribute naloxone at no cost.
• Contact the Statewide Harm Reduction Partnership (SHaRP) for information on local free naloxone resources.
How to Use Naloxone
• Most naloxone comes in a nasal spray form, which is simple to administer.
• Ask the pharmacist for a demonstration or review the instructions in the naloxone kit.
How to Store Naloxone
• Temperature: Store between 59°F and 77°F (15°C to 25°C). Avoid freezing or exposure to extreme heat.
• Light Protection: Keep in its original packaging or a zipper pouch to protect it from sunlight.
Accessibility:
Carry naloxone in a convenient location (e.g., bag, pocket, or belt pouch) for quick retrieval in emergencies.
• Expiration Dates: Regularly check expiration dates and replace expired doses.
• Humidity: Avoid moisture or humidity, which can reduce effectiveness.
Saving Lives
• Naloxone saves lives by reversing opioid overdoses.
• Learn proper administration and storage to ensure your naloxone is effective when needed.
• Over-the-counter access is available, but a prescription may lower costs for insured individuals.
• Free options are available through community organizations and local health departments.