Permanente Medical Group, Oakland, California.
Kaiser Permanente Oakland Medical Center, Department of Emergency Medicine, Oakland, California.
West J Emerg Med. 2024 Jul;25(4):457-464. doi: 10.5811/westjem.17979.
To expand access to naloxone, the state of Illinois implemented a standing order allowing registered pharmacies to dispense the drug without an individual prescription. To participate under the standing order, pharmacies were required to opt in through a formal registration process. In our study we aimed to evaluate the availability and price of naloxone at registered pharmacies.
This was a prospective, de-identified, cross-sectional telephone survey. Trained interviewers posed as potential customers and used a standardized script to determine the availability of naloxone between February-December, 2019. The primary outcome was defined as a pharmacy indicating it carried naloxone, currently had naloxone in stock, and was able to dispense it without an individual prescription.
Of 948 registered pharmacies, 886 (93.5%) were successfully contacted. Of those, 792 (83.4%) carried naloxone, 659 (74.4%) had naloxone in stock, and 472 (53.3%) allowed purchase without a prescription. Naloxone nasal spray (86.4%) was the formulation most commonly stocked. Chain pharmacies were more likely to carry naloxone (adjusted odds ratio [aOR] 3.16, 95% confidence interval [CI] 1.97-5.01, < 0.01) and have naloxone in stock (aOR 2.72, 95% CI 1.76-4.20, < 0.01), but no more likely to dispense it without a prescription. Pharmacies in higher population areas (aOR 0.99, 95% CI 0.99-0.99, < 0.05) and rural areas adjacent to metropolitan areas (aOR 0.5, 95% CI 025-0.98, < 0.05) were less likely to have naloxone available without a prescription. Associations of naloxone availability based on other urbanicity designations, overdose count, and overdose rate were not significant.
Among pharmacies in Illinois that formally registered to dispense naloxone without a prescription, the availability of naloxone remains limited. Additional interventions may be needed to maximize the potential impact of a statewide standing order.
为了扩大纳洛酮的可及性，伊利诺伊州实施了一项常备命令，允许注册药房在没有个人处方的情况下分发该药。要根据常备命令参与，药房需要通过正式注册程序选择加入。在我们的研究中，我们旨在评估注册药房纳洛酮的供应和价格。
这是一项前瞻性、去识别、横断面电话调查。经过培训的访谈者假扮成潜在客户，并使用标准化脚本在 2019 年 2 月至 12 月之间确定纳洛酮的供应情况。主要结果定义为药房表示携带纳洛酮、目前有纳洛酮库存且无需个人处方即可配药。
在 948 家注册药房中，有 886 家（93.5%）成功联系。其中，792 家（83.4%）携带纳洛酮，659 家（74.4%）有纳洛酮库存，472 家（53.3%）允许无需处方购买。纳洛酮鼻喷雾剂（86.4%）是最常见的库存制剂。连锁药房更有可能携带纳洛酮（调整后的优势比 [aOR] 3.16，95%置信区间 [CI] 1.97-5.01，<0.01）和有纳洛酮库存（aOR 2.72，95% CI 1.76-4.20，<0.01），但不太可能无需处方即可配药。人口较多地区的药房（aOR 0.99，95% CI 0.99-0.99，<0.05）和毗邻大都市区的农村地区（aOR 0.5，95% CI 025-0.98，<0.05）不太可能无需处方即可获得纳洛酮。根据其他城市设计分类、过量计数和过量率的纳洛酮供应的关联不显著。
在伊利诺伊州正式注册无需处方即可分发纳洛酮的药房中，纳洛酮的供应仍然有限。可能需要采取额外的干预措施来最大限度地发挥全州常备命令的潜力。
