When it comes to fighting the opioid crisis with naloxone, the role of the pharmacist cannot be overestimated. In fact, a study published this year in JAMA Internal Medicine confirmed that laws allowing pharmacists to directly dispense naloxone without a prescription have helped reduce the rate of fatal opioid overdoses.
These laws are just some of the efforts made by the government to encourage the use of naloxone, which has proven its effectiveness as a life-saving medication. Earlier this year, the FDA also approved the first generic naloxone nasal spray to be used by individuals without medical training.
Despite the known benefits of naloxone, approaching the conversation about its necessity with patients can be a delicate affair. Pharmacists have to overcome a number of challenges in this regard, whether it’s patient reluctance or high costs. As you identify and engage with patients who could benefit from having naloxone on hand, there are a few things to keep in mind to help move the conversation along.
Handling Difficult Conversations
Before kicking off the conversation with patients, it is important to note that some words resonate better than others. A word like “overdose,” for instance, has negative connotations associated with it and may be difficult for many patients to relate to, according to the Narcan website.
Focusing the conversation on facts and emphasizing preventative care is a good approach for patients who may be hesitant to the idea that they may need naloxone. Our Naloxone Intervention report includes an educational handout with facts and statistics that can help facilitate the conversation with patients. This opens the door to share important information, such as how naloxone works and the proper way to administer it, how to identify signs of an overdose, and what the proper response should be.
On the preventative care front, Narcan suggests using language such as “accidental overdose” or “opioid emergency” to drive home the fact that the risks of taking opioids are high. Another tip is to compare naloxone to
something relatable to the patient, like an EpiPen, a seatbelt, or a fire extinguisher — life-saving items which are often on hand even when a person doesn’t need them. Overall, it is essential to remember to be empathetic and unbiased during the conversation so the patient remains engaged.
Addressing High Costs
Naloxone may be more widely available since it doesn’t require a patient-specific prescription in many states, but unfortunately, not every insurance plan covers it. Even when it is covered, the copays may be unaffordable for some patients. Although generic naloxone runs between $20 to $40, some name
brands cost as much as $130 or $140. This may deter patients and discourage them from engaging in conversation about the benefits of a medication they cannot afford.
There’s not much you can do to influence insurance plans, but proactively looking up insurance coverage of naloxone for patients may be a good way to sustain the conversation. Some states also offer assistance programs to help boost the availability of naloxone to patients. For example, New York offers a Naloxone Co-payment Assistance Program (N-CAP) to pharmacies participating in the New York State AIDS Drug Assistance Program. Under this, N-CAP will cover co-payments for naloxone up to $40 for each prescription dispensed for patients with coverage through their health insurance plans. Being aware of what programs are offered in your state could help convince a patient on the fence due to cost.
Adequately Training Staff
In the U.S., there are various rules and regulations around dispensing naloxone that are essential for pharmacy staff to be aware of. For one thing, pharmacists can either prescribe and dispense naloxone or dispense naloxone using a non-specific mechanism such as a standing order. Some states require a certification or training be completed in order to dispense naloxone at the pharmacy. In a few others, standing orders require that patients be educated according to specific protocols. It is essential that pharmacy staff understand what rules exist in your given state, so they are prepared to answer patient questions about the availability of naloxone. Even in states where no training is required, having staff complete training is advisable to ensure they can properly guide patients on the benefits of naloxone and how it is used.
Ultimately, patients will be more likely to respond positively if they feel like they are getting their information from a trusted source and fully understand the necessity of naloxone. Approach the conversation with care and keep in mind that while many people may be sensitive to the topic, having naloxone on hand for emergencies is in the patient’s best interest.