Pharmacies should distribute naloxone along with opioids, URI College of Pharmacy study shows

KINGSTON, R.I. — March 6, 2020 — Pharmacies across the region are being encouraged to distribute naloxone along with higher dose opioid prescriptions and medication combinations to help fight the opioid overdose crisis, according to a recent University of Rhode Island College of Pharmacy study.

Naloxone, a safe and effective antidote drug for opioid-related overdose, is the fastest and most effective way to save someone’s life and restore breathing, according to Clinical Professor Jeffrey Bratberg. Pharmacies should offer the drug along with such prescription opioids as hydrocodone, morphine or fentanyl, to protect patients in the case of an accidental overdose, and they are willing to do so, the study has shown.

“The more naloxone we see in any community, the fewer overdoses we see and the more opportunities to connect people to care,” Bratberg said. “We know that the more pharmacies stock naloxone, the more it’s distributed to the public, the more people are saved.”

Opioids work by binding to receptors on the outside of a person’s cells. While the human body makes its own opioids to relieve pain, which is the reason these receptors exist, too many occupied receptors can lead to an overdose, since activation of these receptors also causes breathing to slow down.

“Naloxone literally knocks those opioid molecules off the receptor,” Bratberg said, noting the process can take as little as two to three minutes. “Eventually, the person will begin to feel pain again and could possibly experience other symptoms of opioid withdrawal. But, more importantly, the person is alive and breathing normally.”

Even if first responders are unsure whether a patient is having an overdose, naloxone is still useful as a “diagnostic aid.” The drug only affects a person when they are having an opioid-related breathing emergency, which makes it a safe choice no matter the situation.

“If I find you unconscious, and I don’t know whether you used opioids or not, I’m just going to use this safe drug to see that maybe it’ll revive you,” Bratberg said.

Bratberg’s study along with other researchers, found that pharmacists had more positive attitudes toward fighting the opioid crisis if they stocked naloxone and allowed anyone to freely acquire it without a prescription via a standing order along with their opioid prescriptions. The study demonstrates how the familiarity of the drug can lead to the acceptance of it.

The more familiar the public and pharmacists are with the drug, the easier it is to dispel the many myths regarding its safety and efficacy. The biggest myth, Bratberg said, is that you are putting yourself in harm’s way if you give someone else naloxone by putting them into withdrawal. Some people think the person will become extremely angry and combative. “Most of the time, they’re just grateful that they’re alive,” Bratberg said.

Other myths include that powerful forms of illegally manufactured fentanyl are resistant to naloxone, and that the wider availability of naloxone will encourage more drug use due to people who use drugs supposedly not having to worry about overdose. Neither are true, Bratberg said.

“There’s no such thing as naloxone parties where people intentionally use too many drugs because they have this crutch of the Naloxone to use,” Bratberg said. “Nobody wants to get naloxone; they just want to live.”

The ultimate goal is to normalize the use of naloxone and change the stigma around possession of the medication. Bratberg is furthering the study by examining the effectiveness of display ads in pharmacies to promote naloxone. He hopes that prescribing naloxone will soon be thought of as simply another safety maneuver like offering flu vaccines.

“There are people who are going to use drugs, but there are ways to help people use them safer,” Bratberg said. “We have to destigmatize this to help save lives.”