Broadening access to naloxone: Community predictors of standing order naloxone distribution in Massachusetts

Chatterjee, Avik; Yan, Shapei; Xuan, Ziming; Waye, Katherine M.; Lambert, Audrey M.; Green, Traci C.; Stopka, Thomas J.; Pollini, Robin A.; Morgan, Jake R.; Walley, Alexander Y.

doi:10.1016/j.drugalcdep.2021.109190

Cited by 18 publications

(6 citation statements)

References 25 publications

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“…Prior research has demonstrated that non-white individuals with OUD are less likely to access treatment or other harm reduction services due to structural barriers and systemic racism ( Hansen et al, 2016 ). This may result in decreased access to and uptake of naloxone among communities who have historically faced punitive responses to drug-related health issues, rather than compassionate treatment and care ( Chatterjee et al, 2022 ; Rowe et al, 2016 ). Future research should investigate how structural racism or practices that create barriers to care for people of color or women may be a source for disparity in the distribution or uptake of naloxone.…”

Section: Discussionmentioning

confidence: 99%

The role of increasing pharmacy and community distributed naloxone in the opioid overdose epidemic in Massachusetts, Rhode Island, and New York City

Morgan

Freibott

Jalali

et al. 2022

Drug and Alcohol Dependence Reports

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Section: Discussionmentioning

confidence: 99%

The role of increasing pharmacy and community distributed naloxone in the opioid overdose epidemic in Massachusetts, Rhode Island, and New York City

Morgan

Freibott

Jalali

et al. 2022

Drug and Alcohol Dependence Reports

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“…In July 2020, the Massachusetts Department of Public Health issued a statewide standing order that allowed retail pharmacies to dispense naloxone without a prescription and required them to maintain a continuous, sufficient supply to meet the needs of the community [ 5 ]. After the standing order took effect, a statewide Massachusetts purchase trial demonstrated high levels of naloxone stocking and dispensing in retail pharmacies, and an analysis of pharmacy reports showed increases in both the quantities of naloxone dispensed and the number of pharmacies dispensing naloxone [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Systemized approach to equipping medical students with naloxone: a student-driven initiative to combat the opioid crisis

Saberi,

Moore,

et al. 2024

BMC Med Educ

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Background Naloxone is an effective and safe opioid reversal medication now approved by the U.S. Food and Drug Administration (FDA) for use with or without a prescription. Despite this, naloxone dissemination lags at a time when U.S. opioid-related mortality expands. The authors proposed distributing naloxone to all U.S. medical students using established statewide standing prescription orders for naloxone, eliminating the financial burden of over-the-counter costs on students and streamlining workflow for the pharmacy. By focusing naloxone distribution on medical students, we are able to capitalize on a group that is already primed on healthcare intervention, while also working to combat stigma in the emerging physician workforce. Methods Beginning August 2022, the authors established a partnership between Harvard Medical School (HMS) and the outpatient pharmacy at Brigham and Women’s Hospital (BWH) to facilitate access to naloxone for HMS medical students. BWH developed a HIPAA-secure electronic form to collect individual prescription information. BWH pharmacists processed submissions daily, integrating the naloxone prescription requests into their workflow for in-person pick-up or mail-order delivery. The electronic form was disseminated to medical students through a required longitudinal addiction medicine curriculum, listserv messaging, and an extracurricular harm reduction workshop. Results Over the 2022–2023 academic year, 63 medical students obtained naloxone kits (two doses per kit) through this collaboration. Conclusions We propose that medical schools advocate for a hospital pharmacy-initiated workflow focused on convenience and accessibility to expand naloxone access to medical students as a strategy to strengthen the U.S. emergency response and prevention efforts aimed at reducing opioid-related morbidity and mortality. Expansion of our program to BWH internal medicine residents increased our distribution to over 110 healthcare workers, and efforts to expand the program to other BWH training programs and clinical sites such as the emergency department and outpatient infectious disease clinics are underway. With more than 90,000 medical students in the U.S., we believe that widespread implementation of targeted naloxone training and distribution to this population is an accessible approach to combating the public health crisis of opioid-related overdoses.

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“…The first study reported that, during the COVID-19 pandemic, respondents identifying as from racial/ethnic minority groups had approximately 10 times greater odds of self-reporting a disruption in naloxone access relative to those identifying as non-Hispanic White [16]. In Massachusetts, two studies found that both pharmacy and community distribution of naloxone was less likely to reach racial and ethnic minorities [17,18].…”

Section: Introductionmentioning

confidence: 99%

“…The first study reported that, during the COVID‐19 pandemic, respondents identifying as from racial/ethnic minority groups had approximately 10 times greater odds of self‐reporting a disruption in naloxone access relative to those identifying as non‐Hispanic White [16]. In Massachusetts, two studies found that both pharmacy and community distribution of naloxone was less likely to reach racial and ethnic minorities [17, 18]. The last study found that among opioid overdose decedents nationally, 77.3% had no evidence of naloxone administration at the time of overdose and that significant differences in naloxone use existed across all socio‐demographic subgroups [19].…”

Section: Introductionmentioning

confidence: 99%

Inequities in naloxone administration among fatal overdose decedents by race and ethnicity in Pennsylvania, 2019–21

Takemoto,

Bolton,

Goetz

2024

Addiction

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AimsThe aim of this study was to characterize the circumstances of drug overdose deaths and determine whether naloxone administration differed by overdose decedent race and ethnicity.Design and settingAnalysis of data on unintentional and undetermined intent drug overdose deaths in Pennsylvania (2019–21) was collected from death certificates and the State Unintentional Drug Overdose Reporting System. Multivariable logistic regression models were adjusted for overdose death circumstances and the odds of naloxone administration were estimated by race/ethnicity and year.CasesThe analytical sample included 3386 fatal overdose decedents in 2019, 3864 in 2020 and 3816 in 2021.MeasurementsEvidence of naloxone administration (yes/no) was defined using scene evidence and toxicology reports from coroner and medical examiner records, while race/ethnicity (Hispanic, non‐Hispanic Black, non‐Hispanic White) was based on the death certificate.FindingsIn the analytic sample, overdose death rates were the highest among Black people and increased over time (rate per 10 000 population, 2019: 4.3; 2020: 6.1; 2021: 6.5); rates were lowest among White people and remained constant over time (rate per 10 000 population, 2019: 2.6; 2020: 2.7; 2021: 2.6). Throughout all years, Black decedents had approximately 40–50% lower odds of naloxone administration compared with White decedents as referent [2019: odds ratio (OR) = 0.7, 95% confidence interval (CI) = 0.5–0.9; 2020: OR = 0.5, 95% CI = 0.4–0.7; 2021: OR = 0.6, 95% CI = 0.5–0.8], while Hispanic decedents had similar odds of naloxone administration to that of White decedents.ConclusionAfter controlling for overdose circumstances in drug overdose deaths in Pennsylvania, USA, from 2019 to 2021, Black people had lower odds of naloxone administration compared with White people, while there were no differences between Hispanic and White people.

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Broadening access to naloxone: Community predictors of standing order naloxone distribution in Massachusetts

Cited by 18 publications

References 25 publications

The role of increasing pharmacy and community distributed naloxone in the opioid overdose epidemic in Massachusetts, Rhode Island, and New York City

The role of increasing pharmacy and community distributed naloxone in the opioid overdose epidemic in Massachusetts, Rhode Island, and New York City

Systemized approach to equipping medical students with naloxone: a student-driven initiative to combat the opioid crisis

Inequities in naloxone administration among fatal overdose decedents by race and ethnicity in Pennsylvania, 2019–21

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