Prevention Point Pittsburgh (PPP) provides health empowerment services to drug users in the eastern U.S. city of Pittsburgh. They do needle exchange and other harm reduction services, including overdose prevention and response trainings with naloxone distribution.
Overdose from prescription drugs
Because PPP considers needle exchange the foundation of its services, they have traditionally worked with injecting drug users. However, in Pittsburgh and throughout the U.S., overdose from prescription drugs has become a much bigger problem, overtaking heroin fatalities. Since prescription drugs are often taken orally rather than injected, Alice Bell, who heads PPP’s Overdose Prevention Project, began to think about ways to get naloxone to this population, who aren’t usually reached through the needle exchange.
PPP staff and volunteers started by talking to doctors who work with the agency to prescribe naloxone; some of them said they would be willing to prescribe it in their normal practices, which include settings like community clinics, homeless shelters, and HIV clinics. In fact, many doctors said they would be willing to prescribe naloxone when they prescribed pain medications as a way to increase safety. Their main obstacle was how to educate and train their patients about overdose and naloxone in a busy doctor’s office or clinic.
Overdose education at the pharmacy
In talking to more and more people about naloxone, Alice got connected to a new community pharmacy affiliated with a nearby university. The pharmacy goes beyond simply filling prescriptions and offers free health screenings such as blood pressure checks, medication therapy management, and is a training site for pharmacy students. Adding overdose prevention education and naloxone training seemed like an obvious extension of their services.
“Although pharmacists have a legal obligation to check that prescriptions are valid and do their best to prevent misuse, educating patients about medication is what they are trained to do,” Alice says. “So, teaching patients how to use this lifesaving medication is a natural fit.”
Committed to naloxone access
Today, if someone with a prescription for an opioid comes into the pharmacy, the pharmacist counsels them on opioid safety and recognizing signs of over-medication and overdose, and explains the benefits of having naloxone on hand for an emergency. If the patient agrees, the pharmacist faxes a standard form to the patient’s physician to request a naloxone prescription and document the overdose training and proper administration of naloxone for the patients’ medical chart. In addition, each month, the pharmacy faxes each physician who has written opioid prescription information on opioid safety and naloxone prescribing. The pharmacy has naloxone stocked at all times, and it is routinely covered by the patient’s regular insurance. Every patient who is prescribed an opioid also receives written material on opioid safety each time they receive the medication.
Less than a year after the program began, the pharmacy had already facilitated several naloxone prescriptions. Terri Kroh, the director of the Center for Pharmacy Services says, “As a…. friend once told me, the pharmacist’s job is to bridge the complexity of science with a patient’s real life and I hope that is what we have been doing at the pharmacy…. We at the pharmacy firmly believe opioid safety education is necessary for ALL – those who are prescribed an opioid, those who misuse an opioid and those who abuse an opioid – and we are committed to making naloxone accessible to them all.”
Alice thinks that having the initial community pharmacy prescribing naloxone makes it easier for other pharmacies to contemplate doing the same thing. “In a lot of the work I do, I try to find one brave person and get them started,” Alice explains. “Then others will follow – it has a snowball effect.”