Accessibility of Naloxone in Pharmacies Registered Under the Illinois Standing Order

• Published in: The western journal of emergency medicine Vol. 25; no. 4; pp. 457 - 464
• Main Authors: Quincy Moore, P, Ellis, Kaitlin, Simmer, Patricia, Waetjen, Mweya, Almirol, Ellen, Salisbury-Afshar, Elizabeth, Pho, Mai T
• Format: Journal Article
• Language: English
• Published: United States Department of Emergency Medicine, University of California, Irvine School of Medicine 01.07.2024; eScholarship Publishing, University of California
• Subjects: Behavioral Health; Cross-Sectional Studies; Drug Overdose - drug therapy; Female; Health Services Accessibility; Humans; Illinois; Male; Naloxone - supply & distribution; Naloxone - therapeutic use; Narcotic Antagonists - supply & distribution; Narcotic Antagonists - therapeutic use; Pharmacies - statistics & numerical data; Prospective Studies; Standing Orders; Substance Use Disorder: Original Research; Illinois
• ISSN: 1936-9018; 1936-900X; 1936-9018
• 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.