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October 31, 2016
Idaho pharmacies offer Narcan without prescription
By Elaine Williams
MOSCOW, Idaho — Safeway is one of the regional retailers putting itself on the front lines in the battle against opioid abuse, allowing its pharmacists to dispense without prescriptions drugs that reverse overdoses.
The increasing availability of Narcan and similar medications follows a revision to Idaho law that went into affect on July 1, 2015. The changes put those drugs into a special category where pharmacists — not just physicians, nurse practitioners and physicians assistants — can prescribe them.
The number of outlets offering Narcan through its pharmacists is starting to proliferate as awareness about Idaho's law grows, said Alex Adams, executive director of the Idaho State Board of Pharmacy.
Walgreens in Lewiston, Moscow and Clarkston, and Albertsons in Lewiston are among the stores that carry it now. Other pharmacies expect to follow. Owl Pharmacies is considering it in Lewiston and Clarkston. Shopko, which has Lewiston and Orofino stores, is working on plans for Idaho.
Washington previously put a similar law on its books where pharmacists can dispense it if they have an agreement with a physician. Albertsons in Clarkston and Safeway in Pullman will offer Narcan without a prescription after they meet that criteria, said Christopher Greiner, patient care services manager for Albertsons and Safeway in Washington, northern Idaho and Alaska.
The loosening of restrictions is a way of getting Narcan into the hands of a population that might hesitate to call authorities in a crisis. It has saved 26,463 lives nationwide in the past 20 years, according to a news release issued by Albertsons and Safeway. "Narcan blocks the opioids for 30-90 minutes to reverse the respiratory depression that would otherwise lead to death."
Walgreens sells single doses for as little as $40. Safeway and Albertsons carry a two-dose pack for $150. The price varies depending on the devices used to administer it.
Insurance can defray the expense for opioid abusers, but the person who might need Narcan has to show up for the consultation for it to be billed that way, Greiner said. It's not clear if other retailers have the same policy.
How much Narcan will be needed in this region is hard to predict. Safeway and Albertsons in the area haven't filled any medical provider prescriptions for it in the past year, even though it has been available for decades.
The number of annual deaths in Washington state from opioids in the past five years has been as low as 647 in 2013 and as high as 718 in 2015, including suicides, according to statistics from the Washington State Department of Health.
Of the 3,480 deaths in the past five years, 12 were in Asotin County, 11 in Whitman County and there were no reported deaths in Garfield County. Idaho doesn't have similar statistics available.
Those close to opioid abusers are often in the best position to save lives. Narcan can be purchased in advance of an emergency, just as an EpiPen is kept on hand for a relative with severe allergies, Greiner said. "Anybody who is seeking it who might be in a position to help someone who is at risk is eligible."
When a third party is purchasing the drug on behalf of someone who has an opioid habit, the basic information Safeway and Albertsons takes from customers, such as their names and telephone numbers, is kept in a file separate from their prescriptions. It's not shared beyond pharmacy employees who need to see it to do their jobs, Greiner said.
The consultation happens in a private room, not in the aisles of the grocery store, and includes instruction about how to give Narcan, Greiner said.
A family member or friend should administer Narcan the instant they see someone has overdosed, just before or as they call 911, Greiner said. "Every second you delay is more time that is risky for the patient."
Still, Greiner warns that pharmacies are not emergency rooms and strongly cautions against seeking Narcan from a pharmacy after a person has already overdosed.
Going through the 20- to 30-minute process of getting the drug at a pharmacy will likely take longer than getting help through traditional channels of summoning paramedics or going to the emergency room, Greiner said. "Coming to a pharmacy might delay getting them the help they really need."
Trained medical personnel need to be involved in all overdoses regardless of who administers the Narcan, Greiner said.
Once Narcan has been dispensed, the danger hasn't necessarily passed, even when people regain consciousness and appear to be acting normally, Greiner said.
Sometimes the doses of opioids are so strong, that people relapse 60 to 90 minutes after receiving Narcan. It's also important to follow-up by getting the patient connected with the right next steps, such as routine medical care and rehabilitation programs, Greiner said.
While the new role pharmacies are playing in the fight against addiction is limited, it's important, Adams said.
Pharmacies are one of the most accessible places in the health care system, open on weekends, evenings and holidays, in a setting where patients don't need appointments, Adams said. "That brings down the barriers and improves convenience."