Researchers say prescription painkillers are readily available, but the naloxone antidote isn’t in every store.
It’s too easy to get opioid-based painkillers from pharmacies and too difficult to get medication used to treat overdoses from these drugs.
Those are the takeaways from a lawsuit filed in Florida against the CVS and Walgreens drugstore chains, as well as a new study that looked at the availability of the anti-overdose drug naloxone in two states that allow pharmacies to distribute the drug without a prescription.
Florida Attorney General Pam Bondi this week accused the companies of playing a role in creating the opioid crisis by failing to stop suspicious prescriptions of large quantities of opioid-based painkillers.
Bondi added the two drugstore chains to an existing lawsuit filed by the state against pharmaceutical companies that make opioid painkillers, including Purdue Pharma, maker of OxyContin.
A spokesperson for CVS said the lawsuit was “without merit,” pointing to steps that the chain has taken in recent years to restrict access to the drugs.
Prescription opioid drugs are widely misused. They were responsible for more than half of the 72,000 overdose deaths in the United States in 2017.
One way that states have tried to cut the death toll is to increase availability of the drug naloxone, sold as Narcan and Evzio.
Sold in injectable and inhaled forms, naloxone can rapidly reverse the effects of an opioid overdose.
When used as directed, the drug can prevent 75 to 100 percent of fatal overdoses.
In April, Surgeon General Jerome Adams said that “expanding the awareness and availability of this medication is a key part of the public health response to the opioid epidemic.”
Narcan has been widely distributed at harm-reduction sites, such as needle-exchange programs, and to emergency medicine technicians, firefighters, and police.
Many states have passed “Good Samaritan” laws that protect people who call police to assist with an overdose, even if they themselves have been using illicit drugs.
Nearly every state now allows pharmacists to distribute naloxone to customers without a prescription.
“When our pharmacists dispense naloxone, they counsel patients and caregivers on a number of important points, including identifying an overdose, the importance of calling 911, giving rescue breaths, administering naloxone, and remaining with the patient until help arrives,” Erin Shields, director of corporate communications for CVS, told Healthline.
CVS also offers coupons for naloxone that can bring the cost of a two-pack dose down below $100.
However, despite the blanket authorization offered by state “standing orders” — basically a statewide naloxone prescription that any pharmacist can use — a pair of studies published in the Journal of the American Medical Association found that many pharmacies either don’t dispense the drug to customers without a prescription or don’t have the drug in stock.
In California, for example, researcher Talia Puzantian of the Keck Graduate Institute and her colleagues found that less than 25 percent of about 1,150 retail pharmacies said they were giving naloxone to people without a doctor’s prescription.
Among those who said they did, less than 50 percent had the nasal version of naloxone in stock.
The Texas study, which focused on big-chain pharmacies such as CVS, Walgreens, and Rite-Aid, found better — but far from complete — compliance.
In that study, 84 percent of pharmacists said they would dispense naloxone, while 69 percent of pharmacies reported they had the medication in stock.
“The chain pharmacies are doing better than individual stores, but still these numbers are woefully low,” Puzantian told Healthline.
However, she stresses that availability of naloxone through pharmacies has improved, even in the months since the research in her study was conducted.
The U.S. Food and Drug Administration (FDA) is looking at other ways to increase naloxone availability, including the development of a generic version of the drug.
Dr. Scott Gottlieb, the FDA commissioner, announced in October that the agency would host an advisory committee meeting in December to discuss ideas such as allowing naloxone — which has no potential for misuse — to be sold over the counter.
The overall number of naloxone prescriptions in the United States is currently quite low, Dr. Kimberly Sue, medical director of the Harm Reduction Coalition, told Healthline.
Sue says pharmacies have a critical role to play in widening distribution of naloxone.
She notes some countries allow pharmacies not only to distribute naloxone but also methadone and buprenorphine, two drugs used to treat opioid addiction.
Users of opioid drugs face a wide range of barriers to get treatment and potentially life-saving drugs like naloxone, Sue says.
However, pharmacies — many open 24 hours a day, seven days a week — are as ubiquitous as Starbucks in the United States and serve a broad spectrum of Americans.
“They could really be on the front lines in the opioid crisis, but so far they’ve been underutilized,” Sue said.