Health Economics Professor Publishes Study in JAMA Internal Medicine that Shows Allowing Pharmacists to Directly Dispense Opioid Antidote Can Sharply Cut Overdose Deaths

Rahi Abouk, PhD

A new study by William Paterson University health economics professor Rahi Abouk published in the Journal of the American Medical Association (JAMA) Internal Medicine shows that allowing pharmacists to dispense the opioid antidote naloxone without a physician’s prescription can sharply reduce the incidence of fatal opioid-related overdoses.

Abouk, associate professor in the University’s Cotsakos College of Business, is the lead author of the research study which examines the association between state laws facilitating pharmacy distribution of naloxone and the risk of fatal overdoses.

While previous research has examined associations between expanded naloxone use and opioid-related deaths, this study is the first to look at the impact of giving pharmacists direct authority to prescribe the drug.

“These findings highlight the importance of coupling naloxone access laws with effective interventions and connections to treatment for patients seen in emergency departments,” says Abouk. “This is the location where such programs may be the most effective.”

Overdose deaths from both prescription and recreational opioid use far exceed those from any prior U.S. drug epidemic, according to RAND Corporation, a nonprofit research institution whose researchers worked with Abouk. The researchers report that the number of opioid-related deaths each year since 2014 has surpassed the number of deaths associated with the peak of the HIV epidemic, as well as the number of deaths caused by auto accidents or gun violence.

Among the strategies adopted by state governments to combat the opioid crisis is increasing the distribution of naloxone, which can reverse the effects of an opioid overdose if given to a person in time. It usually is either injected or delivered as a nasal spray in the case of an overdose.

The objective of this study was to identify which types of naloxone access laws (NALs), if any, are associated with reductions in fatal overdoses involving opioids and examine possible implications for nonfatal overdoses.

The results show that states that adopted laws allowing pharmacists to directly dispense naloxone saw fatal opioid overdoses fall by an average of 27 percent during the second year following passage and 34 percent in subsequent years, according to the study.

In this study, state-level changes in both fatal and nonfatal overdoses from 2005 to 2016 were examined across the 50 states and the District of Columbia after adoption of NALs, while estimating the magnitude of the association for each year relative to time of adoption. Three types of naloxone access laws (NALs) were examined: providing direct authority to pharmacists to prescribe, indirect authority to pharmacists to prescribe, and other NALs.

Although many states have passed some type of law affecting naloxone availability, only laws allowing direct dispensing by pharmacists appear to be useful according to this study. The researchers recommend that communities in which access to naloxone is improved should prepare for increases in nonfatal overdoses and link these individuals to effective treatment.

Researchers found that laws that encourage the distribution of naloxone -- but stop short of allowing direct dispensing by pharmacists -- did little to reduce opioid-related overdose deaths.

In addition to Abouk, other authors of the study include Rosalie Liccardo Pacula and David Powell, both of RAND Corporation.

Support for the study was provided by the Federal Centers for Disease Control and Prevention, and the National Institute on Drug Abuse.

Link to abstract and full text: