Pharmacists in New Mexico have become the first in the United States certified to prescribe a lifesaving anti-overdose drug directly to patients.
The first 60 pharmacists have been trained by the New Mexico Pharmacists Association and Project ECHO on the use of naloxone, which has the brand name Narcan. The medicine is administered by attaching a nasal-tip inhaler to a small vial, which is used to spray a mist into the nose membrane. The drug flows directly to the brain, blocking opioids and restoring breathing.
For New Mexico pharmacists, the issue is really one of a public health emergency, as the state is always at the top for per capita overdose deaths from prescription drugs and heroin, said Dale Tinker, executive director of the New Mexico Pharmacists Association.
“Pharmacists have a chance to change that statistic,” Tinker said. “In our state, pharmacists can write prescriptions. No other state is structured like that.”
It is friends and family members of addicts who often use Narcan on a loved one and credit it for reversing overdoses and saving lives.
For years, Narcan has been used in emergency rooms and by first responders. Massachusetts was one of the first states to make it available to emergency workers, and has so far the state has reported some 2,500 overdose reversals from the drug.
“It’s just incredible, it’s like magic,” Michael Viviano, deputy fire chief in Revere, Mass., told The Associated Press in February. “There’s somebody who’s on the ground who’s literally dead. They have no pulse. Sometimes they’re blue, sometimes they’re black. And you administer this stuff and sometimes, in a minute or two or three, they’re actually up and talking to you.”
Dr. Michael Landen, state epidemiologist with the New Mexico Department of Health, estimates there were as many as 500 statewide overdose reversals due to Narcan in 2013.
“Narcan is one of the keys to preventing prescription drug overdoses,” Landen said. “Allowing people who need access to Narcan and having it available at most pharmacies is very important.”
The Legislature granted the 1,600 New Mexico pharmacists prescribing authority for a number of protocols in 2001 — that’s how flu shots and other vaccinations became available at local pharmacies and chains such as Walgreens and CVS.
Since then, the Board of Pharmacy has expanded procedures and training to help with tuberculosis testing, emergency contraception, tobacco cessation and now Narcan.
One reason the prescribing authority was granted to pharmacies is because New Mexico is so rural, and there are often access problems for patients seeking physician care — more so today with the expansion of Medicaid under the federal Affordable Care Act.
Yet, every small town has a neighborhood pharmacist.
“We are such a rural state, and in so many underserved areas, there are pharmacists located in areas that aren’t served by [medical] providers,” Tinker said.
Landen said expanding supply through pharmacies makes the most sense for New Mexico, as “pharmacists can provide some of the patient and family advice on how to use Narcan.”
The Narcan training for pharmacists, completed Tuesday, was conducted both in person and through videoconferencing by Project ECHO at The University of New Mexico.
Tom Lovett of Nambé Drugs was one of 14 Santa Fe-area pharmacists who completed the four hours of instruction.
Lovett said many of his customers are on long-term pain medication, but even those new to pain medicine or who are prescribed a new dosage should know about Narcan. “It’s a good idea to be able to offer it to our patients, just to let them know the danger of these medications, especially if you’re on them long term. You can forget.”
He said the patient guidance is pretty involved and requires a face-to-face consultation. He will also encourage family member training.
“If you lose consciousness, you’re not going to be able to do this yourself,” Lovett said.
Lovett has ordered the medicine and hopes to be able to offer it to customers by mid-April.
Emily Kaltenbach of the New Mexico Drug Policy Alliance has been an advocate for more access to harm-reduction services throughout New Mexico. As a result, the state was among the first to offer needle-exchange programs to combat hepatitis C and train addicts and their families directly on using Narcan.
Now she advocates that Narcan should be a part of every first-aid kit — especially with long-term pain patients or households with an elderly patient. “There is always a risk of overdose when one is taking pain medicine. It’s really about educating all families,” she said.
Kaltenbach said the effort with pharmacists really was driven by the public health community.
“We’re still not dispensing in all of the state we need to be,” she said. “As more pharmacists get trained, this will open up some new doors in getting naloxone into the hands of those who really need it.”
There is not currently a registry of pharmacists who have finished the training, but there were 14 from Santa Fe — and patients who want the option of Narcan should ask their pharmacist about its availability, Tinker said. Still, there are obstacles to wider distribution.
One pharmacist already has said that a private insurance company denied a reimbursement for a Narcan prescription, Tinker said.
Landen said preparations are almost complete for the state’s Centennial Care program (formerly Medicaid) to cover Narcan — perhaps as early as next month — and that would mean wider acceptance with private insurance companies. With more than 600,000 New Mexicans now on Medicaid, “that would be huge breakthrough,” Landen said.
Contact Bruce Krasnow at firstname.lastname@example.org.