Community pharmacy naloxone supply, before and after rescheduling as an over‐the‐counter drug: sales and prescriptions data, 2014–2018

Abstract

Objectives: To characterise the community pharmacy supply of naloxone by supply type -individual prescription, prescriber bag, and non-dispensed (supplied over the counter or expired) -during 2014-2018; to examine whether the 2016 rescheduling of naloxone as an over-the-counter drug influenced non-dispensed naloxone supply volume.Design, setting: Analysis of monthly naloxone prescriptions (Pharmaceutical Benefits Scheme) and sales data (IQVIA), 2014-2018, for Australia and by state and territory; time series analysis of non-dispensed naloxone supply to assess effect of rescheduling on naloxone supply. Major outcomes:Total naloxone supply to community pharmacies; prescribed and non-dispensed naloxone supply. Results:During 2014-2018, 372 351 400 μg units of naloxone were sold to community pharmacies: non-dispensed naloxone accounted for 205 866.5 units (55.3%), prescriber bags for 155 841 units (41.8%), and individual prescriptions for 10 643.5 units (2.9%). Populationadjusted national naloxone sales to community pharmacies increased between 2014 and 2018 (per year: incidence rate ratio [IRR], 1.15; 95% CI, 1.09-2.22). This increase was primarily attributable to increased volumes of prescriber bag naloxone (IRR, 1.63; 95% CI, 1.50-1.78) and, to a lesser extent, increased individual prescription supply (IRR, 2.04; 95% CI, 1.85-2.26). Non-dispensed naloxone supply volume was unchanged at the national level (IRR, 0.93; 95% CI, 0.85-1.01); changes in non-dispensed supply immediately following rescheduling and subsequently were not statistically significant in time series analyses for most jurisdictions. Conclusions:Total naloxone supply to community pharmacies in Australia increased between 2014 and 2018, but rescheduling that enabled over-the-counter access did not significantly influence the volume of non-dispensed naloxone.The known: Take home naloxone programs are effective for preventing opioid overdose deaths. Most overdoses in Australia involve pharmaceutical opioids, but little is known about how much naloxone is supplied in primary care, where most pharmaceutical opioids are prescribed.The new: The volume of naloxone supplied on individual prescriptions accounted for less than 3% of all naloxone supplied to pharmacies. Further, despite the 2016 scheduling change that permits naloxone supply without prescription, the over-thecounter supply of naloxone did not increase between 2014 and 2018.The implications: Although prescriptions are no longer a barrier to obtaining naloxone, further strategies are required to increase the supply of take home naloxone.

Providing take home naloxone needs to be improved to prevent opioid overdose deaths

“…In their study published in this issue of the MJA , Tse and colleagues assessed naloxone supply to community pharmacies in Australia during 2014–2018 by analysing Pharmaceutical Benefits Scheme (PBS) prescriptions data and sales data supplied by IQVIA . Their findings highlight challenges in expanding THN programs.…”

Editorial: Naloxone for opioid toxicity and overdose in the community

“…Most naloxone was still being supplied as a PBS Prescriber Bag item rather than being obtained over-the-counter. 4 In early 2019, the Australian Government therefore funded a pilot program in New South Wales, South Australia and Western Australia to provide naloxone free of charge through participating pharmacies and other services to people at risk of opioid overdose, and their carers and friends. 5 The pilot has been extended until June 2021.…”

Should we be routinely co‐prescribing naloxone for patients on long term opioids?

“…Using these indications, an Australian study reported that 78% of patients on Schedule 8 opioids for chronic non‐cancer pain qualified for take‐home naloxone 8,9 . Yet current national data show that less than 3% of all naloxone supplied is on individual PBS prescriptions, with most naloxone prescriptions accounted for by harm reduction programs 10 . An additional negligible amount of naloxone is sold over the counter by pharmacists 10 .…”

“…Yet current national data show that less than 3% of all naloxone supplied is on individual PBS prescriptions, with most naloxone prescriptions accounted for by harm reduction programs 10 . An additional negligible amount of naloxone is sold over the counter by pharmacists 10 . Between 2014 and 2018, an estimated 10 642 units of naloxone were supplied in Australia.…”

“…Between 2014 and 2018, an estimated 10 642 units of naloxone were supplied in Australia. Even if a large proportion of this were dispensed to people taking pharmaceutical opioids for chronic pain, it would be vastly insufficient given the 300 000 Australians receiving long term opioids each year 10,11 . The majority of Australian patients on pharmaceutical opioids who are at risk of overdose do not appear to be prescribed this emergency medication.…”