Flash Returns Newsletter July 2018
Add Naloxone Kits to Your Practice
Fight the Crisis and Drive Profitability
This article won’t go into the statistics of the modern opioid crisis as TV, newsletters, state campaigns, and the press releases from the DEA and DOJ make the dreadful situation evident. There is a more significant goal here: something actionable you can do, and even wind up with recognition and profit at the pharmacy. This can be implemented today with no major investment. Consider being THE Naloxone resource for local prescribers. Pain clinics with their high volume and concentration of opioid users are obvious targets. However local urgent care, general practice, outpatient surgery centers, occupational health clinics, and stand alone ERs may have the autonomy and need to work with you. Get set up to dispense kits by ordering the medication, supplies, and printed visual aids for the patient (see link). Then go let people know you are there. With your niche Naloxone practice and “adherence program” following up with and counseling patients, you should be the destination for the prescriber’s patients.
What’s the deal with Naloxone? Any patient using an opioid medication is at risk for overdose. Patients with additional factors like a history of abuse or multiple controlled substance Rxs should be sought out in the pharmacy dispensing system as candidates to have a Naloxone kit dispensed to them. The conversation doesn't have to be accusatory. Opioids are accidentally over dosed for many reasons, not always illicit. The kit merely provides a layer of safety for the patient or maybe even they could be a bystander administering the medication elsewhere in the community. This drug is to be administered by a bystander, complicating the situation as patients must disclose the kit and its instructions to a loved one or caregiver if it is likely to be used. Prescribe to Prevent is an organization with many resources for the pharmacist looking to take Naloxone into their practice.
Intranasal (for example only)1
Naloxone 2 mg/2ml prefilled syringe, 2 syringes
NDC No. 76329-3369-01
SIG: Spray one half of syringe into each nostril upon signs of opioid overdose. Call 911. May repeat ×1.
Atomizer No. 2
SIG: Use as directed for Naloxone administration
Intramuscular (for example only)1
Naloxone 0.4 mg/ml single dose vial, 2 vials
NDC No. 00409-1215-01
SIG: Inject 1 ml IM upon signs of opioid overdose. Call 911. May repeat ×1.
Syringe 3ml 25G ×1 inch No. 2
SIG: Use as directed for Naloxone administration.
Legal. States vary greatly on what can happen at the pharmacy counter. Many provide for a collaborative practice with a provider so you don’t need to get new Rxs constantly. Other states have no provisions at all. Check with you state board before you start! Also make sure if you are administering this agent to someone you are familiar with its safe use, as well as Good Samaritan standards and state administration regulations. Even if there is no established process, make a premade prescription with the drug, quantity, sig, and patient demographics filled out for the provider. A simple pharmacy letter head cover page explaining this patient is using >50 MME (or whatever the dose happens to be) and is statistically at risk for overdose. This can be simply faxed to the provider for authorization. Be sure the patient is thoroughly counseled on the assembly, dosing, identifying overdose symptoms, and to contact first responders (911) immediately. The kit should contain a visual guide, some examples are below. Document this consultation!
Profit. Marking up Naloxone syringes and atomizers doesn't allow for a big way to increase profits. However, there is an opportunity as an ice breaker to offer to stock the physician’s office with kits pursuant to an invoice and your state’s practice act. The goal should be more upstream. Ask the provider if you can have all of their prescribing volume and be number one in their e-scribe (when patients don’t select another pharmacy they prefer). As a location who stocks and specializes in consultation for Naloxone kits, you can increase safety for their patient population which has huge outcomes implications for the prescribers practice. Prescribers choosing you due to niche expertise and expert counseling will drive Rx volume.
Visual guide for dispensing:
All dispensing must be done in accordance with state pharmacy practice acts, this article is information only and not legal or clinical advice.
1. Naloxone Access: A Practical Guide to Pharmacists. CPNP. http://prescribetoprevent.org/wp2015/wp-content/uploads/naloxone-access.pdf