Narcan, the lifesaving overdose-reversal drug, is scarce in N.J. cities that need it most

New Jerseyans living in some of the cities hardest hit by the opioid crisis may find it harder to get lifesaving overdose-reversal drugs at their local pharmacies, a new study has found.

The study, by a team of Rutgers New Jersey Medical School researchers and published in the Journal of Medical Toxicology, surveyed every pharmacy in 10 New Jersey cities between February and July 2017 to determine whether they were stocking naloxone, or Narcan, the brand name for the drug.

At the time the surveys were conducted, only certain pharmacies in the state could dispense Narcan; later that year, the state allowed pharmacies to apply for a standing order to dispense the drug without a prescription.

Pennsylvania has also had a standing order in place, since 2015. Still, despite the standing order, a study surveying nearly 700 Pennsylvania pharmacies in 2016 and 2017 found that only 45 percent were stocking naloxone.

In Philadelphia, the University of Pennsylvania contacted pharmacies in zip codes with high rates of heroin possession in 2016, and found that 40 percent of the pharmacies they contacted stocked the drug, said Jim Garrow, a spokesman for the city’s health department. Pharmacy students from the University of the Sciences later launched an education campaign at dozens of local pharmacies. In early 2018, about 75 percent of the city’s pharmacies were carrying Narcan — and by the end of the year, Mayor Jim Kenney had signed a law requiring every pharmacy in the city to stock it.

Just 31 percent of the 90 New Jersey pharmacies surveyed in the recent Rutgers study carried naloxone. But researchers found that people living in wealthier areas were more likely to have a pharmacy in town that stocked the drug.

In Camden, where the median income is just over $26,000, just four of the city’s 16 pharmacies were stocking naloxone. That’s in a city of 74,532 people whose hospitals handled more than 10,000 opioid-related visits between 2008 and 2015.

Compare that to Little Silver, a town in Monmouth County with a population of 5,908 and a six-digit median income, where two of three pharmacies were carrying naloxone — even though the town has seen far fewer opioid-related hospital visits.

“The results suggest an unsurprising and disturbing pattern: Patients living in the most populous poorer areas are also living in areas with less access to naloxone,” the study authors wrote.

The study didn’t find a statistically significant relationship between an area’s availability of naloxone and its number of opioid-related hospital visits. But the authors did identify cities they call “naloxone deserts” — like Newark, Atlantic City, and Camden, which are dealing with severe opioid crises and whose pharmacies don’t stock naloxone at the rate found in wealthier areas.

“Despite how safe it is to use it’s just not widely available — and the real reason is partly access, partly cost, and partly education,” said Lewis Nelson, the chair of emergency medicine at Rutgers’ medical school in Newark. Though Medicaid covers Narcan, it can cost $70 to $300 out of pocket. Nelson said pharmacies may not stock the drug if customers are unable to afford it.

“A lot of people know about it, and even when they know about it, they still can’t access it,” he said.

The drug is available outside pharmacies, even though the study authors noted that information on community-based programs that dispense naloxone is often hard to come by.

The drug is available for free at the state’s seven syringe exchanges, including in the three cities the study identified as “naloxone deserts.”

Nelson hands out Narcan from his emergency department in Newark. Joanna Dugan, who coordinates one of the state’s three regional opioid overdose prevention programs, hosts Narcan training all over the eight southern counties in New Jersey. She said her program, based in Camden, has dispensed more than 3,466 free Narcan kits since January 2018.

“We do talk at our training about other ways of getting Narcan. And they are pricey. A lower income means it’s hard for someone without insurance to pay for Narcan they may not use,” she said.

Nelson said he wasn’t surprised that more pharmacies weren’t stocking Narcan — “when it really comes down to it, it is a business” — but he was disappointed that, in a state that saw 1,969 lives lost to opioid overdoses in 2017, the antidote wasn’t readily available to many.

“Naloxone is lifesaving. It’s not really the treatment for people with opioid use disorder. It’s a bridge to get into treatment. But you have to be alive to get into treatment,” he said. “[Naloxone] is just a public health safety net that it seems like it should be available for free, for anyone, anytime.”