Jane M. Zhu, Chethan Bachireddy, and Danielle Erkoboni are physicians and National Clinician Scholars at the University of Pennsylvania.
The opioid crisis has shown no signs of slowing despite growing public attention. Recently, 50 people in Philadelphia overdosed on a batch of heroin in a single day. This year, more than 900 people in this city are projected to die from opioid overdose - almost three people a day.
As physicians, we recognize that there is no silver bullet to this crisis, and as such, a public health response should be comprehensive - intervening all along the continuum of misuse, abuse, addiction, and overdose.
As a first step, we need more of the medication naloxone, or Narcan, which reverses the effects of an overdose, in the hands of drug users and members of the public.
One of the city's most direct responses to a growing burden of overdose deaths has been to equip first responders to recognize and respond to drug overdoses using naloxone. While naloxone has been the subject of much public scrutiny, with critics citing it as a "safety net" for drug users to take more risks and seek higher highs, data from around the country do not support these claims. Studies have shown instead that naloxone saves lives; in Philadelphia between January and June 2015 alone, our city's first responders reversed 1,258 overdoses.
Naloxone can be safely administered by intravenous or intramuscular injection, a task that requires little skill and no formal training. It is also available as a nasal spray. Naloxone has no potential for abuse or overdose. Forty years of use by emergency-room doctors has revealed no long-term adverse effects. And when it comes to overdose, timing is everything. The longer someone who overdoses goes without naloxone, the higher the chances of respiratory failure and death. Widespread distribution of naloxone allows for bystanders to act quickly even if first responders are delayed to the scene.
To increase access to naloxone, in October 2015 Pennsylvania Physician General Rachel Levine signed a "standing order" that allows anyone - for example, a friend or family member of someone at risk for overdose - to walk into a pharmacy and obtain naloxone without a prescription. Then, if an opioid overdose occurs, this lifesaving medication will already be on hand.
Unfortunately, pharmacy participation has been low, in part because of the voluntary nature of the program. A June investigation by the Inquirer found that of 14 pharmacies called, only five had naloxone in stock and dispensed it without a physician prescription.
A year out from the standing order, how is access to naloxone faring in Philadelphia?
A group of physicians and doctorally prepared nurses in the National Clinician Scholars program partnered with Prevention Point Philadelphia, a nationally recognized organization in addiction services, to conduct a telephone survey of pharmacies in seven zip codes with the highest volumes of naloxone distribution and heroin possession in the city. Of the 87 pharmacies reached, two important findings emerged.
First, only about 40 percent of pharmacies carried naloxone. Second, approximately half of pharmacies were either unaware of or did not understand the standing order. Many of the pharmacists we spoke to cited the local news as their source for learning about the order. In areas at highest risk for opioid overdose, only one in eight pharmacies both had naloxone in stock and would dispense it without a prescription.
This fieldwork spotlights just one of many opportunities for action, including increasing naloxone education to pharmacies - particularly in areas disproportionately affected by overdose deaths. Widespread teaching can be delivered not only through more public messaging, but also through partnerships with pharmacy professional organizations, schools, and city and state health commissions. This would not only increase awareness, but also dispel stigma associated with naloxone and the standing order. If naloxone is available more widely, and on demand, we will save more lives.
In this time of national division, one of the few areas of agreement is the recognition that the opiate crisis is destroying lives. We must have all hands on deck - from everyday citizens and community organizations to health-care providers and government - before it destroys more.