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` `Breaking the Stigma Against Naloxone Communication, Distribution in the
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BREAKING THE STIGMA AGAINST NALOXONE COMMUNICATION, DISTRIBUTION IN THE PHARMACY

March 18, 2022
Jill Murphy, Associate Editor




Conference | APhA

Session at the American Pharmacists Association Annual Meeting discusses the
importance of naloxone in reducing the burden of the opioid epidemic.



To lead the change and create more patient-centric communication in the pharmacy
regarding naloxone, it is essential to educate pharmacists and pharmacy
technicians on their role in the process, according to a session at the American
Pharmacists Association Annual Meeting and Exposition 2022.

Thomas Franko, PhD, associate professor of pharmacy practice at Wilkes
University, discussed how the health care landscape is currently shifting from
an opioid epidemic to a holistic substance use epidemic, which has caused an
increase in stimulant use, such as cocaine and methamphetamine.

“The opioid epidemic still is part of it, but it’s more than that,” Franko said.
“We also have to look at everything that is causing issues, from nicotine, to
alcohol, to stimulants, and then take into fact all of the social determinants
of health, such as housing insecurity, food insecurity, and financial issues.”

Franko added that the COVID-19 pandemic did not necessarily amplify this
epidemic, but rather put a magnifying glass on the issues some of the patients
are dealing with and made them more well known to the general population.

In terms of pharmacology, the onset of action with naloxone is approximately 2
to 15 minutes, which is injected in what Franko described as a “buddy system,”
because it is safe to administer a second dose if there is no response after 3
minutes. Further, a half-life is 30 to 90 minutes, which may lead to another
dose administration.

Franko advised of the adverse effects of using naloxone, such as anxiety,
vomiting, and anger. He noted that regardless of whether naloxone is
administered via a nasal spray/atomizer or injectable, it is crucial to know the
benefits of using naloxone and the intensity of being in a situation of
injecting it on someone else.

There are some tell-tale signs of opioid-induced respiratory depression, which
can start with a sternum rub, slow breathing/respiratory arrest, or blue
fingernails/lips. After identifying these signs, naloxone in a nasal spray
should be administered in the user’s nostril with a tilted back head, following
a call to 911. The person should also be placed in a recovery position, which
involves laying them on their side with 1 arm up and the bottom arm laying
across them. Their back leg should be extended behind them while the front leg
is bent and crossed over, according to Franko.

Although more than 66,000 doses of naloxone have been administered by first
responders, the dispensing rates from pharmacies have remained low. This
treatment gap can be filled by using state laws/orders/protocols to increase
offers of naloxone to high-risk populations who do not receive a prescription
for it.



“If we want to continue to advance as a profession, we have to use every tool we
have been given to make leverage and this is going to be one of them, since this
should be a slam dunk for us,” Franko said.

The lack of confidence in discussing naloxone and lack of familiarity of the
product has caused many pharmacists and pharmacy technicians to not be as
communicative about the advantages of naloxone.

Decreasing the stigma is the next step for change in these roles, which includes
using person-first language when speaking with patients to make naloxone sound
more like a commonly used item, such as an EpiPen. Additionally, using
open-ended questions, looking at patients holistically, and keeping the context
simple for patients can help change the conversation surrounding opioids and
naloxone.

Franko also mentioned how pharmacists should advertise treatment programs at
their local pharmacy, provide takeback boxes in the pharmacy permitted under
state law, and using a prescription drug monitoring program to identify patients
as a part of the culture change surrounding substance abuse. Especially in a
pharmacy technician role, who is the first person to communicate with each
patient, it is important to engage in a proper conversation with the right
language while making an initial assessment.

“The face of the whole system is the pharmacy technician,” Franko said.
“Technicians are so important, and we all know that we would never make it in
the practice without a pharmacy technician. We need to continue to empower
technicians to make more assessments, more interactions with patients, and help
pharmacists seal the deal with the case of naloxone.”

Naloxone is both safe and effective, and Franko emphasized that many myths
surround its use and change is needed to break the stigma around it.

“As the most accessible health care provider, 90% of the US population lives
within 5 miles of a pharmacy,” Franko said. “We are well positioned to get
naloxone out to communities.”






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