Background: New Mexico has a long-standing history of implementing harm reduction strategies for the prevention of opioid overdose. Most recently, on June 14, 2019, SB221 added language to the New Mexico Pain Relief Act requiring health care providers prescribing opioid analgesics for 5 days or longer to co-prescribe an opioid antagonist along with written information on how to administer the opioid antagonist. At least one study has identified difficulty for patients filling their opioid antagonist prescription, and patients needing to go to multiple pharmacies may not receive their prescriptions.The purpose of this research was to identify the same-day availability of opioid antagonists by surveying the pharmacies in major New Mexico cities.
Methods: To examine barriers from the patient perspective, we performed an audit (“secret shopper”) study of pharmacies in Albuquerque, posing as callers wishing to obtain naloxone. The GoodRX website was used to identify 94 pharmacies in Albuquerque and 106 pharmacies in New Mexican cities outside of Albuquerque, dispensing opioid antagonists. Each location was called during working hours, at least 2 hours prior to closing. We inquired whether naloxone would be available for pick up the same day. If Naloxone was not available for same-day pick up, we asked when it would be available next. Responses were recorded and analyzed from 183 pharmacies. 17 locations were eliminated from analysis because the phone system was down or the pharmacy was permanently closed.
Results: Of the pharmacies reached, 84.7% (155/183) reported they have opioid antagonists available for pick up on the same day. Of the 15.3% (28) pharmacies that did not have same day availability, (17) 60.7% reported availability in 1-2 days, (1) 3.6% pharmacies had availability in 3-4 days, (1) 3.6% of pharmacies had availability in 1 week, and (9) 32.1% pharmacies were unsure of next availability. Of the major cities surveyed in NM, Albuquerque (71.8%), Farmington (87.5%), Rio Rancho (90%), and Las Cruces (93.7%) had the lowest rates of same-day Naloxone availability. Santa Fe, Roswell, Los Lunas, Hobbs, Carlsbad, Taos, Alamogordo, Silver City, Edgewood, Gallup, Espanola, Ruidoso, Belen, and Las Vegas, had 100% same-day availability of Naloxone in all the pharmacies surveyed.
Conclusions: The availability of opioid antagonists in New Mexican pharmacies has not been previously studied, and initial results suggest unpredictable same-day availability. Many patients have misgiving about opioid antagonists, and it places a burden on patients to go to multiple pharmacies or take multiple trips to fill this medications It is somewhat reassuring that most pharmacies without same day naloxone availability would have this within several days, but this delay may reduce the likelihood patients will get fill prescriptions. Opportunities to increase availability exist. Given that hospitalists commonly prescribe opioid antagonists, the topic of Naloxone availability requires further study. Further research may focus on examining the effects on patients when opioid antagonist prescriptions are delayed or unavailable, why there is variability in opioid antagonist availability between different cities, and the reasons for uncertainty when opioid antagonists will be available.
