Boston Medical Center (BMC) has received a $1.3 million grant from the Agency for Healthcare Research and Quality (AHRQ) to support a demonstration project of pharmacy-based naloxone rescue kits to help reduce opioid addiction and overdose death in two New England States: Massachusetts and Rhode Island. The study will be conducted in partnership with Rhode Island Hospital in Providence, CVS Health, based in Woonsocket, Rhode Island, which has pharmacies throughout the U.S., and several local community pharmacies in both states, including Massachusetts-based Eaton Apothecary.
"While education and intervention have come a long way in the past several years, there is still a lot of work to be done to reduce opioid overdose and overdose death," said the study's principal investigator, Traci C. Green, PhD, MSc, deputy director of the Injury Prevention Center at BMC and associate professor of emergency medicine at The Warren Alpert Medical School of Brown University. "Pharmacies have enormous potential to expand the reach and impact of critical public health interventions, just as we have seen happen with pharmacy access to clean syringes and adult immunizations. But how do we do that with naloxone rescue kits? That's what we intend to figure out here in Massachusetts and Rhode Island."
In both states, pharmacists must be trained to distribute naloxone rescue kits through continuing education that covers opioid addiction, overdose risk and the benefits of appropriate use of naloxone. The study will track and analyze data from the participating pharmacies throughout the two states to develop best practices for a national pharmacy-based naloxone rescue kit program.
To address the growing opioid epidemic, hospitals and pharmacies in both states recently began providing naloxone to patients with substance use disorder and their loved ones for immediate use following an overdose. Uniquely, under a standing order from BMC's Alexander Walley, MD, the medical director of the Massachusetts naloxone program and also a Co-Investigator on this study, state-funded community programs train and equip family, friends, and people who use opioids in overdose recognition and naloxone administration. Similar infrastructure is absent in most states, such as Rhode Island. The study will look at how pharmacies can be leveraged in both settings to increase naloxone distribution.
As a leader in addiction medicine, BMC recognized early on the need for such interventions, and in 2009, began providing overdose prevention education and naloxone rescue kits to emergency department patients at risk for opioid overdose. BMC was the first hospital in the country to provide the rescue kits to patients.
Green and Walley, in collaboration with Josiah Rich, MD, MPH, a physician at The Miriam Hospital in Providence, and Jeffrey Bratberg, PharmD, from the University of Rhode Island College of Pharmacy, developed protocols for pharmacies to supply, order and provide naloxone to patients. The protocols are in place throughout Massachusetts and Rhode Island pharmacies, including the 418 CVS pharmacies and all Eaton Apothecary locations in the two states. The authors will identify relevant organizational and community factors associated with successful implementation of the program to incorporate into a national program.
"In Massachusetts and Rhode Island, we have been severely impacted by the epidemic of overdose deaths," said Rich, who also is professor of medicine and epidemiology at the Alpert Medical School of Brown University. "Rhode Island Hospital is honored to partner with BMC, CVS and other local pharmacies to develop a new standard of care that we expect will prevent deaths caused by opioid overdoses."
Drug overdose is the leading cause of injury death in the U.S., greater than car accidents. In fact, according to the Substance Abuse Mental Health Services Administration, more than 24.5 million people age 12 or older in the U.S. (9.4 percent of the population) live with substance use disorders, including 1.9 million who live with prescription opioid abuse or dependence. Each day, according to Centers for Disease Control and Prevention, 100 Americans die of drug overdose.
"CVS Health has a long-standing commitment to prevent prescription drug abuse and our participation in this demonstration project complements our ongoing efforts to expand the availability and distribution of naloxone to prevent opioid overdoses," said William Shrank, MD, chief scientific officer of CVS Health and a study investigator. "All of our CVS/pharmacy locations in Rhode Island and Massachusetts keep naloxone in stock and it is available without a prescription. In addition, by the end of this month, CVS/pharmacy will be able to dispense naloxone without a prescription in 14 additional states."
Naloxone can be obtained from pharmacies without a prescription in Massachusetts and Rhode Island.
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