the push to spread naloxone to every corner of Texas where it can bring drug users back from the brink. Since a 2015 state law made it legal for lay- people to administer naloxone outside a medical care setting, TONI and oth- er organizations have worked to take advantage of the law. Several standing pharmaceutical orders, including one from the Texas Pharmacy Association (TPA), have expanded naloxone ac- cess in Texas. “I felt the standing order was im- portant because we’re currently in a historic opioid epidemic in our coun- try and our state,” said Austin addic- tion psychiatrist Carlos Tirado, MD, who issued the standing order for TPA. But as naloxone becomes more
available on paper, the skyrocketing cost of the drug, which has grabbed the attention of lawmakers in Wash- ington, D.C., is hindering efforts to en- hance access.
“There is too much at stake for people not to have access to this medication.”
NEW LAW, NEW OPPORTUNITY During last year’s session, the Texas Legislature passed Senate Bill 1462 by Sen. Royce West (D-Dallas), clearing the way for physicians to prescribe an opioid antagonist to anyone in dan- ger of experiencing an opioid-related overdose or to anyone in a position to help the opioid user. The Texas Medi- cal Association strongly supported the law, which allows anyone witnessing a person experiencing an overdose to administer naloxone on the spot. The person administering the naloxone can do so by either intravenous or in- tramuscular injection or by intranasal spray. SB 1462 took effect Sept. 1, 2015. (See “A True Antidote,” October 2015 Texas Medicine, pages 41–47, or visit
www.texmed.org/TrueAntidote.) U.S. Centers for Disease Control
and Prevention (CDC) data show prescription opioids and heroin killed more people in 2014 than any other year on record. According to CDC, more than 28,000 people died in 2014 from opioids, including more than 14,000 from overdoses involv-
50 TEXAS MEDICINE September 2016
ing prescription opioids. Texas had 2,601 drug overdose deaths in 2014, according to CDC data, a rate of 9.7 per 100,000 population. Almost 2 mil- lion Americans abused or were depen- dent on prescription opioids in 2014. Alicia Kowalchuk, DO, an assis-
tant professor in Baylor College of Medicine’s Department of Family and Community Medicine, says TONI ap- proached her last winter and asked her if she’d be willing to write a stand- ing order if the organization could find a willing pharmacy partner. TONI dis- tributes naloxone and trains addicts and their loved ones on how to use it. Dr. Kowalchuk says many of the
other states that have passed similar legislation have had a physician step up to write a blanket order like the one she wrote for Walgreens. The month following Dr. Kowal-
chuk’s order, TPA announced it would implement a physician’s standing or- der authorizing pharmacists to dis- pense naloxone after they had com- pleted a one-hour training course ac- credited by the Accreditation Council for Pharmacy Education. That order took effect Aug. 1. Justin Hudman, TPA’s director of
public affairs, says the standing order includes all the available formulations of naloxone, also known by the trade name Narcan. “They would need to get some ba-
sic education in how to educate the patient because, as we know, this is a little bit different than the nor- mal counseling,” Mr. Hudman said of pharmacists taking the education course to act under the standing order. “The individuals who receive it need to have a basic understanding of what to look for as far as what will be warning signs or signs of an overdose, so it’s a little bit different … than when they would be taking it themselves.” In late July, CVS Health announced
it had established a standing order to make naloxone available without a prescription at all of its pharmacies in Texas, as well as locations in 30 other states.
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