Please write 100 words responses to each post of my peers

1) Good afternoon everyone,

Assuming that I am a pharmacist in the state of Florida, state statute 456.44 (6) states that the opioid antagonist (such as Narcan, or generic naloxone) is only required when prescribing a Schedule II controlled substance when prescribed to treat pain for traumatic injury with a Severity Score of 9 or higher (2019). The Florida Department of Health advises that there is no law that prohibits a pharmacist from dispensing an opioid without the emergency opioid antagonist (Florida Health Source, 2018).

The Federal Drug Administration recommends that naloxone (brand name Narcan) be prescribed by providers when prescribing opioid pain relievers (2020). The FDA further advises that naloxone is to be used when opioid overdose occurs with observed respiratory depression or inability to awaken, and that naloxone is safe to use for elderly patients even when the cause of the observed symptoms was not caused by an opioid (2020). Although emergency opioid antagonists are encouraged, recommended and considered safe, neither the federal government nor the state of Florida require that a pharmacist dispenses the opioid antagonist in Florida when an opioid is prescribed. Therefore, I would educate the patient of the importance of this medication to prevent severe injury or death in the event of an overdose. I would also educate that taking the opioid as prescribed, and avoiding alcohol or certain other medications during use would reduce the likelihood of overdose (FDA, 2020). I would advise that through the Helping Emergency Responders Obtain Support Program (HEROS), emergency response agencies in Florida such as law enforcement, fire departments and Emergency Medical Technicians are obtaining the opioid emergency antagonists to use in response to suspected opioid overdose encounters (Florida Health, 2021), however, a patient having access to their own opioid antagonist and letting others know when and how to use it can reduce deaths (FDA, 2020). Emergency opioid antagonists are only temporary and should be followed with emergency medical treatment (FDA, 2020). Since cost was the largest factor for the elderly patient, I would inform them that Medicare part D benefits cover Narcan but their out of pocket cost may vary (Medicare.org, 2020). I would also offer that prescriiption discount programs such as GoodRx lists the pricing of the generic Naloxone as much less than $100, with pricing at various retailers ranging from $24.17 to $52.16.

References:

Controlled Substance Prescribing, XXXII. Fla. Stat. § 456.44 (2019). https://www.flsenate.gov/Laws/Statutes/2019/456.44

Florida Health. (2021, November 2). Helping emergency responders obtain support (HEROS) program. Florida Health. http://www.floridahealth.gov/licensing-and-regulation/ems-system/heros.html

Florida Health Medical Quality Assurance. (2018, July 6). House Bill 21: Frequently asked questions. Florida Health Medical Quality Assurance.
https://www.flhealthsource.gov/FloridaTakeControl/files/HB21-FAQ.pdf

GoodRx. (2021). Naloxone. GoodRx. https://www.goodrx.com/naloxone

Medicare.org. (n.d.). Does Medicare cover Narcan? Medicare.org. https://www.medicare.org/articles/does-medicare-cover-narcan/

2) If I am a pharmacist and a patient presents a NARCAN prescriiption that will cost $100, and an elderly patient has relayed to me that they are on restricted budget, there are a couple of things that I would respond and address. If the elderly patient asks me if the prescriiption is needed, I will assume that the if the patient has been prescribed NARCAN, it is for a reason. I would then explain to the patient that yes, this prescriiption of NARCAN is needed, in addition I would address and explain to the patient why NARCAN is recommended and prescribed to patients that are using opioids for the following reasons:

Patients that have a greater risk of overdose on opioids
Patients that are prescribed opioids and other drugs that may affect the central nervous system
Patients that may have young children or members of the household that may accidentally ingest opioids, and house members that are abusing opioids
Once I explained the reasons why a provider would prescribe NARCAN, I would move on to explain any opioids and other drugs that the patient has been prescribed and the importance of the NARCAN.

Naloxone, also known as NARCAN “is an opioid antagonist, is a safe rescue medication that laypeople can administer to reverse an overdose” (Khan et al, 2020). So, if you or anyone in your home should ever overdose on the medication prescribed NARCAN can be administered to reverse the possible overdose.
It is important that you let everyone around you know that you have NARCAN and where it is so in case of an emergency you receive help. It is critical to call 911 once NARCAN is administered.
Always keep your medication locked away for your use and access only. The NARCAN should be easily accessible for emergency use.
Lastly, I also know that “in most states and the District of Columbia, you can obtain naloxone from a pharmacy under a standing order that takes the place of an individual prescriiption” and furthermore “some states also allow you to obtain naloxone without a prescriiption from a community-based program or pharmacy” (U.S. FDA, 2020). So, I would then research and contact our health department and local nonprofits who can assist the elderly patient with receiving NARCAN without the expensive cost.

References:

Kahn, L. S., Wozniak, M., Vest, B. M., [supanova_question]