The opioid overdose-reversing drug naloxone has been saving lives for decades. New national data shows that in recent years, pharmacies have been dispensing the drug at increasing rates.
Carlton County pharmacies dispensed the second-highest rate of naloxone in Minnesota in 2018, with 346 prescriptions dispensed per 100,000 people, according to data from the Centers for Disease Control obtained through the Associated Press.
The CDC’s data only includes naloxone dispensed by pharmacies and doesn't reflect how much naloxone is actually in a community, since harm-reduction programs like the Rural Aids Action Network in Duluth also dispense naloxone and first responders regularly have to administer the drug after arriving on the scene of an overdose.
Carlton County public health educator Ali Mueller has dedicated countless hours to educating pharmacists, residents and others on the importance of naloxone in combating the opioid epidemic. She views the data as proof that hard work is paying off.
“We just wanted to educate people and break the stigma. You can’t help somebody if they’re not alive,” Mueller said. “We have this antidote that can help someone so they can get treatment or help when they need it.”
In 2017, the Minnesota Board of Pharmacy started a naloxone prescription protocol that allows pharmacists to distribute the drug to anyone. No one's required to have a prescription to buy the overdose-reversing drug.
Also in 2017, Mueller and Laura Palombi, assistant professor at the University of Minnesota's College of Pharmacy in Duluth, provided educational trainings on naloxone to staff at the six pharmacies in Carlton County. Palombi has worked on a variety of projects addressing substance use disorder in the county.
Mueller credits pharmacists in the county for embracing the state’s naloxone prescription protocol, and thus increasing the amount of naloxone that’s in the community.
“I think it's important to note that the Carlton County pharmacies are kind of ahead of the game,” Mueller said. ... They could have easily said, ‘No, we don't want this.’ They really took the initiative and really wanted to help.”
Following the naloxone training, Kendra Metz, the manager of Thrifty White Pharmacy in Moose Lake, developed a procedure using recommendations from the Board of Pharmacy for her staff to use when educating patients. The procedure educates patients on the factors that put a person at risk of an overdose as well as naloxone’s role in reversing an overdose.
Staff members share the information with any patient who is new to an opioid prescription, changing opioid prescriptions or on a higher-dose opioid. Patients are also told what an overdose looks like and how to administer naloxone.
The opioid antidote can be administered as an injection or nasal spray and is also known by its brand name of Narcan.
“I compare it a lot to a fire extinguisher,” Metz said of naloxone. “I hope you never have to use, but just in case it’s there.”
She said that when patients hear the educational spiel, they usually opt to purchase a naloxone prescription along with their opioid prescription. And more often than not, insurance companies pay for the naloxone.
In terms of the number of naloxone prescriptions dispensed per opioid prescription, Carlton County dispensed the third-highest in the state. For every 100 high-dose opioid prescriptions dispensed, pharmacies in the county also dispensed 2.9 naloxone prescriptions.
Considering the CDC recommends prescribers pair every high-dose opioid prescription with naloxone, that number is nowhere near perfect, but it’s far better than the national rate. In 2018, for every high-dose opioid prescribed in the country, only one naloxone prescription was dispensed.
Metz said the Moose Lake Thrifty White Pharmacy also sells naloxone to people who aren’t on an opioid prescription, such as people who have had a family member overdose and want to have the antidote on hand just in case it happens again. However, most of the patients who leave with naloxone are educated by staff.
“As long as you’re coming off nonjudgmental and you’re just educating them — because it’s a safety net, it truly is — most people are open to it,” Metz said.
How our neighbors rate
Pharmacies in Pine County dispensed the fourth-most naloxone prescriptions in the state at 258.58 prescriptions per 100,000 people. For every 100 high-dose opioid prescriptions prescribed, pharmacies in Pine County dispensed 2.46 naloxone prescriptions. That’s the fifth most in the state.
St. Louis County ranked 27th out of 87 counties at 94.24 prescriptions dispensed per 100,000 people. For every 100 high-dose opioids prescriptions prescribed, pharmacies in St. Louis County dispensed 0.86 naloxone prescriptions.