Starting this month, District residents can walk into their local pharmacy and ask for a certain drug for free: naloxone, the overdose-reversing drug.
Seventeen pharmacies spanning every ward in D.C. are participating in a new pilot program to allow pharmacists to dispense the drug to people who don’t have a prescription. It follows a 2018 standing order issued by DC Health that allowed pharmacies to complete DC Health training to receive certification to dispense the drug to those who don’t have prescriptions.
Additionally, any patient who picks up an opioid prescription from one of these pharmacies will also receive a free naloxone, in the form of the nasal-spray Narcan.
But while local organizations and DC Health are excited about the pilot, it doesn’t mean everyone will be taking advantage of it right away.
Alexandra Bradley, mobile services manager at the nonprofit HIPS, has been giving out free naloxone as part of HIPS’ harm reduction program since well before the pilot. In addition to naloxone, the group gives out condoms and offers information on syringe exchange programs. For Bradley, any reduction in barriers to accessing naloxone is a good thing.
But Bradley also says that for the clients HIPS serves, which include sex workers, people with substance use disorders, and people experiencing homelessness, pilots like these aren’t always practical. “To go to the pharmacy, you have to be willing to ask a pharmacist in public about Narcan and risk them acting a certain way,” she says. She adds that there’s still a stigma around accessing naloxone.
According to an American Medical Association opioid report released this month, there’s a mistaken belief that naloxone will encourage “risky behavior,” or encourage people to continue using knowing there’s an antidote. And this might make people fearful to ask for it, even if the drug isn’t intended for them, but rather for a friend or a family member.
Instead of going to a pharmacy, Bradley says community members can receive free naloxone from HIPS directly. The group gives it out when they do outreach activities. According to Bradley, the Department of Health provides a lot of community-based organizations like HIPS with free naloxone to hand out. That way people can receive it, no questions asked, from a group familiar to them.
However, the pilot is a great back-up for emergencies when HIPS and other community-based organizations aren’t immediately available, Bradley says.
According to DC Health, there have been 72 opioid-related deaths as of May 31 this year. Last year, 213 people died from opioid overdoses in the District. Just last month, in a NoMa underpass homeless encampment, a person there died of an overdose. This is a community HIPS often serves.
Karen Cunningham is the executive director of Everyone Home DC, an organization serving people who are at risk of, or experiencing, homelessness. She says the pilot is a great way to raise awareness of naloxone. She says naloxone is safe and easy to administer and has no harmful impacts, even if someone is not experiencing an overdose.
Harm reduction is also part of Everyone Home DC’s work. Like HIPS, their street outreach team carries naloxone when interacting with people experiencing homelessness and is prepared to administer it as needed.
The group also partners with Unity Healthcare, which does medical outreach to people experiencing homelessness and also can provide naloxone.
But, like Bradley, Cunningham knows there’s a stigma around asking for naloxone.
And she also knows that for the clients Everyone Home DC serves, even asking the nurses at Unity for naloxone can be difficult. It means admitting you have a substance use disorder.
“I do imagine it may be difficult to take that step and go inside a pharmacy and ask for it in that way,” she says. “Hopefully some people will.”
On the other hand, Cunningham says, some people may be less worried about going to a pharmacy if it means facing a potential stranger rather than someone they know. The pilot provides multiple avenues to allow people to access naloxone, depending on their comfort level, Cunningham says. She calls the initiative just another way to help destigmatize carrying naloxone.
She also says that family members and friends of people experience substance use disorders might be more likely to get naloxone at the pharmacies, knowing the resource is so easily accessible.
Michael Kharfen, senior deputy director of the HIV/AIDs, Hepatitis, STD and TB Administration at DC Health, also understands that there’s a stigma. Does asking for naloxone make it appear that you’re at high risk for an overdose?
Kharfen is helping to lead the pilot and he also hopes it’ll reduce the stigma of carrying the life-saving drug.
“A pharmacy is a place where you pick up diabetes medicine,” he wants to remind people. And naloxone is just another medication you pick up. He says it’s easy to pick up a Narcan kit. All you need to do is walk into the pharmacy. Insurance isn’t required, he says, but pharmacists do ask for your name to be put into a log to be documented by DC Health.
Kharfen says pharmacists have been trained to give people information on how to use the drug. Just last weekend, the Howard University College of Pharmacy held its annual Opioid Symposium and Naloxone Administration where area pharmacists got hands-on naloxone training, according to the Washington D.C. Pharmacy Association.
Beyond hands-on training and information, Kharfen says pharmacists know the populations they’re serving. “They’re community-type pharmacies. They’re used to populations that are diverse,” he says. This is valuable because the people who are receiving naloxone come from all types of background, he says.
But, Kharfen also shares Bradley’s and Cunningham’s insight. “We know there can be times where those programs aren’t accessible, so we wanted to make sure there are pharmacies nearby.”
He also agrees with Cunningham that this pilot may very well be for friends and family of those who need naloxone. “While you can go to your own provider to get a prescription, this is also available.”
And DC Health has more plans to break down stigma and increase access. Kharfen says the department is working on expanding knowledge of community providers on how to use naloxone and when it should be used. He also says the department hopes to post an online naloxone training for people to access through the DC Health website.
“We’re making as many possible access points for people to get naloxone,” he says.