Optimizing the Distribution of Pharmacy-Dispensed Naloxone Using Spatial Mapping Techniques in Rural Areas

• Date: 01 October 2020
• Published date: 01 October 2020
• Author: Somalee Banerjee
• DOI: 10.1177/0022042620945673
• Subject Matter: Articles

https://doi.org/10.1177/0022042620945673

Journal of Drug Issues

2020, Vol. 50(4) 604 –612

© The Author(s) 2020

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DOI: 10.1177/0022042620945673

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Article

Optimizing the Distribution of

Pharmacy-Dispensed Naloxone

Using Spatial Mapping Techniques

in Rural Areas

Somalee Banerjee, MD, MPH,1,2

Abstract

With the worsening opioid epidemic, recent changes allow pharmacies to sell naloxone through

standing orders to reverse opioid overdoses. This study assesses direct dispensed naloxone

availability through pharmacy chains in California in 2016, and utilizes spatial analysis techniques

to suggest optimal stocking of naloxone. Rural counties were less likely to have a pharmacy

selling naloxone even though overdose death rates were higher in rural counties (odds ratio

[OR] = 0.225; 95% confidence interval [CI] = [0.059, 0.854]). Pharmacies closest to the center

of the population in these rural counties were identified as ideal stocking locations. Rural

counties with high overdose death rates have the lowest rates of naloxone, but spatial analysis

can determine pre-existing chain pharmacies that can stock naloxone.

Keywords

naloxone, mapping, pharmacy, geospatial, rural

Introduction

The opioid epidemic and opioid-associated mortality within the United States has recently gained

increasing attention as a public health crisis due to the skyrocketing number of opioid overdose

deaths with a 200% increase since 2000 (Paulozzi et al., 2011; Rudd et al., 2016). Strategies to

reduce mortality from the opioid epidemic have taken multimodal approaches including harm

reduction methods, such as opioid overdose reversal with naloxone. Naloxone hydrochloride is a

µ-opioid receptor competitive antagonist that quickly reverses opioid effects temporarily, and

thus prevents respiratory depression and death due to an opioid overdose (Beheshti et al., 2015).

Historically, naloxone was only administered in medical facilities; however, over the last two

decades, liberalizing naloxone access has been used as a means of community harm reduction in

the opioid epidemic. Previously this was limited to first responders and community distribution

programs, and access had been concentrated in urban areas (Hawk et al., 2015; Wheeler et al.,

2015). The National Institutes of Health (NIH) and the U.S. Food & Drug Administration (U.S.

FDA) have recommended the use of naloxone, a common opioid reversal agent, to reduce opioid

1University of California, Berkeley, USA

2Kaiser Permanente, Oakland, CA, USA

Corresponding Author:

Somalee Banerjee, Department of Internal Medicine, Kaiser Foundation Hospital, 3600 Broadway, Oakland, CA

94611, USA.

Email: somalee.banerjee@kp.org

945673JODXXX10.1177/0022042620945673Journal of Drug IssuesBanerjee

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