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. 2018 Nov 13;320(18):1934–1937. doi: 10.1001/jama.2018.15892

Table. Telephone Audit Responses—Accessibility of Naloxone Under Standing Orders by Pharmacists in Chain Pharmacies in Texas (N = 2317 Pharmacies)a.

Questions Affirmative Responses, No./Total No. (%) [95% CI]
1. Would the pharmacist dispense naloxone without a prescription? 1940/2317 (83.7) [82.2-85.2]
2. Was the pharmacist aware of the standing order? 2041/2317 (88.1) [87.0-89.2]
3. Was at least 1 formulation of naloxone currently in stock at the pharmacy? 1771/2317 (76.4) [74.7-78.1]
4. If naloxone was not in stock …
I. Does the pharmacy typically have it in stock? 217/531 (40.9) [36.8-45.2]
II. Would the pharmacy order naloxone on request? 405/531 (76.3) [72.4-79.7]
5. What dosage form of naloxone was available?
I. Nasal form 1686/1771 (95.2) [94.1-96.1]
i. Narcan nasal spray only 1544/1686 (91.6) [90.2-92.8]
ii. Prefilled syringe with atomization device only 53/1686 (3.1) [2.4-4.1]
iii. Both nasal forms 82/1686 (4.9) [3.9-6.0]
iv. Unknown 7/1686 (0.4) [0.2-0.9]
II. Injectable form 365/1771 (20.6) [18.8-22.6]
i. Vial plus intramuscular syringe only 265/365 (72.6) [67.8-76.9]
ii. Evzio auto-injector only 50/365 (13.7) [10.5-17.5]
iii. Both injectable forms 22/365 (6.0) [4.0-9.0]
III. Both nasal and injectable forms 281/1771 (15.9) [14.2-17.7]
6. Would the pharmacist sell an intramuscular syringe without a prescription? 924/1237 (74.7) [72.2-77.0]
7. Would the pharmacist dispense naloxone to a third party (ie, to non–opioid user to use for someone else)? 1852/2317 (79.9) [78.3-81.6]
8. Would the pharmacist bill a third party’s insurance if purchasing the naloxone for someone else (eg, to have on hand for emergencies or because of concern for a family member or friend)? 1151/2317 (49.7) [47.8-51.9]
Assessment of combinations of audit questions to estimate immediate availability
What proportion of pharmacies were willing to dispense naloxone without a prescription AND currently had naloxone in stock?b 1607/2317 (69.4) [67.5/71.2]
What proportion of pharmacies were willing to dispense naloxone without a prescription AND currently had naloxone in stock OR were willing to order naloxone?c 1893/2317 (81.7) [80.1-83.2]
What proportion of pharmacies were willing to dispense naloxone without a prescription AND currently had naloxone in stock AND were willing to bill a third party’s insurance?d 959/2317 (41.4) [39.4-43.4]
a

Specific questions asked to obtain answers 1-8: (1) “Do I need a prescription to get naloxone or can I just come in and purchase it from you?” (2) If response to question 1 was “no,” caller would ask “Oh, I was at a presentation recently and they said that pharmacists at CVS, Walgreens, Walmart, and HEB have a standing order to dispense naloxone. Is your pharmacy not included in that?” (3) “Do you have naloxone in stock right now?” (4) If response to question 3 was “no,” caller would ask “Are you just out of it or do you not normally carry it?” and “Would you be able to order some for me?” (5) If response to question 3 was “yes,” caller would ask “Which version?” (6) “If I want to get the vial and the intramuscular syringe, am I able to buy the syringe there or do I need a prescription for that?” (7) “Even if I don’t use an opioid, am I able to purchase naloxone for someone else as a precaution?” (8) “If I am getting the naloxone to use in case someone else overdoses, can I still use my own insurance to purchase the naloxone?”

b

This question was not specifically asked during telephone audit. The numerator in question 9 includes stores with pharmacists answering affirmatively to both questions 1 and 3.

c

This question was not specifically asked during telephone audit. The numerator in question 10 includes stores with pharmacists answering affirmatively to both question 1 and question 3 or 4.

d

This question was not specifically asked during telephone audit. The numerator in question 11 includes stores with pharmacists answering affirmatively to all 3 of questions 1, 3, and 8.