Naloxone kits are portable pouches containing an opioid antidote that can be administered through the nose to revive an unresponsive person who is overdosing. Credit: Eric Shelton/Mississippi Today

Almost half of Mississippi pharmacists are not readily storing and selling naloxone, according to a study conducted by researchers at the University of Mississippi. 

More than 40% of Mississippi pharmacies do not carry naloxone, despite a 2017 standing order from the state that allows pharmacists to dispense naloxone with or without a prescription at a patient’s request. 

This is the first study since the passage of the order to investigate the accessibility of naloxone, commonly known as Narcan – a drug that can reverse the effects of an opioid overdose.  

Emily Gravlee, a fourth-year University of Mississippi doctoral student in pharmacy administration Credit: Courtesy of Emily Gravlee

Emily Gravlee, a fourth-year University of Mississippi doctoral student in pharmacy administration and creator of the study for her master’s thesis, said it’s important to have naloxone available at community pharmacies because they are access points for many people. 

“If we don’t have naloxone available at community pharmacies, then that could potentially represent a missed opportunity for a patient to receive a life-saving medication,” Gravlee told Mississippi Today. 

Using a secret shopper method, volunteers cold-called 591 community pharmacies to request the drug: 328 were independent pharmacies, 147 were chain pharmacies and 116 were grocery store pharmacies.  

The report showed that only 25% of independent pharmacies had naloxone available for same-day pickup, resulting in the lowest proportion out of the three groups. Fifty-six percent of grocery store pharmacies offered naloxone. 

Because of a death in the family, Mona Arnold-McBride, executive director of the Mississippi Pharmacists Association, was not available before publication to comment.

Sujith Ramachandran, associate professor of the Department of Pharmacy Administration at the University of Mississippi and one of the paper’s coauthors, said there could be multiple reasons that independent pharmacies fall short among community pharmacies. 

Standardized corporate policies may be in place throughout chain pharmacies to stock and dispense naloxone, while independent pharmacies’ policies vary from business to business.  

“I personally know some independent pharmacies that took an initiative to make sure they stock naloxone and are engaging in harm reduction services where possible, but that sort of proactiveness is not consistent across all independent pharmacies,” Ramachandran told Mississippi Today. 

Robert Hugh Dozier, executive director of Mississippi Independent Pharmacies Association (MIPA), said the association sees naloxone availability as a positive because it can keep people safe, but ultimately, independent pharmacies will each decide whether or not to stock naloxone.

“If the product is priced too high, and the pharmacy cost is high, they might not be able to stock that product in their pharmacy,” Dozier told Mississippi Today. “There also may not be a market need for it in their surrounding area.” 

According to the Mississippi Opioid and Heroin Data Collaborative, 78% of overdosing deaths in the state were caused by opioids in 2022, compared to 72% in 2021. 

The University of Mississippi study noted how naloxone was least available in the western part of the state. 

Naloxone Same-Day Availability Under a Standing Order in Mississippi by County Credit: Naloxone Accessibility Under the State Standing Order Across Mississippi. JAMA Netw Open. July 6, 2023. Page 6. Copyright © 2023. American Medical Association. All rights reserved.

Gravlee said broadly speaking, educational interventions about the accessibility of naloxone could be a useful approach for both pharmacies and people.

“Maybe, more than we realize, it’s a two-piece problem,” Gravlee said. “Pharmacies may not know about the standing order or understand the standing order, but also patients, people, in the community may not know that they can receive this drug under the standing order.”

Under the Health’s Opioid and Substance Use Disorder Program through the Mississippi State Department of Health, Mississippians can receive free naloxone kits, which cost about $100 without insurance coverage.

The naloxone kits include two doses of naloxone, an index card on how to recognize an overdose, the signs and symptoms a person may experience and how to administer naloxone. 

For every person who requests naloxone, a pharmacist transcribes the prescription, and the order is then labeled and shipped to the individual’s mailing address. 

There have been roughly 7,000 kits shipped directly to individuals as of early September, according to the state Department of Health. 

UPDATE 9/27/23: This story has been updated to reflect why Mona Arnold-McBride was unavailable for comment before the story’s publication.

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Pamela “Pam” Dankins is currently a 2023 summer intern at Mississippi Today. She graduated from Mississippi State University with a bachelor’s degree in print and digital journalism in May 2023. Her work has been published in the Northeast Mississippi Daily Journal in Tupelo, Miss., Mississippi Free Press in Jackson, Miss., Monroe Journal in Amory, Miss., and The Reflector student newspaper, in Starkville, Miss. Throughout her academic career, she received the Stephen D. Lee Scholar award, became a member of Phi Kappa Phi Honor Society and a member of Gamma Beta Phi Society. In her free time, Pam writes/publishes poetry books, listens to music ranging from K-Pop to Classical, and relaxes. She is an Amory native.