Collaborative Pharmacy Practice Agreements: A novel approach to expand naloxone access to reduce opioid overdose death

Nationally, drug poisonings are the second leading cause of accidental death among adults and the leading cause of adult accidental death in Rhode Island (RI) and 15 other states. Drug-related deaths claimed the lives of 193 Rhode Islanders in 2008—nearly 4 people each week. Accidental drug intoxications -overdoses- comprise the vast majority of these poisonings, and opioids are the most common drugs involved in overdose death. Distribution of naloxone, an opiate antagonist capable of reversing overdose, to lay persons and opiate users has been demonstrated to be a feasible and effective component of a comprehensive approach to lowering opiate-related mortality. However, access to naloxone is often limited by provider hesitance to prescribe for community use and by limited funding for community-based programs to scale-up small naloxone programs. Pharmacies are an under-utilized component of the health care system, with highly-trained health care professionals who are very skilled at patient counseling. The use of Collaborative Pharmacy Practice Agreements (CPAs) between a prescriber and CPA-certified pharmacists may provide opportunities for medical providers and pharmacists to work together to increase access to naloxone in their community for prescription and illicit opioid users. A CPA was drafted in RI in a collaborative effort with the RI pharmacy board. CPA pilot implementation will provide coordinated service provision between a single prescriber, and a number of pharmacists at a single pharmacy increasing access to naloxone, and naloxone refills, in the community. The rationale, methods, CPA content, implementation, and status of the CPA pilot will be presented.