Three pharmacy school students gathered outside a windowless brick storefront in Fairhill, just blocks from Philadelphia’s most notorious heroin encampment.
The shop they were about to enter–Cambria Pharmacy–serves an area hit hard by opioid overdoses. But the pharmacists-in-training would soon discover that it didn’t carry naloxone, a lifesaving medication that can revive users who OD on heroin and other opioids.
The students, from the Philadelphia College of Pharmacy at University of the Sciences, are part of an outreach effort whose aim is to increase the availability of naloxone in city neighborhoods with the highest overdose rates.
The number of people killed by drug overdoses in Philadelphia grew to 900 in 2016. Yet, in neighborhoods like Fairhill that suffer high numbers of overdoses, this medication is still hard to come by. Pennsylvania’s physician general issued a standing order in October of 2015 that made it legal for pharmacies to provide naloxone to anyone who walks in asking for it. But drugstores are not required to stock it, and a survey of pharmacies in city zip codes that suffer the most overdoses found that fewer than one in eight had the opioid antidote available. About half of the stores surveyed either didn’t know about the standing order or didn’t understand it.
A lack of education about the standing order may be partly to blame for the low stocking of naloxone. Many pharmacists aren’t accustomed to filling prescriptions under a standing order and may not know the process for dispensing the medication, said Daniel Ventricelli, a professor of clinical pharmacy at University of the Sciences and an advisor to the students organizing the outreach program.
“Other reasons may be that there’s still stigma surrounding addiction and substance abuse, and opiate addiction and its treatment,” said Ventricelli.
Some who are critical of making naloxone freely available believe that the medication could serve as a kind of insurance policy for drug users seeking more potent and deadly highs.
The pharmacy school students are going out into the neighborhoods where the lifesaving medication is scarce to educate pharmacies about the standing order and address any stigmas they encounter. More than 50 of them have signed up, along with faculty members and volunteers from Prevention Point Philadelphia.
“We’re really going to let the pharmacy students do most of the talking, because I really believe that pharmacists will listen to future pharmacists,” said Prevention Point’s Silvana Mazzella, who is helping organize the effort.
At Cambria Pharmacy, pharmacist David Ostrow told the students he wasn’t clear on the new rules for dispensing naloxone.
“Who do you put in as a physician on a standing order?” Ostrow said.
Third-year student Whitney Ly, 21, supplied the answer: Dr. Rachel Levine, the physician general of Pennsylvania.
The students also answered Ostrow’s questions on how to bill insurance for the drug, and which formulations are best. Ostrow said he had been holding back on ordering the medication because he hadn’t received that kind of education on naloxone–which also goes by the brand name “narcan.”
At the end of the conversation, Ostrow said he would be adding narcan to the next day’s order. It was exactly what the students were hoping to hear.