Plan to Make Overdose Drug Accessible Falters

NEW YORK — In 2015, when they unveiled the city’s plan to battle opioid-related deaths, Mayor Bill de Blasio and his wife, Chirlane McCray, said that from that day on New Yorkers would be able to get the overdose-reversing drug naloxone at participating pharmacies without a prescription.

“Anyone who fears they will one day find their child, spouse or sibling collapsed on the floor and not breathing now has the power to walk into a neighborhood pharmacy and purchase the medication that can reverse that nightmare,” McCray said, with the mayor by her side.

But three years later, an examination by The New York Times has found that of the 720 pharmacies on the city’s list of locations that provide the drug, only about a third actually had it and would dispense it without a prescription. The list is used on the city’s website, the NYC Health Map, the Stop OD NYC app and when someone calls 311.

Phone calls placed to every pharmacy on the list in March found compliance with the program to be spotty, at best.

In the Bronx, which is battling a surge in heroin use and where more people died of opioid-related overdoses than in any other borough in 2016, only about a quarter of the more than 100 pharmacies on the list had the drug and followed the protocol. Requests for it were often met with bewilderment.

“Can you spell that?” said a pharmacy worker at a Rite Aid in Mount Eden, in one of the areas with the highest opioid-related overdose rates in the city.

“We don’t carry it,” said a pharmacy worker at a Rite Aid in Mott Haven.

Some pharmacy workers inaccurately said that only the person in need of the drug could buy it, and then only with a prescription. “Are you having an overdose? You can’t buy it for someone else,” a pharmacy worker said at a Walgreens in Bronx Park, another area with a high overdose death rate. “If it’s for someone else, they would need to get a prescription.”

Activists were alarmed by the findings. “It’s shocking and upsetting,” said Van Asher, who runs daily operations and the syringe exchange at St. Ann’s Corner of Harm Reduction in the Bronx. “That’s akin to if I were a diabetic and I went to pick up my insulin and they didn’t have it,” he said. “It’s a lifesaving drug.”

The importance of having naloxone available was made clear just last week, when the U.S. surgeon general, Dr. Jerome M. Adams, issued a national advisory recommending that more Americans carry it and learn to use it — the first advisory from the surgeon general in more than a decade.

But that did not mean pharmacies should be neglected, Asher said. “People might go to pharmacies who would never go into a needle exchange,” he said. If they were told they needed a prescription or had to wait for the drug, they could grow discouraged and might not have it when they needed it. The consequence?

“It’s the loss of a loved one,” he said. “Plain and simple.” Olivia Lapeyrolerie, a spokeswoman for de Blasio, called the situation “unacceptable” and said that City Hall had instructed the health department to immediately contact all the participating pharmacies.

The drug was hardest to find outside Manhattan, The Times found. This winter, a woman in her 40s named Rebecca tried to buy naloxone in Brooklyn after learning that a friend was bingeing on prescription painkillers. (Rebecca asked to be identified only by her first name to protect her friend’s privacy.) “I’ll just throw it in my work bag and I’ll have it wherever I go,” she recalled thinking.

She pulled up the city’s map on her phone, and a number of pharmacies in downtown Brooklyn came up. At the first Duane Reade she visited, when she asked for naloxone, “I had to repeat it a couple of times,” she said. “They were nice enough but they said they didn’t have any in stock.”

At the next store, another Duane Reade, she had no better luck. “He just said, ‘Nope. We don’t carry that.’ I went around the corner to a CVS and got the same story from them. The pharmacist said I was one of three people who had ever come to ask for it. The lead pharmacist popped her head up and said, ‘Is everything OK? Is this an emergency?'”

“They have these giant billboards in the subway,” she added, referring to the city’s public awareness campaign featuring posters of people who saved someone’s life using naloxone. “You’d think there would be some follow-through.”

The program was created with the idea that anyone, including minors, could walk into a participating pharmacy and get the drug, under what is known as a standing order: Pharmacists were to use the city health commissioner’s name, Mary T. Bassett, in place of a prescribing physician’s. They were to show the customer how to administer naloxone and bill their insurance. (Initially, Rite Aid and some independent pharmacies enrolled; the chains CVS and Walgreens, which owns Duane Reade, later announced their own standing orders, increasing the number of pharmacies on the list.) In response to queries about the availability of the drug, Bassett said of the pharmacies, “They are learning, as we are.” She added: “We want everyone to be able to walk into a pharmacy and get naloxone.”

According to the health department, if a pharmacy did not have naloxone in stock, but offered to order it, it was considered to be meeting the program’s guidelines. If a pharmacy enrolled in the program required a prescription, however, that was a mistake.

Bassett said in addition to contacting stores on the list, the department would send workers to as many as 800 independent pharmacies in neighborhoods with high rates of overdose deaths.

To determine how readily available the drug was, The Times placed calls to all 720 pharmacies the city said were in the program over a one-week period in March. At about 270, naloxone was in stock and no prescription was required; roughly 90 more had it in stock but required a prescription.

At the other 360 or so pharmacies, naloxone was not available. Most pharmacists said it was out of stock, citing low demand, but could be ordered. But dozens said their store did not carry the drug. Several locations on the list, which was last updated in January, had nonworking numbers.

There was also widespread confusion among pharmacy workers about dispensing protocol, including whose insurance should cover the drug. Visits to pharmacies around the city revealed that signs and pamphlets about the drug were rare. In at least one case, confusion over prescription requirements had serious consequences.

This winter, a man overdosed outside a Rite Aid on Richmond Avenue on Staten Island. “A man ran in. He started screaming, ‘Someone give me Narcan!'” said a customer named Lisa, who asked to be identified only by her first name. “They said, ‘We can’t give it to you without a prescription.’ He said, ‘There’s a guy dying in the parking lot!’ They said they were not allowed.”

Lisa went outside and waited for an ambulance with other bystanders. “The guy was totally lifeless. He was just lying there,” she said. Workers at Rite Aid confirmed the episode.

The Rite Aid was on the city’s list of locations that provide the drug. A spokeswoman for the chain, Ashley Flower, said, “Naloxone can be dispensed without a prescription at all New York Rite Aid pharmacies. As it relates to this incident, we are looking into the matter.”

It was not clear what happened to the man who overdosed.

After queries from The New York Times, the chains Rite Aid, CVS and Walgreens confirmed that naloxone was available without a prescription at all locations in New York and said they were reviewing procedures with personnel at all New York City locations.

The city’s initiatives around naloxone have been credited with helping to curb the number of overdose deaths, which appear to have leveled off in the past year after sharply rising in previous years. But those working close to the crisis say there’s still much work to be done.

They included Beth Kennedy, who started keeping naloxone on hand when one of her twin daughters was addicted to painkillers and heroin. When Kennedy recently visited her neighborhood pharmacy — a Rite Aid in Rockaway Park, Queens, on the city’s list — a pharmacist told her that her insurance would not cover naloxone and that it would cost $150. Pharmacy workers later said it was “probably better” to have a prescription in the patient’s name if they were going to order it.

Joseph Rushford, from Brooklyn, said he had stashed a kit in a bureau at home and had to use it one day last winter when his 23-year-old son overdosed. “He was in the front room, dying on me,” he said. When Rushford tried to replenish his supply at a pharmacy, he was discouraged by the high cost and muddled information and left empty-handed.

Many parents who have the drug keep it a secret, said Cindy San Jose, from Queens, whose daughter went into treatment as a teenager. “Shh,” said San Jose, raising a finger to her lips. “We hide it because we don’t want to encourage them.”

“We hide it at home,” she said. “Because we don’t want them to know. We don’t want them to overdose.”