155 - Availability and Knowledge of Naloxone Distribution in an Urban Area

Publication Number: 1145.155

Riya S. Mehta, Sidwell Friends School, washington, DC, United States; Gia M. Badolato, Children's National Health System, Washington, DC, United States; Alix P. Mahon, Children's National Health System, Washington, DC, United States; Daniel X.. Zhang, The Warren Alpert Medical School of Brown University, Providence, RI, United States; Meleah Boyle, Children's National Health System, Washington, DC, United States; Alicia Rolin, Children's National Health System, WASHINGTON, DC, United States

Background: Adolescent opioid use is an escalating public health concern. Between 2019-2021, median monthly overdose deaths among individuals aged 10-19 years increased by 109%, with opioids implicated in nearly 90% of cases. In Washington, DC (DC), opioid-related pediatric emergency department visits doubled from 2022 to 2023. Naloxone, a safe and effective opioid antagonist, can reverse opioid overdose when administered promptly. Despite its efficacy and over-the-counter availability without age restriction, naloxone utilization among adolescents remains limited. Alarmingly, Centers for Disease Control and Prevention data indicate that naloxone was not administered in 70% of fatal overdoses among 10-19 years, even though a bystander was present in more than two-thirds of these cases. Concerns persist that adolescents face unique barriers to access, including uncertainty about pharmacy policies, fear of stigma, and misconceptions about age-related purchasing restrictions.

Objective: To describe the availability and knowledge of naloxone distribution in DC pharmacies

Design/Methods: This cross-sectional study included all outpatient DC pharmacies identified through the DC Department of Health. Trained staff conducted standardized phone calls to assess naloxone availability. For pharmacies selling naloxone, additional questions addressed purchasing requirements including the need for a prescription, name or identification, and whether sale to adolescents was permitted. Staff also asked whether naloxone was available over or behind the counter. Pharmacy locations were geocoded and linked to the Child Opportunity Index (COI), a neighborhood-level measure of childhood opportunity. Descriptive statistics summarized availability and knowledge by pharmacy type and COI.

Results: Of the 149 DC pharmacies, 155 (79.9%) met inclusion criteria. Pharmacy types included chain (41.7%), independent (37.4%), supermarket (17.4%), and hospital-affiliated (3.5%) which were distributed across all COI levels (Table 1). Most pharmacies (88.7%) reported selling naloxone, though only 69.6% had it in stock with the majority (76.1%) keeping it behind the counter. Knowledge of naloxone policies was low: only 24.5% answered all three purchasing questions correctly. Availability, knowledge, and access did not significantly differ by pharmacy type or COI.

Conclusion(s): Although naloxone was widely available in DC pharmacies, misinformation about purchasing requirements was common. Targeted pharmacy education is needed to improve access to naloxone and ensure adolescents can obtain this lifesaving medication without unnecessary barriers.

Table 1: Pharmacy Characteristics


Table 2
Results by pharmacy type, listing status as a free naloxone distribution site, and Child Opportunity Index (COI) level.