title: Pharmacy-based statewide naloxone distribution: A novel "top-down, bottom-up" approach.
abstract: OBJECTIVE
  To highlight New Mexico's multifaceted approach to widespread pharmacy naloxone distribution and to share the interventions as a tool for improving pharmacy-based naloxone practices in other states.
  
  
  METHODS
  New Mexico had the second highest drug overdose death rate in 2014 of which 53% were related to prescription opioids. Opioid overdose death is preventable through the use of naloxone, a safe and effective medication that reverses the effects of prescription opioids and heroin. Pharmacists can play an important role in providing naloxone to individuals who use prescription opioids.
  
  
  METHODS
  Not applicable.
  Not applicable.
  
  
  METHODS
  A multifaceted approach was utilized in New Mexico from the top down with legislative passage of provisions for a statewide standing order and New Mexico Department of Health support for pharmacy-based naloxone delivery. A bottom up approach was also initiated with the development and implementation of a training program for pharmacists and pharmacy technicians.
  
  
  RESULTS
  Naloxone Medicaid claims were used to illustrate statewide distribution and utilization of the pharmacist statewide standing order for naloxone. Percent of pharmacies dispensing naloxone in each county were calculated. Trained pharmacy staff completed a program evaluation form. Questions about quality of instruction and ability of trainer to meet stated objectives were rated on a Likert scale.
  
  
  RESULTS
  There were 808 naloxone Medicaid claims from 100 outpatient pharmacies during the first half of 2016, a 9-fold increase over 2014. The "A Dose of Rxeality" training program evaluation indicated that participants felt the training was free from bias and met all stated objectives (4 out of 4 on Likert scale).
  
  
  CONCLUSIONS
  A multi-pronged approach coupling state and community collaboration was successful in overcoming barriers and challenges associated with pharmacy naloxone distribution and ensured its success as an effective avenue for naloxone acquisition in urban and rural communities.
authors.forename: Kate J
authors.initials: KJ
authors.lastname: Morton
authors.forename: Brianna
authors.initials: B
authors.lastname: Harrand
authors.forename: Carly Cloud
authors.initials: CC
authors.lastname: Floyd
authors.forename: Craig
authors.initials: C
authors.lastname: Schaefer
authors.forename: Julie
authors.initials: J
authors.lastname: Acosta
authors.forename: Bridget Claire
authors.initials: BC
authors.lastname: Logan
authors.forename: Karen
authors.initials: K
authors.lastname: Clark
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D003299:Cooperative Behavior; D062787:Drug Overdose / Q000188:drug therapy* / Q000453:epidemiology; D004513:Education, Pharmacy, Continuing / Q000379:methods; D004521:Educational Measurement; D006801:Humans; D008484:Medicaid; D009270:Naloxone / Q000008:administration & dosage* / Q000600:supply & distribution; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000600:supply & distribution; D009516:New Mexico; D009293:Opioid-Related Disorders / Q000150:complications; D010593:Pharmaceutical Services / Q000458:organization & administration*; D010595:Pharmacists / Q000458:organization & administration; D010596:Pharmacy Technicians / Q000193:education / Q000458:organization & administration; D014481:United States
chemical_list: D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D009270:Naloxone