Naloxone Accessibility Across Mississippi

Background/Objectives Despite widespread standing orders allowing pharmacies to dispense naloxone under protocol or without a prescription, there is substantial variation in naloxone availability and cost geographically. This study geospatially assessed naloxone availability and cost across community pharmacies within Mississippi. Additionally, this study examined the association of county-level characteristics, including rurality, race, household income, overdose numbers, and percent uninsured, with naloxone availability. This study aims to inform health policymakers about effectiveness of current naloxone standing orders, and to guide potential interventions for improving naloxone accessibility at the community-level. Methods This study was a “mystery shopper” telephone census of naloxone availability and cost at all Mississippi pharmacies. Naloxone availability and cost were descriptively analyzed. T-tests were used to detect differences in naloxone availability based on county racial makeup, income, overdose deaths, and percentage uninsured. Chi-square tests were used to detect differences in naloxone availability based on pharmacy type and county rurality. Results Overall, there were 591 publicly-available community pharmacies surveyed in Mississippi. Overall, only 36.6% (n=216) of Mississippi pharmacies indicated that naloxone was available under state standing order. The mean cost for naloxone nasal spray was $105.58 (range $38.11 to $229.39). Differences existed in naloxone availability based on pharmacy type (X2 (2, 591) =41.09, p \u3c 0.001), but not pharmacy rurality (X2 (2, N = 591) = 3.06, p = 0.216). There was no difference in naloxone availability according to county-level measures. Mapping naloxone availability revealed that 16 (19.25%) of 82 Mississippi counties had no naloxone availability at community pharmacies. Almost half (n =30, 46.88%) of all counties where a pharmacy stocked naloxone nasal spray had naloxone nasal spray available for less than $100. Implications This study demonstrates that, despite lawful availability, naloxone is not widely available across the state of Mississippi. Lack of external drivers of naloxone availability suggest that naloxone availability may be driven by pharmacies. Further studies examining reasons for low naloxone availability, particularly among community pharmacies, should be conducted. Additionally, follow-up analyses of pharmacy pricing for naloxone are warranted