New Mexico has an opioid overdose rate higher than the national average, coming in 15th out of 50 states when last ranked in 2018, with overdose rates that vary across demographic variables.10 Consequently, New Mexico state law added language requiring clinicians prescribing opioids for 5 days or longer to co-prescribe naloxone along with written information on how to administer the opioid antagonist.11 New Mexico is also a geographically large state with a relatively low overall population characterized by striking health disparities, particularly as related to access to care.
The purpose of this study is to describe the same-day availability of naloxone throughout the state of New Mexico after a change in state law requiring co-prescription was enacted, to help identify challenges to patients receiving it. Comprehensive examination of barriers to patients accessing this life-saving medication can advise strategies to both improve patient-centered care and potentially reduce deaths.
Methods
To better understand barriers to patients obtaining naloxone, in July and August of 2019 we performed an audit (“secret shopper”) study of all pharmacies in the state, posing as patients wishing to obtain naloxone. A publicly available list of every pharmacy in New Mexico was used to identify 89 pharmacies in Albuquerque (the most populous city in New Mexico) and 106 pharmacies throughout the rest of the state.12
Every pharmacy was called via a publicly available phone number during business hours (confirmed via an internet search), at least 2 hours prior to closing. One of 3 researchers telephoned pharmacies posing as a patient and inquired whether naloxone would be available for pick up the same day. If the pharmacy confirmed it was available that day, the call concluded. If naloxone was unavailable for same day pick up, researchers asked when it would be next available. Each pharmacy was called once, and neither insurance information nor cost was offered or requested. All questions were asked in English by native English speakers.
All responses were recorded in a secure spreadsheet. Once all responses were received and reviewed, they were characterized in discrete response categories: same day, within 1 to 2 days, within 3 to 4 days, within a week, or unsure/unknown. Naloxone availability was also tracked by city/municipality, and this was compared to the state’s population distribution.