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Background: In Georgia, recent measures have expanded public access to naloxone-containing products like Narcan® to combat opioid-related overdose deaths. Although laypersons may legally purchase naloxone products without a prescription for use during opioid-related overdose events, barriers may remain. Methods: We conducted an anonymous telephone survey to investigate three potential barriers to purchasing naloxone (Narcan®) in Georgia: availability, price, and working knowledge of legal requirements among pharmacy representatives. We surveyed pharmacy representatives in select Georgia counties with high volumes or high rates of poisoning deaths compared with other counties. We also compared responses among chain and non-chain representatives. Descriptive statistics are presented concerning the availability, price, and required documentation to purchase Narcan®. Results: Representatives from all 120 pharmacies contacted completed the survey, comprising 6.8% of eligible pharmacies. Availability of Narcan® varied among counties categorized by poisoning deaths: High Rate Counties (50%; n=40), High Volume Counties (66%; n=38), and Comparison Counties (64%, n=42). Narcan® was more available in chain pharmacies (76.7%; n=73) than in non-chain pharmacies (34.0%; n=47). Mean prices for Narcan® were similar among county type: High Volume ($131.46); High Rate ($134.19); and Comparison ($124.50). However, the mean price was much lower in chain versus non-chain pharmacies ($120.91 vs. $149.72). Representatives in chain pharmacies were more likely to state that a prescription was not required to purchase Narcan® (58.9 % vs. 30.0%). Conclusions: In Georgia, barriers related to availability, price, and dispensing requirements for Narcan® persist, decreasing the likelihood of purchase by those who may need a safe, easily administered form of naloxone. Narcan® was generally more available and cost less in chain pharmacies. Representatives in non-chain pharmacies were more likely to require a non-legally necessary prescription to sell Narcan®. Training/intervention opportunities targeting pharmacy staff may help increase layperson access to naloxone products and could ultimately prevent opioid-related overdose deaths.

Introduction Opioid overdose rescue situations are time-critical, high-stress scenarios that frequently require nonmedical first responders or bystanders to intervene and administer naloxone to avoid opioid-induced fatalities. Training nonmedical personnel to respond during such mentally constraining situations presents the human factors challenge of how best to design a safe and effective lay delivery system. This paper comparatively evaluates the ease of use of two nasal naloxone administration products: NARCAN® Nasal Spray and a naloxone prefilled syringe with nasal atomizer (PFS-NA). Methods We evaluated the use requirements and usability of NARCAN® Nasal Spray versus a naloxone PFS-NA using a systems-oriented method. First, we determined the use requirements of different user groups. Next, we focused on constructing a human factors task analysis of both products. Finally, we conducted a comparative risk assessment of the tasks that were different between the two products. Results Inexperienced users, such as nonmedical first responders and bystanders, are at the highest risk of incorrectly administering naloxone, particularly in high-stress emergency opioid overdose situations. The device Preparation and Medication Delivery tasks most differentiate the use of NARCAN® Nasal Spray and a PFS-NA. The level of task complexity and number of steps within those tasks is substantially greater for a PFS-NA than for the NARCAN® Nasal Spray. Conclusions NARCAN® Nasal Spray requires fewer steps and is easier to administer than a naloxone PFS-NA. Thus, using NARCAN® Nasal Spray should increase the likelihood that nonmedical personnel correctly deliver naloxone in time-critical, high-stress opioid overdose rescue situations. Funding ADAPT Pharma, Inc.