Overdose Antidote Is Supposed to Be Easy to Get. It’s Not.


“Can you spell that?” said a pharmacy worker at a Rite Aid on Featherbed Lane in Mount Eden, in one of the areas with the highest opioid-related overdose rates in the city.

“We don’t carry it,” said a pharmacy worker at a Rite Aid on Westchester Avenue in Mott Haven, another such neighborhood.

Some pharmacy workers inaccurately said that only the person in need of the drug could buy it, and then only with a prescription. “Are you having an overdose? You can’t buy it for someone else,” a pharmacy worker said at a Walgreens in Bronx Park, another area with a high overdose death rate. “If it’s for someone else, they would need to get a prescription.”

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The Pharmacy in Harlem is one of the participating stores and keeps a sign in the window saying the drug is available.

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Ryan Christopher Jones for The New York Times

Activists on the front lines of the crisis were alarmed by the findings. “It’s shocking and upsetting,” said Van Asher, who runs daily operations and the syringe exchange at St. Ann’s Corner of Harm Reduction in the Bronx. “That’s akin to if I were a diabetic and I went to pick up my insulin and they didn’t have it,” he said. “It’s a lifesaving drug.”

The importance of having naloxone available was made clear just last week, when the United States surgeon general, Dr. Jerome M. Adams, issued a national advisory recommending that more Americans carry it and learn to use it — the first advisory from the surgeon general in more than a decade.

Naloxone comes in either an injection or a nasal spray commonly known by the brand name Narcan. New York City officials are engaged in what the city’s health commissioner calls a “full-court press” to get the drug to the public, and since last July, more than 70,000 naloxone kits have been distributed to the police, health care providers, homeless shelters and community-based organizations. When the mayor recently announced the city would spend an additional $22 million a year on anti-opioid initiatives, bringing annual funding for its HealingNYC program to $60 million, he said some of the extra funds would go toward increased training and distribution of naloxone.

But that did not mean pharmacies should be neglected, Mr. Asher said. “People might go to pharmacies who would never go into a needle exchange,” he said. If they were told they needed a prescription or had to wait for the drug, they could grow discouraged and might not have it when they needed it. The consequence?

“It’s the loss of a loved one,” he said. “Plain and simple.”

Olivia Lapeyrolerie, a spokeswoman for Mr. de Blasio, called the situation “unacceptable” and said that City Hall had instructed the health department to immediately contact all the participating pharmacies.

The drug was hardest to find outside Manhattan, The Times found. This winter, a woman in her 40s named Rebecca tried to buy naloxone in Brooklyn after learning that a friend was bingeing on prescription painkillers. (Rebecca asked to be identified only by her first name to protect her friend’s privacy.) “I’ll just throw it in my work bag and I’ll have it wherever I go,” she recalled thinking.

She pulled up the city’s map on her phone, and a number of pharmacies in Downtown Brooklyn came up. At the first Duane Reade she visited, when she asked for naloxone, “I had to repeat it a couple of times,” she said. “They were nice enough but they said they didn’t have any in stock.”

At the next store on the list, another Duane Reade, she had no better luck. “He just said, ‘Nope. We don’t carry that.’ I went around the corner to a CVS and got the same story from them. The pharmacist said I was one of three people who had ever come to ask for it. The lead pharmacist popped her head up and said, ‘Is everything O.K.? Is this an emergency?’ ”

“They have these giant billboards in the subway,” she added, referring to the city’s public awareness campaign featuring posters of people who saved someone’s life using naloxone. “You’d think there would be some follow-through.”

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The city has been advertising on the subways about the importance of having naloxone to combat overdoses, but actually getting the drug can be difficult.

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Ryan Christopher Jones for The New York Times

The program was created with the idea that anyone, including minors, could walk into a participating pharmacy and leave with the drug, under what is known as a standing order: Pharmacists were to use the city health commissioner’s name, Mary T. Bassett, in place of a prescribing physician’s. They were to show the customer how to administer naloxone and bill their insurance. (Initially, Rite Aid and some independent pharmacies enrolled; the chains CVS and Walgreens, which owns Duane Reade, later announced their own standing orders, increasing the number of pharmacies on the list.)

In response to queries about the availability of the drug, Dr. Bassett said of the pharmacies, “They are learning, as we are.” She added: “We want everyone to be able to walk into a pharmacy and get naloxone.”

According to the health department, if a pharmacy on the list did not have naloxone in stock, but offered to order it, they were considered to be meeting the program’s guidelines. If a pharmacy enrolled in the program required a prescription, however, that was a mistake.

Dr. Bassett said that in addition to contacting stores on the list, the department would send workers to as many as 800 independent pharmacies in neighborhoods with high rates of overdose deaths.

To determine how readily available the drug is, The Times placed calls to all 720 pharmacies that the city said were taking part in the program over a one-week period in March. At about 270, naloxone was in stock and no prescription was required; roughly 90 more had it in stock but required a prescription.

At the other 360 or so pharmacies, naloxone was not available. Most pharmacists said it was out of stock, citing low demand, but could be ordered. But dozens said their store did not carry the drug. Several locations on the list, which was last updated in January, had nonworking numbers.

There was also widespread confusion among pharmacy workers about dispensing protocol, including whose insurance should cover the drug. Visits to pharmacies around the city revealed that signs and pamphlets about the drug were rare.

In at least one case, confusion over prescription requirements has had serious consequences.

This winter, a man overdosed outside a Rite Aid on Richmond Avenue on Staten Island. “A man ran in. He started screaming, ‘Someone give me Narcan!’ ” said a customer named Lisa, who asked to be identified only by her first name. “They said, ‘We can’t give it to you without a prescription.’ He said, ‘There’s a guy dying in the parking lot!’ They said they were not allowed.”

Lisa went outside and waited for an ambulance with other bystanders. “The guy was totally lifeless. He was just lying there,” she said. Workers at Rite Aid confirmed the episode.

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