Mississippi pharmacies can dispense naloxone without a prescription. Less than half actually do

In 2017, Mississippi's Department of Health issued a standing order to all pharmacies in the state permitting pharmacists to dispense naloxone, an opioid overdose-reversing medication commonly sold under the brand Narcan, to patients with or without a prescription. 

Six years later, only 37% of Mississippi pharmacies had the overdose-reversing medication available and were willing to dispense under the order. Roughly 40% had the drug on hand but were unwilling to dispense it, according to the findings of a study released by researchers at the University of Mississippi. 

“Around 2020 there were some papers coming out about naloxone availability, and I was interested in these papers and looked at them. The more I looked into it, I noticed there wasn't a lot of literature around naloxone availability in the southeastern United States, my home, where I live,” said Emily Gravlee, a PhD candidate in the University of Mississippi’s Department of Pharmacy Administration. 

“And I thought it would be a really interesting question. We in Mississippi have implemented policies to improve access to naloxone — but what does that look like in practice?” 

Gravlee and several volunteers conducted the study by utilizing a survey method known as 'secret shopper', calling all of Mississippi's 591 pharmacies and requesting naloxone without a prescription, as the standing order permits. When the survey was completed, certain regions of the state stood apart from others in a lack of availability.

“You can see that there seems to be this general lack of naloxone availability in the Delta, a region of Mississippi that has a high proportion of African-American constituents. It's known for longstanding income disparities and health disparities,” said Gravlee. “And so there didn't seem to be a lot of naloxone available under state standing order in that region in general. And that's a little bit concerning because we know that opioid overdoses have been increasing in frequency among African-American individuals – we've seen this trend since about 2011.” 

Deaths from opioid overdoses nationally increased by more than 120% between January 2020 and January 2022, according to the Center for Disease Control and Prevention. 

Both the Delta and southwest Mississippi have faced sharp spikes in overdoses in recent months: More than 60 overdose-related health emergencies were reported in June alone between Adams, Amite, Franklin, Jefferson, Lawrence, Lincoln, Pike, Walthall and Wilkinson counties.

But amid that rise, the state’s 2017 standing order is not the only method for Mississippians to access naloxone without a prescription. In the instance someone visits one of the 242 pharmacies who either refused to dispense the medication or said they were unaware of the order, the Mississippi Department of Health will mail a naloxone kit at no cost. 

“I think that what our work did is bring awareness to an issue and this idea that there's low availability under state standing order across the state. But really we don't have good insight into why that is,” said Gravlee. “So I think the next step, if we're going to move forward in any direction, is really digging down with more research and understanding that ‘why.’ And I think once we do understand that, we will be really well equipped to address this problem and take action against it, because it is a solvable problem.”