{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T21:14:32Z","timestamp":1791580472219,"version":"4.3.4"},"reference-count":48,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Despite the proliferation of pharmacy standing-order naloxone dispensing across many US states before the change to over-the-counter status, few policy analyses have evaluated the implementation of pharmacy naloxone standing orders in addressing opioid overdose fatality among communities.<\/jats:p><\/jats:sec>Objective<\/jats:title>To determine whether the implementation of pharmacy standing-order naloxone was associated with lower opioid fatality rates compared with communities without pharmacies with standing-order naloxone.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This retrospective multisite study was conducted with an interrupted time series analysis across 351 municipalities in Massachusetts over 24 quarters (from January 1, 2013, through December 31, 2018). Standing-order naloxone dispensing data were collected from 2 sources for all major chain pharmacies and many independent pharmacies, covering 70% of retail pharmacies in Massachusetts. Municipalities had various standing-order naloxone implementation inceptions during the study period. Data were analyzed from December 2021 to November 2023.<\/jats:p><\/jats:sec>Exposure<\/jats:title>The main exposure was measured by the first quarter with standing-order naloxone dispensation as the actual implementation inception.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary study outcome was municipal opioid fatality rate per 100\u202f000 population obtained from the Massachusetts Registry of Vital Records and Statistics.<\/jats:p><\/jats:sec>Results<\/jats:title>The median (IQR) population size across 351 municipalities was 10\u202f314 (3635 to 21\u202f781) people, with mean (SD) proportion of female individuals was 51.1% (2.8 percentage points). Pharmacies from 214 municipalities (60.9%) reported dispensing standing-order naloxone over the study period. At the baseline of the first quarter of 2013, municipalities that eventually had standing-order naloxone had greater quarterly opioid fatality rates compared with those that never implemented standing-order naloxone (3.51 vs 1.03 deaths per 100\u202f000 population; P<\/jats:italic>\u2009&amp;lt;\u2009.001). After adjusting for municipal-level sociodemographic and opioid prevention factors, there was significant slope decrease of opioid fatality rates (annualized rate ratio, 0.84; 95% CI, 0.78-0.91; P<\/jats:italic>\u2009&amp;lt;\u2009.001) following standing-order naloxone dispensing, compared with the municipalities that did not implement standing-order naloxone. There were no significant level changes of opioid fatality rates in the adjusted models. Sensitivity analyses yielded similar and significant findings.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>These findings suggest that community pharmacy dispensing of naloxone with standing orders was associated with a relative, gradual, and significant decrease in opioid fatality rates compared with communities that did not implement the standing-order naloxone program. These findings support the expansion of naloxone access, including over-the-counter naloxone as part of a multifaceted approach to address opioid overdose.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.27236","type":"journal-article","created":{"date-parts":[[2024,8,29]],"date-time":"2024-08-29T15:40:52Z","timestamp":1724946052000},"page":"e2427236","source":"Crossref","is-referenced-by-count":13,"title":["Pharmacy Naloxone Standing Order and Community Opioid Fatality Rates Over Time"],"prefix":"10.1001","volume":"7","author":[{"given":"Ziming","family":"Xuan","sequence":"first","affiliation":[{"name":"Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts"},{"name":"Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander Y.","family":"Walley","sequence":"additional","affiliation":[{"name":"Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shapei","family":"Yan","sequence":"additional","affiliation":[{"name":"Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avik","family":"Chatterjee","sequence":"additional","affiliation":[{"name":"Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Traci G.","family":"Green","sequence":"additional","affiliation":[{"name":"Institute for Behavioral Health, The Heller School for Social Policy and Management at Brandeis University, Waltham, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin A.","family":"Pollini","sequence":"additional","affiliation":[{"name":"Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown"},{"name":"Department of Epidemiology and Biostatistics, West Virginia University School of Public Health, Morgantown"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2024,8,29]]},"reference":[{"issue":"3","key":"zoi240841r4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.rr7103a1","article-title":"CDC clinical practice guideline for prescribing opioids for pain\u2014United States, 2022.","volume":"71","author":"Dowell","year":"2022","journal-title":"MMWR Recomm Rep"},{"issue":"3","key":"zoi240841r6","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1097\/ADM.0000000000000899","article-title":"Physician-approved protocols increase naloxone dispensing rates.","volume":"16","author":"Gangal","year":"2022","journal-title":"J Addict Med"},{"issue":"1","key":"zoi240841r7","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.20310","article-title":"Association between a state law allowing pharmacists to dispense naloxone without a prescription and naloxone dispensing rates.","volume":"3","author":"Gangal","year":"2020","journal-title":"JAMA Netw Open"},{"issue":"6","key":"zoi240841r8","doi-asserted-by":"publisher","first-page":"e289","DOI":"10.1016\/j.amepre.2021.05.042","article-title":"Trends in state-level pharmacy-based naloxone dispensing rates, 2012-2019.","volume":"61","author":"Guy","year":"2021","journal-title":"Am J Prev Med"},{"key":"zoi240841r10","doi-asserted-by":"publisher","first-page":"f174","DOI":"10.1136\/bmj.f174","article-title":"Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis.","volume":"346","author":"Walley","year":"2013","journal-title":"BMJ"},{"issue":"6","key":"zoi240841r11","doi-asserted-by":"publisher","first-page":"853","DOI":"10.1016\/j.japh.2020.05.016","article-title":"Assessing pharmacy-based naloxone access using an innovative purchase trial methodology.","volume":"60","author":"Pollini","year":"2020","journal-title":"J Am Pharm Assoc (2003)"},{"issue":"8","key":"zoi240841r12","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.2105\/AJPH.2021.306306","article-title":"The effect of overdose education and naloxone distribution: an umbrella review of systematic reviews.","volume":"111","author":"Razaghizad","year":"2021","journal-title":"Am J Public Health"},{"issue":"4","key":"zoi240841r13","doi-asserted-by":"publisher","first-page":"245","DOI":"10.7326\/M15-2771","article-title":"Nonrandomized intervention study of naloxone coprescription for primary care patients receiving long-term opioid therapy for pain.","volume":"165","author":"Coffin","year":"2016","journal-title":"Ann Intern Med"},{"key":"zoi240841r15","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1016\/j.addbeh.2018.03.014","article-title":"Opioid-overdose laws association with opioid use and overdose mortality.","volume":"86","author":"McClellan","year":"2018","journal-title":"Addict Behav"},{"issue":"6","key":"zoi240841r16","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1001\/jamainternmed.2019.0272","article-title":"Association between state laws facilitating pharmacy distribution of naloxone and risk of fatal overdose.","volume":"179","author":"Abouk","year":"2019","journal-title":"JAMA Intern Med"},{"key":"zoi240841r17","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2022.109473","article-title":"Impact of a publicly funded pharmacy-dispensed naloxone program on fatal opioid overdose rates: a population-based study.","volume":"236","author":"Antoniou","year":"2022","journal-title":"Drug Alcohol Depend"},{"issue":"7","key":"zoi240841r18","doi-asserted-by":"publisher","first-page":"314","DOI":"10.5694\/mja2.v212.7","article-title":"Community pharmacy naloxone supply, before and after rescheduling as an over-the-counter drug: sales and prescriptions data, 2014-2018.","volume":"212","author":"Tse","year":"2020","journal-title":"Med J Aust"},{"issue":"5","key":"zoi240841r20","doi-asserted-by":"publisher","first-page":"1546","DOI":"10.1016\/j.japh.2022.03.015","article-title":"Pharmacy naloxone codispensing: A mixed methods study of practices and perspectives under a statewide standing order program.","volume":"62","author":"Pollini","year":"2022","journal-title":"J Am Pharm Assoc (2003)"},{"key":"zoi240841r22","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2019.11.010","article-title":"Rurality and differences in pharmacy characteristics and community factors associated with provision of naloxone in the pharmacy.","volume":"85","author":"Green","year":"2020","journal-title":"Int J Drug Policy"},{"issue":"6","key":"zoi240841r23","doi-asserted-by":"publisher","first-page":"881","DOI":"10.2105\/AJPH.2020.305620","article-title":"Laws mandating coprescription of naloxone and their impact on naloxone prescription in five US states, 2014-2018.","volume":"110","author":"Green","year":"2020","journal-title":"Am J Public Health"},{"key":"zoi240841r24","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2021.109190","article-title":"Broadening access to naloxone: Community predictors of standing order naloxone distribution in Massachusetts.","volume":"230","author":"Chatterjee","year":"2022","journal-title":"Drug Alcohol Depend"},{"issue":"1","key":"zoi240841r26","doi-asserted-by":"publisher","first-page":"19579","DOI":"10.1038\/s41598-020-76685-z","article-title":"311 Service requests as indicators of neighborhood distress and opioid use disorder.","volume":"10","author":"Li","year":"2020","journal-title":"Sci Rep"},{"issue":"2","key":"zoi240841r27","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1056\/NEJMsa064115","article-title":"Release from prison\u2014a high risk of death for former inmates.","volume":"356","author":"Binswanger","year":"2007","journal-title":"N Engl J Med"},{"issue":"34","key":"zoi240841r28","doi-asserted-by":"publisher","first-page":"737","DOI":"10.15585\/mmwr.mm6834a2","article-title":"Changes in opioid-involved overdose deaths by opioid type and presence of benzodiazepines, cocaine, and methamphetamine\u201425 states, July-December 2017 to January-June 2018.","volume":"68","author":"Gladden","year":"2019","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"6","key":"zoi240841r29","doi-asserted-by":"publisher","first-page":"831","DOI":"10.1001\/jama.1990.03440060077036","article-title":"Withdrawing payment for nonscientific drug therapy. Intended and unexpected effects of a large-scale natural experiment.","volume":"263","author":"Soumerai","year":"1990","journal-title":"JAMA"},{"issue":"4","key":"zoi240841r30","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1046\/j.1365-2710.2002.00430.x","article-title":"Segmented regression analysis of interrupted time series studies in medication use research.","volume":"27","author":"Wagner","year":"2002","journal-title":"J Clin Pharm Ther"},{"issue":"10","key":"zoi240841r31","doi-asserted-by":"publisher","first-page":"943","DOI":"10.1093\/oxfordjournals.aje.a117183","article-title":"Use of Poisson regression and time series analysis for detecting changes over time in rates of child injury following a prevention program.","volume":"140","author":"Kuhn","year":"1994","journal-title":"Am J Epidemiol"},{"issue":"1","key":"zoi240841r32","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1111\/biom.2001.57.issue-1","article-title":"Akaike\u2019s information criterion in generalized estimating equations.","volume":"57","author":"Pan","year":"2001","journal-title":"Biometrics"},{"issue":"22","key":"zoi240841r33","doi-asserted-by":"publisher","first-page":"2401","DOI":"10.1001\/jama.2014.16153","article-title":"Methods for evaluating changes in health care policy: the difference-in-differences approach.","volume":"312","author":"Dimick","year":"2014","journal-title":"JAMA"},{"issue":"2","key":"zoi240841r34","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1080\/14494035.2019.1626595","article-title":"Are wicked problems really so wicked: perceptions of policy problems.","volume":"38","author":"Peters","year":"2019","journal-title":"Policy Soc"},{"issue":"2S","key":"zoi240841r35","doi-asserted-by":"publisher","first-page":"S19","DOI":"10.1016\/j.japh.2017.01.013","article-title":"Perpetuating stigma or reducing risk? Perspectives from naloxone consumers and pharmacists on pharmacy-based naloxone in 2 states.","volume":"57","author":"Green","year":"2017","journal-title":"J Am Pharm Assoc (2003)"},{"issue":"2","key":"zoi240841r36","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1016\/j.japh.2019.11.004","article-title":"Pharmacist attitudes toward pharmacy-based naloxone: a cross-sectional survey study.","volume":"60","author":"Burstein","year":"2020","journal-title":"J Am Pharm Assoc (2003)"},{"issue":"10","key":"zoi240841r37","doi-asserted-by":"publisher","first-page":"1493","DOI":"10.1016\/j.sapharm.2020.01.006","article-title":"Pharmacy leaders\u2019 beliefs about how pharmacies can support a sustainable approach to providing naloxone to the community.","volume":"16","author":"Donovan","year":"2020","journal-title":"Res Social Adm Pharm"},{"issue":"3","key":"zoi240841r38","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1007\/s11524-019-00349-1","article-title":"Beliefs associated with pharmacy-based naloxone: a qualitative study of pharmacy-based naloxone purchasers and people at risk for opioid overdose.","volume":"96","author":"Donovan","year":"2019","journal-title":"J Urban Health"},{"issue":"5","key":"zoi240841r39","doi-asserted-by":"publisher","first-page":"740","DOI":"10.1016\/j.japh.2020.03.005","article-title":"Revisiting pharmacy-based naloxone with pharmacists and naloxone consumers in 2 states: 2017 perspectives and evolving approaches.","volume":"60","author":"Green","year":"2020","journal-title":"J Am Pharm Assoc (2003)"},{"issue":"1","key":"zoi240841r40","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1080\/08897077.2020.1736236","article-title":"Pharmacy on-site overdose protocols and prevention of overdose.","volume":"43","author":"Green","year":"2022","journal-title":"Subst Abus"},{"issue":"1","key":"zoi240841r41","doi-asserted-by":"publisher","first-page":"901","DOI":"10.1080\/08897077.2021.2010162","article-title":"Study protocol for the Respond to Prevent Study: a multi-state randomized controlled trial to improve provision of naloxone, buprenorphine and nonprescription syringes in community pharmacies.","volume":"43","author":"Green","year":"2022","journal-title":"Subst Abus"},{"issue":"1","key":"zoi240841r42","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0227966","article-title":"Socioeconomic risk factors for fatal opioid overdoses in the United States: findings from the Mortality Disparities in American Communities Study (MDAC).","volume":"15","author":"Altekruse","year":"2020","journal-title":"PLoS One"},{"issue":"5","key":"zoi240841r43","doi-asserted-by":"publisher","first-page":"1141","DOI":"10.1111\/hesr.v58.5","article-title":"Comparison of a national commercial pharmacy naloxone data source to state and city pharmacy naloxone data sources\u2014Rhode Island, Massachusetts, and New York City, 2013-2019.","volume":"58","author":"Chatterjee","year":"2023","journal-title":"Health Serv Res"},{"issue":"6","key":"zoi240841r44","doi-asserted-by":"publisher","first-page":"1402","DOI":"10.1007\/s11606-022-07876-9","article-title":"Electronic Advisories Increase Naloxone Prescribing Across Health Care Settings.","volume":"38","author":"Heiman","year":"2023","journal-title":"J Gen Intern Med"},{"issue":"6","key":"zoi240841r45","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.6215","article-title":"Association of naloxone coprescription laws with naloxone prescription dispensing in the United States.","volume":"2","author":"Sohn","year":"2019","journal-title":"JAMA Netw Open"},{"key":"zoi240841r46","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1186\/1471-2458-14-297","article-title":"Overdose rescues by trained and untrained participants and change in opioid use among substance-using participants in overdose education and naloxone distribution programs: a retrospective cohort study.","volume":"14","author":"Doe-Simkins","year":"2014","journal-title":"BMC Public Health"},{"key":"zoi240841r47","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1016\/j.addbeh.2017.03.008","article-title":"No evidence of compensatory drug use risk behavior among heroin users after receiving take-home naloxone.","volume":"71","author":"Jones","year":"2017","journal-title":"Addict Behav"},{"key":"zoi240841r48","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2021.103513","article-title":"Does naloxone provision lead to increased substance use: a systematic review to assess if there is evidence of a \u2018moral hazard\u2019 associated with naloxone supply.","volume":"100","author":"Tse","year":"2022","journal-title":"Int J Drug Policy"},{"key":"zoi240841r14","doi-asserted-by":"crossref","DOI":"10.3386\/w23171","volume-title":"With a Little Help From My Friends: The Effects of naloxone Access and Good Samaritan Laws on Opioid-Related Deaths","author":"Rees","year":"2017"},{"key":"zoi240841r1","unstructured":"Ahmad? FB, Cisewski? JA, Rossen? LM, Sutton? P. Provisional drug overdose death counts. National Center for Health Statistics. 2023. Accessed September 17, 2023. https:\/\/www.cdc.gov\/nchs\/nvss\/vsrr\/drug-overdose-data.htm"},{"key":"zoi240841r2","unstructured":"US Department of Health & Human Services. Overdose prevention strategy. Accessed January 10, 2023. https:\/\/www.hhs.gov\/overdose-prevention\/"},{"key":"zoi240841r3","unstructured":"The White House. National drug control strategy. Accessed January 10, 2023. https:\/\/www.whitehouse.gov\/wp-content\/uploads\/2022\/04\/National-Drug-Control-2022Strategy.pdf"},{"key":"zoi240841r5","unstructured":"The Network for Public Health Law. Opioid misuse and overdose prevention: 50-state survey. Accessed April 9, 2021. https:\/\/www.networkforphl.org\/wp-content\/uploads\/2021\/02\/50-State-Survey-Legal-Interventions-to-Reduce-Overdose-Mortality-Naloxone-Access-Laws.pdf"},{"key":"zoi240841r9","unstructured":"US Food and Drug Administration. FDA approves first over-the-counter naloxone nasal spray: agency continues to take critical steps to reduce drug overdose deaths being driven primarily by illicit opioids. News release. March 29, 2023. Accessed April 9, 2023. https:\/\/www.fda.gov\/news-events\/press-announcements\/fda-approves-first-over-counter-naloxone-nasal-spray"},{"key":"zoi240841r19","unstructured":"Commonwealth of Massachusetts Executive Department Office of Governor Deval L. Patrick. Governor Patrick declares public health emergency, announces actions to address opioid addiction epidemic. News release. March 27, 2014. Accessed April 9, 2023. https:\/\/archives.lib.state.ma.us\/bitstream\/handle\/2452\/207588\/ocn795183245-2014-03-27b.pdf?sequence=1&isAllowed=y"},{"key":"zoi240841r21","unstructured":"The Commonwealth of Massachusetts Executive Office of Health and Human Services. Policy No. 2018-04: naloxone dispensing via standing order. Accessed December 10, 2022. https:\/\/www.mass.gov\/doc\/policy-2018-04-naloxone-dispensing-via-standing-order\/download"},{"key":"zoi240841r25","unstructured":"US Census Bureau. American Community Survey 5-year data (2009-2021). Accessed November 1, 2022. https:\/\/www.census.gov\/data\/developers\/data-sets\/acs-5year.html"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2822958\/xuan_2024_oi_240841_1724347648.23691.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,29]],"date-time":"2024-08-29T15:40:59Z","timestamp":1724946059000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2822958"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,29]]},"references-count":48,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2024,8,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2024.27236","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,29]]}}}