Finding Narcan is supposed to be easy. In Worcester, that's not always the case

WORCESTER – Garry Levitsky is a familiar sight behind the counter at Beacon Pharmacy on Main Street.

He's worked there as a pharmacist for over 50 years, and it's a labor of love for Levitsky, because his family has owned the pharmacy for over 80 years. That stretch represents a long investment in the Main South neighborhood.

But when the topic of naloxone came up, Levitsky became animated when he talked about the nasal spray, known by its brand name Narcan, that reverses the potential life-and-death effects of an opioid overdose.

Levistsky said the opioid crisis has gripped the area around his store, and he’s never once denied Narcan to anyone who rushed into his store to say they needed it for an emergency. Nor has he asked anyone in that predicament to pay for it. “I’ve given out many, many, many doses of Narcan. I’ve never refused anyone in an emergency,” he said.

Narcan is kept behind the counter at Beacon Pharmacy. Each box contains two doses of the spray, at a cost of roughly $60 per box. Levitsky mentioned his business has a standing order with the state to sell the medicine.

The standing order went into effect statewide in 2018 to combat the opioid crisis. It meant all pharmacies could sell naloxone without a prescription to any person at risk of experiencing an overdose. Anyone wishing to carry the medicine in order to administer it in a crisis could also buy it.

However, it appears the standing order may have limited sales to those most at risk of suffering a drug overdose, because the medicine was kept behind the counter. A customer had to ask for it and give their personal information at the time of sale. That could dissuade sales because of the stigma tied to drug use.

Naloxone gets over-the-counter approval

That's where the U.S. Food and Drug Administration stepped in. It approved the over-the-counter sale of a four-milligram dose of naloxone in March. Much like cold and flu medicine, the FDA's decision meant naloxone is to be sold out in the open, on the sales floor. The thinking is more people facing the risk of an overdose will buy the medicine if they can do it anonymously, without having to go to the counter and ask for it.

The FDA's goal was to increase access to the medicine and save lives throughout the U.S. But are Massachusetts and Worcester meeting that goal?

Not all pharmacies have naloxone on sales floor

A random sample of independent and chain pharmacies in Worcester conducted by the Telegram and Gazette showed a wide disparity in how naloxone is sold. Only one of the seven pharmacies visited by the T & G sold Narcan out on the sales floor, and that was the Walmart Supercenter.

Meanwhile, the state Department of Public Health sent a memo last month to all Massachusetts retailers encouraging them to make Narcan more visible in their stores. Health officials would like to see the medicine displayed toward the front of the store and in front of cash registers, not behind counters or locked in cabinets that requires a customer to ask for the medicine. The goal is anonymous purchases so the stigma of drug use won’t inhibit access to Narcan.

Making Narcan conspicuously present in pharmacies is supported by Paul Hattis, a senior fellow at the Lown Institute, a nonpartisan health care think tank. "I support the sentiment to make Narcan more available to people that might be able to administer it and save a life," he said.

The Massachusetts Pharmacists Association did not return a request for comment, and the Health Foundation of Central Massachusetts said it was not available to weigh in on the topic. UMass Memorial Health declined a request to speak with Dr. Kavita Babu, the health system's chief opioid officer.

Pharmacists explain sales methods

Besides the independent Beacon Pharmacy and the Walmart Supercenter, other pharmacies visited by the T&G included two independent stores: Worcester Pharmacy on Southbridge Street and Boulevard Pharmaceutical Compounding Center on Shrewsbury Street. Other commercial pharmacies visited included Walgreens at Park Avenue and Chandler Street and two CVS pharmacies at 500 Grafton St. and 44 West Boylston St.

Some pharmacists at these locations explained how naloxone is sold in their stores. At Worcester Pharmacy, pharmacist Ahmad Eljarouch said the business has a standing order with the state and keeps Narcan behind the counter. Customers must ask for it, and their personal information is needed only when buying the medicine through their insurance.

Worcester Pharmacy stores Narcan behind the counter, said Eljarouch, so staff can make sure a customer knows how to use the medicine. Like Levitsky at Beacon Pharmacy, Eljarouch said any customer that needs the medicine in an emergency will get it right away, for free.

The pharmacy sells the two-dose box of Narcan for $75, and sales are not brisk, averaging four sales monthly, according to Eljarouch.

At the Walgreens, Narcan priced at $49.99 was behind the counters at the pharmacy and at the front of the store. Walgreens did not respond to a request for comment.

Narcan was in a locked cabinet at the CVS at 500 Grafton St., with each box selling for $44.99. A store pharmacist said potential theft is a concern and mentioned that she hasn’t seen the state guidelines that encouraged retailers to place Narcan out in the open.

An employee at the CVS at 44 West Boylston St. didn’t know where the Narcan was located and needed the store manager to find it. What the manager showed was not a supply on the shelves but a stack of cards that instructed the customer to go to the front checkout to buy the medicine.

"We have ample supply of over-the-counter Narcan at CVS Pharmacy stores, including those in Massachusetts," said a CVS email. The company said the medicine is stocked at the front store registers and easily accessible on store shelves near the pharmacy.

At the Boulevard Pharmaceutical Compounding Center, where custom medicines are made, pharmacist and owner Kal Boukhatem said his business doesn’t sell over-the-counter medicines because there is no walk-in business.

However, Boukhatem went behind the counter and returned with a box of the two-dose Narcan nasal spray. Inspectors from the Massachusetts Board of Registration in Pharmacy require that pharmacies carry Narcan, Boukhatem said.

What concerns Boukhatem is Worcester's sizable low-income community that might not be able to afford Narcan. "We need to investigate the cost...It would be nice to make it affordable for the public," he said.

If someone entered his store in a state of panic asking for Narcan, Boukhatem said, “I would just give it to them. No questions asked."

Free Narcan widely available

Meanwhile, more than 86,000 free naloxone kits were distributed last year in Massachusetts through the state's Community Naloxone Program, according to the state Department of Public Health. The free kits resulted in at least 2,600 overdose reversals, according to the department.

In Worcester, free Narcan is available via boxes, called NaloBox, located throughout the city in municipal buildings and social service agencies. There are a total of 20 boxes, including one on the first floor of City Hall. Each NaloBox contains two boxes of Narcan, with each of the two boxes containing 12 doses of medicine.

Eleven more NaloBoxes are expected to be placed at city buildings and local agencies, according to a city spokesman.

Contact Henry Schwan at henry.schwan@telegram.com. Follow him on X: @henrytelegram.

This article originally appeared on Telegram & Gazette: Narcan naloxone access varies across Worcester pharmacies