ORCID
https://orcid.org/0000-0002-7608-5827
Date of Award
Spring 2025
Language
English
Embargo Period
5-11-2025
Document Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
College/School/Department
Department of Public Administration and Policy
Program
Public Administration and Policy
First Advisor
Ashley Fox
Committee Members
Tomoko Udo, Patricia Strach
Keywords
public policy, substance use policy, naloxone, Naloxone Access Laws, naloxone standing order, opioids
Subject Categories
Health Policy
Abstract
The United States (US) has experienced a significant increase in the number of opioid overdose deaths since 1999. Drug overdoses are now the leading cause of accidental death in the US, surpassing other injury causes such as motor vehicle accidents. Opioids are most commonly associated with drug overdose deaths. The opioid overdose reversal medication naloxone, commonly known by the brand name Narcan®, has gained popularity in recent years as a critical tool for reducing the number of opioid overdose deaths. Naloxone Access Laws (NALs) and standing orders have been implemented by states nationwide in an effort to increase the availability and distribution of naloxone. In this three-paper dissertation, I examine the availability and affordability of naloxone in pharmacies since the New York State (NYS) NAL and standing order were signed into law. My research revolves around the central question: Is naloxone accessible in NYS pharmacies? In answering this question, I can determine whether the NYS NAL and standing order are being effectively implemented and whether they are meeting their intended goal to increase the availability of naloxone for consumers in the pharmacy setting.
In paper 1, I developed a probability sample of pharmacies across the state and leveraged a secret shopper study design to collect data on whether naloxone was in stock, available without a prescription, and the out-of-pocket cost. Findings from paper 1 show variation in naloxone access across the state and high out-of-pocket costs for consumers. In paper 2, I expand on the knowledge developed in paper 1 by determining the influencing factors of naloxone availability and cost variation across the state. Findings from paper 2 suggest that pharmacy type is the greatest predictor of availability, and that demographic characteristics and rurality do not influence naloxone availability and cost. In paper 3, I aim to provide the necessary contextual information around naloxone dispensing by conducting semi-structured interviews with currently licensed and practicing NYS pharmacists. Findings from paper 3 show there are several barriers and facilitators to naloxone dispensing from the perspective of pharmacists. In addition to the barriers and facilitators to dispensing, findings from paper 3 illuminated both the pervasiveness of stigma as well as the disconnect between perceived importance and practicality. Nearly all participants independently discussed the stigma related to naloxone. Additionally, participants reported that they believed pharmacies were a critical access point and important for increasing naloxone availability in the community, something commonly posited in the literature. Despite that, participants reported that customers infrequently asked about or purchased naloxone. The disconnect between the perceived importance of pharmacy availability and the practical frequency of consumer purchases forces us to re-examine the idea that pharmacies are an effective location for dispensing naloxone, due in part to customer awareness, comfort, and cost.
This three-paper dissertation contributes key findings to the existing literature. Findings from paper 1 suggest that while cost barriers remain, naloxone in the pharmacy is widely, yet unevenly, available across the state. Despite variation, rates of availability are high compared to findings from other states. Findings from paper 2 suggest that the variation in naloxone availability is not likely due to regional or demographic attributes such as rurality, race, ethnicity, and age, but instead due to the type of pharmacy, with chains being more likely to have naloxone available. Furthermore, naloxone cost is not influenced by pharmacy type, region, or other demographic or economic attributes. Findings from paper 3 suggest that the NYS NAL and standing order have been effective in increasing naloxone access in pharmacies and that pharmacists are accurately carrying out the policies as intended. This is supported by the findings in papers 1 and 2 as well. However, findings from paper 3 call into question whether the effort to increase naloxone in the pharmacy setting is resulting in the population at the highest risk of overdose having increased access to naloxone. Furthermore, findings from paper 3 suggest that we need greater exploration into understanding the impact of stigma on the design and implementation of NALs and standing orders.
License
This work is licensed under the University at Albany Standard Author Agreement.
Recommended Citation
Maloney, Dina R., "Naloxone Availability and Affordability: An Analysis of Pharmacies across New York State" (2025). Electronic Theses & Dissertations (2024 - present). 200.
https://scholarsarchive.library.albany.edu/etd/200
