Will Stone/KJZZ

Naloxone is an opioid overdose reversal drug.

As the opioid epidemic continues to spread across the country, the Centers for Disease Control and Prevention said the biggest issue is not access to the drugs themselves but the antidote.

According to a recent CDC report, the overall number of opioid prescriptions nationally has decreased significantly, and prescriptions of the overdose reversal drug naloxone doubled from 2017 to 2018. But the exception is in rural counties, many of which are struggling to provide the naloxone to those prescribed opioids.

During a teleconference Tuesday, Dr. Anne Schuchat, CDC principal deputy director, said despite going from about 270,000 naloxone prescriptions in 2017 to 556,000 in 2018, the number of naloxone prescriptions dispensed for each high-dose opioid prescription remains low.

“Overdose reversal through naloxone provides an opportunity to save lives, improve the safety and effectiveness of pain management, offer treatment for addiction, prevent future overdose, and improve productivity and quality of life,” Schuchat said.

On average, 130 Americans die every day from an opioid overdose, Schuchat said. And only one naloxone prescription is dispensed for every 70 high-dose opioid prescriptions nationwide.

That means that if each person with a high-dose opioid prescription were offered naloxone, nearly 9 million prescriptions for naloxone could have been dispensed in 2018, according to the CDC.

Many states have laws or “standing orders” that allow pharmacists to dispense naloxone without a prescription, contributing to fewer deaths. Arizona is one of them. And that is why Arizona Department of Health Services Director Dr. Cara Christ said that the state is not seeing a problem in rural counties.

“The department issued a standing order so that anybody can walk into a pharmacy and ask for naloxone and get it without having to get a doctor's prescription,” Christ said. “So we've really tried to get rid of every barrier so that people who need or want access to naloxone have it.”

Christ said in addition to its over-the-counter availability in Arizona, naloxone is co-prescribed with any opioid prescription that is at least 90 morphine milligram equivalents — though the CDC recommends co-prescribing naloxone with any opioid prescription over 50 MME.

But Christ said 12 of Arizona’s 15 counties are in the top quartile of counties across the nation in naloxone distribution.

“It's the combination between a lot of the education that we've done, in addition to removing that barrier by having the standing order, and there is a law that allows pharmacists to dispense it without a prescription, and then having the law for requiring co-prescription at a specific dose,” Christ said. “I think those have been identified as some of the best practices, and those are some of the reasons that Arizona is doing so well.”

With more opioids containing fentanyl, Christ said it is not good enough to just co-prescribe naloxone: doctors need to prescribe the right amount.

“Opioid products that are laced with fentanyl require more doses of naloxone in order to overcome and to pull people out of that overdose state,” Christ said. “So that's one of the challenges — sometimes it can take two to three doses to revive somebody when fentanyl is on board.”

Despite the progress in Arizona, Christ said that the state still has a long way to go, much like the rest of the country.

“With the opioid crisis, we know that our fight is far from over. We know that we are still seeing deaths due to opioids,” Christ said.