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Marley GT, Annis IE, Egan KL, Delamater P, Carpenter DM. Naloxone Availability and Cost After Transition to an Over-the-Counter Product. JAMA HEALTH FORUM 2024; 5:e241920. [PMID: 39058509 PMCID: PMC11282446 DOI: 10.1001/jamahealthforum.2024.1920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 05/17/2024] [Indexed: 07/28/2024] Open
Abstract
Importance The US Food and Drug Administration approved Narcan, a nasal spray formulation of naloxone, for sale as an over-the-counter (OTC) medication in March 2023. The purpose of OTC approval was to improve naloxone accessibility to reduce opioid overdoses; however, research has not yet evaluated whether naloxone's availability and cost changed since this policy was implemented. Objective To evaluate whether the accessibility and cost of naloxone at North Carolina community pharmacies changed after OTC naloxone became available and whether cost and availability varied by pharmacy type and urbanicity. Design, Setting, and Participants This longitudinal telephone-based secret shopper survey study included a stratified sample of 202 North Carolina community pharmacies, including health department, independent, and chain pharmacies. There were 2 separate data collection efforts from March to April 2023 (before OTC naloxone could be sold at pharmacies) and November 2023 to January 2024 (after OTC naloxone was sold at pharmacies). Exposure OTC naloxone first became available for sale at community pharmacies in September 2023. Main Outcomes and Measures The main outcomes were same-day availability of naloxone without a clinician-issued prescription and the quoted out-of-pocket cost for cash-paying patients. Results Data were collected from 192 pharmacies. Same-day naloxone availability increased from 42.2% (81 of 192) before OTC naloxone availability to 57.8% (111 of 192) after (P < .001). The mean (SD) quoted out-of-pocket cost decreased from $90.93 ($42.6) pre-OTC availability to $62.67 ($41.0) post-OTC availability (P < .001). Independent pharmacies had higher mean (SD) costs than chain pharmacies in both the pre-OTC phase ($109.47 [$37.90] vs $86.40 [$35.70]; P < .001) and post-OTC phase ($77.59 [$38.90] vs $57.74 [$35.90]; P = .004). Out-of-pocket costs did not differ by urbanicity in the pre-OTC phase; however, mean (SD) costs were higher at suburban ($88.67 [$66.80]) and rural ($65.43 [$35.00]) pharmacies compared with urban pharmacies ($53.58 [$29.00]) in the post-OTC phase (P = .003). Conclusions and Relevance The Food and Drug Administration's approval of OTC naloxone nasal spray contributed to an increase in pharmacy-based availability of naloxone and a reduction of its cost for cash-paying patients. Cost was higher at independent pharmacies compared with chain pharmacies and lower in urban pharmacies compared with suburban and rural pharmacies.
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Affiliation(s)
- Grace T. Marley
- UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
- South East Area Health Education Center, Wilmington, North Carolina
| | - Izabela E. Annis
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill
| | - Kathleen L. Egan
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Paul Delamater
- Department of Geography and Environment, University of North Carolina at Chapel Hill
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Branchflower A, Lundin RM, Harvey C, Hill H. Psychiatrists can save lives with naloxone. Australas Psychiatry 2024:10398562241249062. [PMID: 38657130 DOI: 10.1177/10398562241249062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
OBJECTIVES Naloxone is an effective medication used to reverse opioid overdoses. Distributing naloxone directly to those at risk, therefore, reduces the risk of opioid-related deaths. New legislation in Australia means a prescription is no longer required to access naloxone. Whilst acknowledging the benefits of increased access, we aim to evaluate the impact psychiatrists can have on naloxone provision due to their unique position as doctors often working with those who may be at risk. METHODS Data was recorded on those accessing naloxone from a co-located addiction and mental health service. Descriptive statistics were generated to establish the cohort characteristics, prior knowledge of naloxone and outcome of previously supplied naloxone. RESULTS Naloxone was dispensed 488 times from 2021 to 2023. 267 people had previously been prescribed naloxone from these sites where 137 (51.3%) were reportedly used in an opioid reversal. CONCLUSIONS Our findings highlight the importance of community access to naloxone in reducing opioid-related harm. Whilst removing the need for a prescription makes naloxone more accessible, it remains vital that doctors remain involved in this process to broaden the reach of supply to those at risk.
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Affiliation(s)
- Antigone Branchflower
- Change to Improve Mental Health (CHIME), Barwon Health MHDAS, University Hospital Geelong, Geelong, AU-VIC, Australia
| | - Robert M Lundin
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, AU-VIC, Australia
- Mental Health Services, Alcohol and Other Drugs Integrated Treatment Team, Mildura Base Public Hospital, Mildura, AU-VIC, Australia
| | - Craig Harvey
- Change to Improve Mental Health (CHIME), Barwon Health MHDAS, University Hospital Geelong, Geelong, AU-VIC, Australia
| | - Harry Hill
- Change to Improve Mental Health (CHIME), Barwon Health MHDAS, University Hospital Geelong, Geelong, AU-VIC, Australia
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, AU-VIC, Australia
- Albury Wodonga Health, Mental Health, Wangaratta, AU-VIC, Australia
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Nesoff ED, Meisel ZF, Saeed H, Martins SS. Neighborhood and Individual Disparities in Community-Based Naloxone Access for Opioid Overdose Prevention. J Urban Health 2024; 101:64-74. [PMID: 38196059 PMCID: PMC10897088 DOI: 10.1007/s11524-023-00821-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 01/11/2024]
Abstract
Improving access to naloxone for laypersons is a cornerstone of the US strategy to reduce opioid overdose deaths. This study evaluated change in distance to opioid overdose prevention programs (OOPPs) providing walk-in naloxone across two time points. We also explored individual and neighborhood disparities in distance to OOPPs, associations between 2020 OOPP locations and 2018 overdoses, and associations between OOPPs and neighborhood fatal overdose rates. Using fatal opioid overdose locations in 2018 (n = 1167) and 2020 (n = 2045) in New York City, we mapped OOPP locations and fatal overdose locations to visualize areas of unmet naloxone need. We used logistic regression to assess individual (age, sex, race/ethnicity) and neighborhood correlates of odds of an overdose occurring within walking distance (≤ 0.5 miles or 0.8 km) of an OOPP and negative binomial regression to assess the relationship between census tract-level OOPP counts and overdose rates. Distance to OOPPs significantly improved over time, with average distance decreasing by 1.7 miles (2.7 km) (p < 0.001). OOPPs were more likely to be located in neighborhoods with higher poverty in both years and in closer proximity to Latinos in 2020-suggesting improved access for Latinos and in higher poverty neighborhoods. OOPP locations in 2020 were significantly positively associated with overdose locations in 2018. OOPPs were not well-situated in neighborhoods with elevated overdose rates in 2018 but were better situated in 2020, controlling for other neighborhood variables. Community lay naloxone access through OOPPs improved over time and could have promising effects for improved overdose rates in the future.
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Affiliation(s)
- Elizabeth D Nesoff
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, 423 Guardian Dr, Philadelphia, PA, 19104, USA.
| | - Zachary F Meisel
- Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, 423 Guardian Dr, Philadelphia, PA, 19104, USA
| | - Huda Saeed
- Brown University, 75 Waterman Street, Providence, RI, 02912, USA
| | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W168th St, 5th Floor, New York, NY, 10032, USA
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Du AL, Rishel CA, Sun EC. Association Between Naloxone Coprescription Mandates and Postoperative Outcomes. Ann Surg 2023; 278:e995-e1002. [PMID: 36805578 PMCID: PMC10439975 DOI: 10.1097/sla.0000000000005821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
INTRODUCTION The opioid epidemic is a public health issue in the United States. The objective of this study was to evaluate the association between naloxone coprescription mandates and postoperative outcomes. BACKGROUND Data on naloxone coprescription mandates show mixed evidence for fatal overdoses in the broader population. How these mandates have impacted surgical patients has not been fully explored. METHODS Healthcare claims data were used to identify all patients undergoing 1 of 50 common procedures between January 1, 2004, and June 30, 2019, and categorized as high risk for opioid overdose. The primary outcomes were an emergency department visit or hospital admission within 30 postoperative days. To reduce confounding, the association between this outcome and the implementation of naloxone coprescription mandates was estimated using a difference-in-differences approach. RESULTS The study included 429,878 surgical patients with an average age of 54.8 years (SD=15.9 years) and with 257,728 females (60.0%). There was no significant association between naloxone prescribing mandates and the primary outcomes. After adjustment for potential confounders, the incidence of hospital admission was 3.26% after implementation of a naloxone coprescription mandate compared with 3.33% before (difference change: -0.08%, 95% CI: -0.44% to 0.29%, P =0.68). The incidence of an emergency department visit was 7.06% after implementation of a naloxone coprescription mandate compared with 7.73% before (difference: -0.67%, 95% CI: -1.39% to 0.05%, P =0.07). These results were robust to a variety of sensitivity and subgroup analyses. CONCLUSIONS Naloxone coprescription mandates were not associated with a statistically or clinically significant change in emergency department visits or hospital admissions within 30 postoperative days.
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Affiliation(s)
- Austin L Du
- School of Medicine, University of California, San Diego, La Jolla, CA
| | - Chris A Rishel
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Eric C Sun
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
- Department of Health Policy, Stanford University School of Medicine, Stanford, CA
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Sohn M, Delcher C, Talbert JC, Cheng Y, Xu Y, Jadhav ED, Freeman PR. The Impact of Naloxone Coprescribing Mandates on Opioid-Involved Overdose Deaths. Am J Prev Med 2023; 64:483-491. [PMID: 36496279 DOI: 10.1016/j.amepre.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/21/2022] [Accepted: 10/13/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Since 2017, a total of 10 states have mandated naloxone coprescribing intended to prevent fatal opioid overdoses. This study aims to assess the association between naloxone coprescribing/offering mandates and opioid-involved overdose deaths on the basis of the opioid type. METHODS Data on overdose deaths from 1999 to 2020 came from the National Center for Health Statistics CDC WONDER Online Database. This study examined deaths stratified by illicit/synthetic opioids and prescription/treatment opioids. Difference-in-difference negative binomial regression models estimated average marginal effects and 95% CIs. Covariates included opioid dispensing rate, Good Samaritan law, pharmacy-based naloxone access law, mandatory use of prescription drug monitoring program, and recreational cannabis dispensaries. Data collection and analysis were conducted in 2022. RESULTS Ten states implemented naloxone coprescribing/offering mandates during the period. Coprescribing/offering mandates significantly reduced the number of prescription/treatment overdose deaths by 8.61 per state per quarter (95% CI= -15.13, -2.09), a 16% reduction from the counterfactual estimates. Coprescribing/offering mandates did not significantly impact illicit/synthetic overdose deaths (average marginal effect=0.32; 95% CI= -18.27, 18.91). CONCLUSIONS Coprescribing/offering mandates prevent overdose deaths for its target population, individuals using prescription/treatment opioids. These mandates do not appear to impact populations using illicit/synthetic opioids; thus, expanded efforts are needed to reach these individuals.
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Affiliation(s)
- Minji Sohn
- College of Pharmacy, Ferris State University, Big Rapids, Michigan.
| | - Chris Delcher
- Institute for Pharmaceutical Outcomes and Policy (IPOP), Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, Kentucky
| | - Jeffery C Talbert
- Institute for Biomedical Informatics, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Yue Cheng
- Institute for Pharmaceutical Outcomes and Policy (IPOP), Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, Kentucky
| | - Yong Xu
- Marketing Department, College of Business, Ferris State University, Big Rapids, Michigan
| | - Emmanuel D Jadhav
- College of Health Professions, Ferris State University, Big Rapids, Michigan
| | - Patricia R Freeman
- Institute for Pharmaceutical Outcomes and Policy (IPOP), Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, Kentucky
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Téllez-López AM, Bermudez-Camps IB, Reyes-Hernández I, Fegadolli C, Gómez-Oliván LM. Methodological - Theoretical approach to phenomenological studies on the experience of medication use: A systematic review. Res Social Adm Pharm 2023; 19:845-858. [PMID: 36878811 DOI: 10.1016/j.sapharm.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/04/2023] [Accepted: 02/16/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND The study of medication use should include pharmacological, family, and social dimensions to explain how the lived experiences, beliefs, and perceptions of everyone, and their social and cultural environment affects consumption, using for this purpose the qualitative approach. OBJECTIVE To conduct a systematic review of the theoretical-methodological approaches to phenomenology to identify studies that allow an understanding of patients' experiences with the use of medications.a. METHODS A systematic literature search was conducted following the PRISMA guidelines to identify studies that address phenomenological research on patients' experiences of medications used and to apply them in subsequent studies. A thematic analysis was performed using ATLAS.ti software to facilitate data management. RESULTS Twenty-six articles were identified, most of them including adult patients diagnosed with chronic degenerative diseases. The semantic network obtained places Phenomenology at the center as the interpretative referential framework, with three theoretical approaches: descriptive, interpretative, and perceptual under the philosophies of Husserl, Heidegger, and Merleau-Ponty respectively; two techniques to collect data which are in-depth interview and focus groups; and to explore the life experiences of patients and understand the meaning in the context of their lives, thematic analysis, content analysis, and interpretative phenomenological analysis were identified. CONCLUSIONS It was evidenced that Qualitative Research approaches, methodologies, and techniques are applicable to describe people's experiences towards the use of medications. Phenomenology constitutes a useful referential framework in qualitative research to explain the experiences and perceptions about the disease and the use of medicines.
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Spadaro A, Agarwal AK, Sangha HK, Perrone J, Delgado MK, Lowenstein M. Motivation to Carry Naloxone: A Qualitative Analysis of Emergency Department Patients. Am J Health Promot 2023; 37:200-209. [PMID: 35686433 PMCID: PMC9949384 DOI: 10.1177/08901171221107908] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Our aim was to explore perspectives of patients who received naloxone in the emergency department (ED) about (1) naloxone carrying and use following an ED visit and (2) motivation for performing these behaviors. DESIGN Semi-structured interviews of patients prescribed naloxone at ED discharge. SETTINGS Three urban academic EDs in Philadelphia, PA. PARTICIPANTS 25 participants completed the in-depth, semi-structured interviews and demographic surveys. Participants were majority male, African American, and had previously witnessed or experienced an overdose. METHODS Interviews were recorded, transcribed and analyzed using content analysis. We used a hybrid inductive-deductive approach that included prespecified and emergent themes. RESULTS We found that naloxone carrying behavior was variable and influenced by four main motivators: (1) naloxone access; (2) personal experience and salience of naloxone, (3) comfort with naloxone administration, and (4) societal influences on naloxone carrying. In particular, those with personal history of overdose or close friends or family at risk were motivated to carry naloxone. CONCLUSIONS Participants in this study reported several important motivators for naloxone carrying after an ED visit, including ease of naloxone access and comfort, perceived risk of experiencing or encountering an overdose, and social influences on naloxone carrying behaviors. EDs, health systems, and public health officials should consider these factors influencing motivation when designing future interventions to increase access, carrying, and use of naloxone.
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Affiliation(s)
- Anthony Spadaro
- Department of Emergency Medicine, Perelman School of Medicine and the Center for Public Health Initiatives at the University of Pennsylvania, Philadelphia, PA, USA
| | - Anish K. Agarwal
- Department of Emergency Medicine, Perelman School of Medicine the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Hareena K. Sangha
- Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jeanmarie Perrone
- Department of Emergency Medicine, Perelman School of Medicine the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Mucio Kit Delgado
- Department of Emergency Medicine, Perelman School of Medicine the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Margaret Lowenstein
- Division of General Internal Medicine, Perelman School of Medicine and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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Hohmann LA, Krauss Z, Patel J, Marley GT. Public Perceptions of Community Pharmacy-Based Naloxone Services: A National Cross-Sectional Survey. PHARMACY 2022; 10:pharmacy10060171. [PMID: 36548327 PMCID: PMC9781939 DOI: 10.3390/pharmacy10060171] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/03/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
Little is known about the general public's perceptions regarding community pharmacist-delivered naloxone services at the national level. Accordingly, the purpose of this study was to describe the US general public's awareness, knowledge, beliefs, comfort, perceived barriers, abilities, and communication preferences related to community pharmacy-based naloxone services. A national, online cross-sectional survey was conducted in September 2021 among US adults ≥18 years recruited via Amazon Mechanical Turk (MTurk). Primary outcome measures were assessed via 5-point Likert-type scales, including: (1) naloxone awareness and knowledge; (2) naloxone beliefs; (3) comfort with pharmacist-provided naloxone; (4) perceived barriers to pharmacy-based naloxone; (5) opioid overdose competencies, concerns, and readiness; and (6) preferred pharmacist-patient naloxone communication strategy. Analyses included descriptive statistics and logistic regression models to assess predictors of preferred communication strategies. Of 301 respondents, 82.1% were White, 48.8% female, and mean 43 years. Eighty-five percent were unaware of pharmacy-provided naloxone and mean [SD] knowledge score was low (29.3% [16.8]). Mean [SD] beliefs (3.78 [0.61]) and comfort (3.70 [0.54]) were positive, while perceived barriers were low/neutral (2.93 [0.78]). For communication, 54% preferred general advertisement, 32.9% universal offer, and 13.3% targeted offer. The odds of preferring a general advertisement or universal offer over a targeted offer increased with greater awareness (AOR:4.52; p = 0.003) and comfort (AOR:3.79; p = 0.003), and decreased with greater competence (AOR:0.35; p = 0.001). Although awareness and knowledge regarding community pharmacy-based naloxone services was low, beliefs and comfort were positive and perceived barriers were low/neutral. General or universal offers of naloxone were preferred over targeted approaches. Future studies should test the impact of communication strategies on naloxone uptake.
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Affiliation(s)
- Lindsey A. Hohmann
- Harrison College of Pharmacy, Auburn University, 2316 Walker Building, Auburn, AL 36849, USA
- Correspondence: ; Tel.: +1-334-844-4092
| | - Zach Krauss
- Health Sciences Center, School of Pharmacy, Cedarville University, 251 N Main St., Cedarville, OH 45314, USA
| | - Jitisha Patel
- Bernard J Dunn School of Pharmacy, Shenandoah University, 1775 N Sector Ct, Winchester, VA 22601, USA
| | - Grace T. Marley
- Eshelman School of Pharmacy, University of North Carolina (UNC), 301 Pharmacy Ln, Chapel Hill, NC 27599, USA
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Lowenstein M, Sangha HK, Spadaro A, Perrone J, Delgado MK, Agarwal AK. Patient perspectives on naloxone receipt in the emergency department: a qualitative exploration. Harm Reduct J 2022; 19:97. [PMID: 36028882 PMCID: PMC9412772 DOI: 10.1186/s12954-022-00677-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 08/15/2022] [Indexed: 12/03/2022] Open
Abstract
Background Emergency departments (EDs) are important venues for the distribution of naloxone to patients at high risk of opioid overdose, but less is known about patient perceptions on naloxone or best practices for patient education and communication. Our aim was to conduct an in-depth exploration of knowledge and attitudes toward ED naloxone distribution among patients who received a naloxone prescription. Methods We conducted semi-structured telephone interviews with 25 adult participants seen and discharged from three urban, academic EDs in Philadelphia, PA, with a naloxone prescription between November 2020 and February 2021. Interviews focused on awareness of naloxone as well as attitudes and experiences receiving naloxone in the ED. We used thematic content analysis to identify key themes reflecting patient attitudes and experiences.
Results Of the 25 participants, 72% had previously witnessed an overdose and 48% had personally experienced a non-fatal overdose. Nineteen participants (76%) self-disclosed a history of substance use or overdose, and one reported receiving an opioid prescription during their ED visit and no history of substance use. In interviews, we identified wide variability in participant levels of knowledge about overdose risk, the role of naloxone in reducing risk, and naloxone access. A subset of participants was highly engaged with community harm reduction resources and well versed in naloxone access and use. A second subset was familiar with naloxone, but largely obtained it through healthcare settings such as the ED, while a final group was largely unfamiliar with naloxone. While most participants expressed positive attitudes about receiving naloxone from the ED, the quality of discussions with ED providers was variable, with some participants not even aware they were receiving a naloxone prescription until discharge.
Conclusions Naloxone prescribing in the ED was acceptable and valued by most participants, but there are missed opportunities for communication and education. These findings underscore the critical role that EDs play in mitigating risks for patients who are not engaged with other healthcare or community health providers and can inform future work about the effective implementation of harm reduction strategies in ED settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12954-022-00677-7.
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Affiliation(s)
- Margaret Lowenstein
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, 122 Blockley Hall, 421 Guardian Drive, Philadelphia, PA, 19104, USA. .,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA. .,Center for Addiction Medicine and Policy, University of Pennsylvania, Philadelphia, PA, USA.
| | - Hareena K Sangha
- Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Anthony Spadaro
- Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jeanmarie Perrone
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.,Center for Addiction Medicine and Policy, University of Pennsylvania, Philadelphia, PA, USA.,Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - M Kit Delgado
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.,Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Anish K Agarwal
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.,Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Antoniou T, Men S, Tadrous M, Leece P, Munro C, Gomes T. Impact of a publicly funded pharmacy-dispensed naloxone program on fatal opioid overdose rates: A population-based study. Drug Alcohol Depend 2022; 236:109473. [PMID: 35523113 DOI: 10.1016/j.drugalcdep.2022.109473] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Studies examining the impact of pharmacy-dispensed naloxone programs on fatal opioid overdose rates are lacking. We examined the impact of the publicly funded Ontario Naloxone Program for Pharmacies (ONPP), implemented in June 2016, on provincial rates of opioid overdose deaths. METHODS We conducted a population-based interrupted time-series study between July 1, 2012 and December 31, 2018. We considered a parsimonious model with terms for time, ONPP implementation, and time following the ONPP implementation. Models were adjusted for population characteristics, number of pharmacies and rate of naloxone distributed through non-pharmacy sites within provincial public health units. RESULTS In the parsimonious model, the ONPP was associated with a non-significant 9% reduction in the level of fatal opioid overdoses (rate ratio [RR] 0.91; 95% confidence interval [CI] 0.79-1.06), a finding that was most pronounced in regions in the lowest tertile of implementation (RR 0.75; 95% CI 0.62-0.91). Following multivariable adjustment, there was an increase in the level (RR 1.06; 95% CI 0.94-1.19) and slope change (RR 1.06; 95% CI 1.02-1.10) of fatal overdose rates. CONCLUSION The ONPP is insufficient as a single intervention to meaningfully reduce rates of fatal opioid overdoses during a period in which the cause of these deaths shifted from prescription opioids to highly potent fentanyl analogs. Access to additional harm reduction, treatment, and other interventions is necessary to prevent deaths and optimize the health of people who use drugs.
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Affiliation(s)
- Tony Antoniou
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada; Department of Family and Community Medicine, Unity Health, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Ontario Drug Policy Research Network, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada.
| | | | - Mina Tadrous
- ICES, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Toronto, Ontario, Canada
| | - Pamela Leece
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Public Health Ontario, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Charlotte Munro
- Ontario Drug Policy Research Network, Toronto, Ontario, Canada
| | - Tara Gomes
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada; Ontario Drug Policy Research Network, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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11
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Grant S, Smart R. Expert views on state-level naloxone access laws: a qualitative analysis of an online modified-Delphi process. Harm Reduct J 2022; 19:64. [PMID: 35676719 PMCID: PMC9175531 DOI: 10.1186/s12954-022-00645-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/21/2022] [Indexed: 11/18/2022] Open
Abstract
Background Expanding availability to naloxone is a core harm reduction strategy in efforts to address the opioid epidemic. In the US, state-level legislation is a prominent mechanism to expand naloxone availability through various venues, such as community pharmacies. This qualitative study aimed to identify and summarize the views of experts on state-level naloxone access laws. Methods We conducted a three-round modified-Delphi process using the online ExpertLens platform. Participants included 46 key stakeholders representing various groups (advocates, healthcare providers, human/social service practitioners, policymakers, and researchers) with expertise naloxone access laws. Participants commented on the effectiveness and implementability of 15 state-level naloxone access laws (NALs). We thematically analyzed participant comments to summarize views on NALs overall and specific types of NAL. Results Participants commented that the effectiveness of NALs in reducing opioid-related mortality depends on their ability to make sustained, significant impacts on population-level naloxone availability. Participants generally believed that increased naloxone availability does not have appreciable negative impacts on the prevalence of opioid misuse, opioid use disorder (OUD), and non-fatal opioid overdoses. Implementation barriers include stigma among the general public, affordability of naloxone, and reliance on an inequitable healthcare system. Conclusions Experts believe NALs that significantly increase naloxone access are associated with less overdose mortality without risking substantial unintended public health outcomes. To maximize impacts, high-value NALs should explicitly counter existing healthcare system inequities, address stigmatization of opioid use and naloxone, maintain reasonable prices for purchasing naloxone, and target settings beyond community pharmacies to distribute naloxone.
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Affiliation(s)
- Sean Grant
- Department of Social and Behavioral Sciences, Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, RG 6046, Indianapolis, IN, 46202, USA.
| | - Rosanna Smart
- Economics, Sociology, and Statistics Department, RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
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12
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Rivera AV, Nolan ML, Paone D, Carrillo SA, Braunstein SL. Gaps in naloxone ownership among people who inject drugs during the fentanyl wave of the opioid overdose epidemic in New York City, 2018. Subst Abuse 2022; 43:1172-1179. [PMID: 35617642 DOI: 10.1080/08897077.2022.2074597] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: Community distribution of naloxone, a medication that reverses opioid overdose, is an effective public health strategy to prevent overdose deaths. However, data are limited on who has naloxone during the current fentanyl wave of the opioid overdose epidemic in the United States. We aim to determine correlates of naloxone ownership among a community sample of people who inject drugs (PWID) from New York City (NYC). Methods: Data were drawn from the National HIV Behavioral Surveillance Study among PWID. Participants were recruited via respondent-driven sampling. Eligible participants completed an interviewer-administered survey. Log-linked Poisson regression was used to determine adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs) current naloxone ownership. Results: Of 503 PWID, 60% currently owned naloxone. In the past 12 months, 74% witnessed an opioid overdose and 25% experienced one. Those who experienced current homelessness were less likely to own naloxone (aPR: 0.79; 95% CI: 0.68, 0.91), as were those who had been recently incarcerated (aPR: 0.83; 95% CI: 0.71, 0.97). Respondents who reported recent known or possible fentanyl use were more likely to own naloxone (aPR: 1.23; 95% CI: 1.07, 1.43) as were those who experienced an opioid overdose in the past 12 months (aPR: 1.33; 95% CI: 1.15, 1.53). Conclusions: The prevalence of naloxone ownership among PWID in NYC was high, potentially due to widespread community naloxone distribution programs; however, gaps in naloxone ownership existed. Interventions that further ease access to naloxone, such as reclassifying naloxone as an over-the-counter medication and making it available "off the shelf," should be considered. More research is needed to identify barriers to access, uptake, and sustained possession within this group to maximize the impact of naloxone distribution during the ongoing fentanyl wave of the opioid overdose epidemic.
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Affiliation(s)
- Alexis V Rivera
- New York City Department of Health and Mental Hygiene, Bureau of Hepatitis, HIV, and STIs, Long Island City, New York, USA
| | - Michelle L Nolan
- New York City Department of Health and Mental Hygiene, Bureau of Alcohol and Drug Use, Prevention, Care and Treatment, Long Island City, New Yoork, USA
| | - Denise Paone
- New York City Department of Health and Mental Hygiene, Bureau of Alcohol and Drug Use, Prevention, Care and Treatment, Long Island City, New Yoork, USA
| | - Sidney A Carrillo
- New York City Department of Health and Mental Hygiene, Bureau of Hepatitis, HIV, and STIs, Long Island City, New York, USA
| | - Sarah L Braunstein
- New York City Department of Health and Mental Hygiene, Bureau of Hepatitis, HIV, and STIs, Long Island City, New York, USA
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13
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Adeosun SO. Stigma by Association: To what Extent is the Attitude Toward Naloxone Affected by the Stigma of Opioid Use Disorder? J Pharm Pract 2022:8971900221097173. [PMID: 35505618 DOI: 10.1177/08971900221097173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The United States opioid epidemic is fueled by illicit opioid abuse and prescription opioid misuse and abuse. Consequently, cases of opioid use disorder (OUD, opioid addiction), opioid overdose, and related deaths have increased since the year 2000. Naloxone is an opioid antagonist that rapidly reverses opioid intoxication to prevent death from overdose. It is one of the major risk mitigation strategies recommended in the 2016 Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain. However, despite the exponential increase in dispensing and distribution of naloxone, opioid overdose and related deaths have continued to increase; suggesting that the increased naloxone supply still lags the need. This discordance is attributed at least in part to the negative attitude toward naloxone, which is based on the belief that naloxone is only meant for "addicts" and "abusers" (OUD patients). This negative attitude or so-called naloxone stigma is therefore considered a major barrier for naloxone distribution and consequently, overdose-death prevention efforts. This article presents evidence that challenges common assertions about OUD stigma being the sole and direct driving force behind naloxone stigma, and the purported magnitude of the barrier that naloxone stigma constitutes for naloxone distribution programs among the stakeholders (patients, pharmacists, and prescribers). The case was then made to operationalize and quantify the construct among the stakeholders to determine the extent to which OUD stigma drives naloxone stigma, and the relative impact of naloxone stigma as a barrier for naloxone distribution efforts.
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Affiliation(s)
- Samuel O Adeosun
- Department of Clinical Sciences, Fred Wilson School of Pharmacy, 465018High Point University, High Point NC, US
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14
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Tofighi B, Martino D, Lekas HM, Williams SZ, Blau C, Lewis CF. Scaling opioid overdose prevention and naloxone dispensation among rural and small metro area pharmacists: findings from a qualitative study. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2070877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Babak Tofighi
- Division of Social Solutions and Services Research, State Office of Mental Health, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York, US
- Department of Population Health, University School of Medicine, Orangeburg, New York, US
- Center for Drug Use and HIV Research, University, College of Global Public Health, Orangeburg, New York, US
| | - Daniele Martino
- Division of Social Solutions and Services Research, State Office of Mental Health, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York, US
| | - Helen-Maria Lekas
- Division of Social Solutions and Services Research, State Office of Mental Health, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York, US
- Department of Psychiatry, University School of Medicine, Orangeburg, New York, US
| | - Sharifa Z. Williams
- Division of Social Solutions and Services Research, State Office of Mental Health, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York, US
| | - Chloe Blau
- Division of Social Solutions and Services Research, State Office of Mental Health, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York, US
| | - Crystal F. Lewis
- Division of Social Solutions and Services Research, State Office of Mental Health, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York, US
- Department of Psychiatry, University School of Medicine, Orangeburg, New York, US
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15
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Pollini RA, Ozga JE, Joyce R, Xuan Z, Walley AY. Limited access to pharmacy-based naloxone in West Virginia: Results from a statewide purchase trial. Drug Alcohol Depend 2022; 231:109259. [PMID: 34998246 PMCID: PMC8810724 DOI: 10.1016/j.drugalcdep.2021.109259] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND West Virginia (WV) has the highest overdose mortality rate in the United States and expanding naloxone access is crucial for reducing opioid overdose deaths. We conducted a purchase trial to establish an objective measure of naloxone access under WV's naloxone standing order (NSO) program. METHODS A stratified random sample of 200 chain and independent retail pharmacies across WV were included. Each pharmacy underwent two purchase attempts-one by a person who used illicit opioids (PWUIO) and one by a potential bystander who did not use illicit opioids but had a relationship with a PWUIO. We used matched-pairs analysis to identify differences in outcomes by purchaser type (PWUIO vs bystander). Chi-square and independent-samples t-tests were used to compare outcomes by pharmacy type (chain vs independent). RESULTS Overall, 29% of purchase attempts were successful, with no significant difference between PWUIO and bystanders (p = 0.798). Fewer than half (44%) of successful purchases included verbal counseling, and bystanders were more likely to receive counseling than PWUIO (33% vs 4%, p = 0.018). Common reasons for failed purchases were naloxone not being in stock (41%), requiring a naloxone prescription (35%), and/or requiring formal identification (23%). Chain pharmacies were more likely to sell naloxone than independents (35% vs 19%, p = 0.001). CONCLUSIONS We documented limited naloxone access under the WV NSO. These findings indicate that simply establishing an NSO program is insufficient to expand access. Implementation efforts should ensure adequate naloxone stocks, pro-active delivery of NSO-related information and pharmacist training, and avoidance of recordkeeping requirements that may impede access.
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Affiliation(s)
- Robin A. Pollini
- Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, 3602 Collins Ferry Road, Morgantown WV, 26505, United States,Department of Epidemiology, School of Public Health, West Virginia University, 3602 Collins Ferry Road, Morgantown WV, 26505, United States
| | - Jenny E. Ozga
- Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, 3602 Collins Ferry Road, Morgantown WV, 26505, United States
| | - Rebecca Joyce
- Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, 3602 Collins Ferry Road, Morgantown WV, 26505, United States
| | - Ziming Xuan
- Department of Community Health Sciences, School of Public Health, Boston University, Crosstown Building - CT 454, 801 Massachusetts Ave, 4th Floor, Boston, MA 02118, United States
| | - Alexander Y. Walley
- Boston Medical Center and Boston University School of Medicine, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA 02118, United States
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16
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Green TC, Bratberga J, Irwin AN, Boggisb J, Gray M, Leichtling G, Bolivar D, Floyd A, Al-Jammali Z, Arnold J, Hansen R, Hartung D. 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. Subst Abus 2022; 43:901-905. [PMID: 35213293 PMCID: PMC9720900 DOI: 10.1080/08897077.2021.2010162] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Access to the opioid antidote naloxone is a critical component of addressing the opioid crisis. Naloxone is a population-level prevention intervention associated with substantial reductions in overdose mortality and reduction of nonfatal overdose. Pharmacies' pivotal role in dispensing medications like buprenorphine for the treatment of opioid use disorder and selling nonprescription syringes places them at the crossroads of opioid access and risk mitigation methods like naloxone provision. Testing ways to optimize pharmacy-based naloxone provision will be key as the country expands the implementation of naloxone through the medical system. In the Respond to Prevent Study, we conducted a large, practical study of a pharmacy-focused intervention in a sample of Washington, Oregon, Massachusetts and New Hampshire community chain pharmacies to increase naloxone dispensing and improve opioid safety. The intervention integrated two evidence-based educational toolkits and streamlined materials to enhance the focus on naloxone policy, stigma reduction, and patient communications around naloxone, nonprescription syringes and buprenorphine access. The real-world study implemented a stepped wedge, clustered randomized trial design across 175 community chain pharmacies to evaluate the effectiveness of the Respond to Prevent intervention in increasing: (a) pharmacy based naloxone distribution rates, naloxone-related patient engagement, and pharmacist and technicians' attitudes, knowledge, perceived behavioral control and self-efficacy toward naloxone; and (b) pharmacy nonprescription syringe sales, and pharmacist and technicians' attitudes, knowledge, perceived behavioral control and self-efficacy toward dispensing buprenorphine for opioid use disorder (secondary outcomes). This commentary provides a brief narrative about the study and presents insights on the design and adaptations to our study protocol, including those adopted during the unprecedented COVID-19 pandemic further compounded by Western wildfires in 2020.
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Affiliation(s)
- Traci C Green
- Brandeis University, Opioid Policy Research Collaborative, The Heller School for Social Policy and Management, 415 South Street, Heller-Brown Building, Waltham, MA 02453 USA
| | - Jeffrey Bratberga
- University of Rhode Island College of Pharmacy, 7 Greenhouse Road, Kingston, RI 02881 USA
| | - Adriane N Irwin
- Oregon State University College of Pharmacy, 1601 SW Jefferson Way, Corvallis, OR 97331 USA
| | - Jesse Boggisb
- Brandeis University, Opioid Policy Research Collaborative, The Heller School for Social Policy and Management, 415 South Street, Heller-Brown Building, Waltham, MA 02453 USA
| | - Mary Gray
- Comagine Health, 650 NE Holladay St # 1700, Portland, OR 97232 USA
| | | | - Derek Bolivar
- Brandeis University, Opioid Policy Research Collaborative, The Heller School for Social Policy and Management, 415 South Street, Heller-Brown Building, Waltham, MA 02453 USA
| | - Anthony Floyd
- University of Washington, University of Washington, Box 357631, H364 Health Sciences Building, Seattle WA 98195-7631 USA
| | - Zain Al-Jammali
- Oregon State University College of Pharmacy, 1601 SW Jefferson Way, Corvallis, OR 97331 USA
| | - Jenny Arnold
- Washington State Pharmacy Association, 411 Williams Ave S, Renton, WA 98057 USA
| | - Ryan Hansen
- University of Washington, University of Washington, Box 357631, H364 Health Sciences Building, Seattle WA 98195-7631 USA
| | - Daniel Hartung
- Oregon State University College of Pharmacy, 1601 SW Jefferson Way, Corvallis, OR 97331 USA
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17
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Smart R, Grant S. Effectiveness and implementability of state-level naloxone access policies: Expert consensus from an online modified-Delphi process. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 98:103383. [PMID: 34340167 PMCID: PMC8671224 DOI: 10.1016/j.drugpo.2021.103383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/23/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Naloxone distribution, a key global strategy to prevent fatal opioid overdose, has been a recent target of legislation in the U.S., but there is insufficient empirical evidence from causal inference methods to identify which components of these policies successfully reduce opioid-related harms. This study aimed to examine expert consensus on the effectiveness and implementability of various state-level naloxone policies. METHODS We used the online ExpertLens platform to conduct a three-round modified-Delphi process with a purposive sample of 46 key stakeholders (advocates, healthcare providers, human/social service practitioners, policymakers, and researchers) with naloxone policy expertise. The Effectiveness Panel (n = 24) rated average effects of 15 types of policies on naloxone pharmacy distribution, opioid use disorder (OUD) prevalence, nonfatal opioid-related overdoses, and opioid-related overdose mortality. The Implementation Panel (n = 22) rated the same policies on acceptability, feasibility, affordability, and equitability. We compared ratings across policies using medians and inter-percentile ranges, with consensus measured using the RAND/UCLA Appropriateness Method Inter-Percentile Range Adjusted for Symmetry technique. RESULTS Experts reached consensus on all items. Except for liability protections and required provision of education or training, experts perceived all policies to generate moderate-to-large increases in naloxone pharmacy distribution. However, only three policies were expected to yield substantive decreases on fatal overdose: statewide standing/protocol order, over-the-counter supply, and statewide "free naloxone." Of these, experts rated only statewide standing/protocol orders as highly affordable and equitable, and unlikely to generate meaningful population-level effects on OUD or nonfatal opioid-related overdose. Across all policies, experts rated naloxone prescribing mandates relatively lower in acceptability, feasibility, affordability, and equitability. CONCLUSION Experts believe statewide standing/protocol orders are an effective, implementable, and equitable policy for addressing opioid-related overdose mortality. While experts believe many other broad policies are effective in reducing opioid-related harms, they also believe these policies face implementation challenges related to cost and reaching vulnerable populations.
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Affiliation(s)
- Rosanna Smart
- Economics, Sociology, and Statistics Department, RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, USA.
| | - Sean Grant
- Department of Social & Behavioral Sciences, Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, RG 6046, Indianapolis, IN 46202, USA
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18
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Evoy KE, Hill LG, Davis CS. Reply to Letter to the Editor Regarding Article: "Considering the Potential Benefits of Over-The-Counter Naloxone" [Response To Letter]. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2021; 10:77-78. [PMID: 34268103 PMCID: PMC8277415 DOI: 10.2147/iprp.s327403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Kirk E Evoy
- Division of Pharmacotherapy, The University of Texas at Austin College of Pharmacy, San Antonio, TX, USA.,Department of Pharmacy, University Health, San Antonio, TX, USA
| | - Lucas G Hill
- Division of Pharmacy Practice, The University of Texas at Austin College of Pharmacy, Austin, TX, USA
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19
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Weiner SG, Hoppe JA. Prescribing Naloxone to High-Risk Patients in the Emergency Department: Is it Enough? Jt Comm J Qual Patient Saf 2021; 47:340-342. [PMID: 33958290 PMCID: PMC8165019 DOI: 10.1016/j.jcjq.2021.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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20
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Ko J, Chan E, Doroudgar S. Patient perspectives of barriers to naloxone obtainment and use in a primary care, underserved setting: A qualitative study. Subst Abus 2021; 42:1030-1039. [PMID: 33945451 DOI: 10.1080/08897077.2021.1915915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Gaps in naloxone obtainment and use are not well studied, particularly among minoritized groups. Objective: To describe patient perspectives that serve as barriers to naloxone obtainment and the number of patients who obtained naloxone in a primarily African American population in a primary care, underserved setting. Methods: This qualitative study conducted semi-structured interviews and included 36 adults who were prescribed naloxone at a federally qualified health center using convenience sampling. Participants answered survey questions describing naloxone acceptability, perceived risk for overdose, and barriers to naloxone use. Results: Sixty-nine percent of the patients were Black or African American. The majority of patients attempted to fill their naloxone at a local pharmacy (69%) and reported no difficulties (88%). Five major themes revealed: overall positive views of naloxone because it saves lives; existing knowledge gaps related to indications for naloxone prescription; stigma surrounding receiving a naloxone prescription; inadequacies of the patient education provided; and the role providers play in naloxone receptivity Conclusions: Among a majority African American population, many perceived naloxone to be lifesaving. However, stigmatizing perceptions and inability to recall patient education contribute to a perception of low overdose risk. Further research describing the impact of the opioid epidemic on underrepresented groups is necessary.
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Affiliation(s)
- Jennifer Ko
- Department of Clinical Sciences, Touro University College of Pharmacy, Vallejo, CA, USA
| | - Emily Chan
- Department of Clinical Sciences, Touro University College of Pharmacy, Vallejo, CA, USA
| | - Shadi Doroudgar
- Department of Clinical Sciences, Touro University College of Pharmacy, Vallejo, CA, USA
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McMillan SS, Chan H, Hattingh LH. Australian Community Pharmacy Harm-Minimisation Services: Scope for Service Expansion to Improve Healthcare Access. PHARMACY 2021; 9:pharmacy9020095. [PMID: 33926030 PMCID: PMC8167599 DOI: 10.3390/pharmacy9020095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/23/2021] [Accepted: 04/24/2021] [Indexed: 11/16/2022] Open
Abstract
Community pharmacies are well positioned to participate in harm-minimisation services to reduce harms caused by both licit and illicit substances. Considering developments in pharmacist practices and the introduction of new professional pharmacy services, we identified a need to explore the contemporary role of community pharmacy in harm minimisation. Semi-structured interviews were undertaken to explore the opinions of stakeholders, pharmacy staff, and clients about the role of community pharmacy in harm minimisation, including provision of current services, experiences, and expectations. Participants (n = 28) included 5 stakeholders, 9 consumers, and 14 staff members from seven community pharmacies. Three over-arching themes were identified across the three participants groups: (i) scope and provision, (ii) complexity, and (iii) importance of person-centred advice and support in relation to community pharmacy harm minimisation services. Community pharmacies are valuable healthcare destinations for delivery of harm minimisation services, with scope for service expansion. Further education, support, and remuneration are needed, as well as linkage to other sector providers, in order to ensure that pharmacists and pharmacy staff are well equipped to provide a range of harm minimisation services.
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Affiliation(s)
- Sara S. McMillan
- Gold Coast Campus, School of Pharmacy and Pharmacology, Griffith University, Southport 4215, Australia;
| | - Hidy Chan
- The Pharmacy Guild of Australia, Queensland Branch, Brisbane 4000, Australia;
| | - Laetitia H. Hattingh
- Gold Coast Campus, School of Pharmacy and Pharmacology, Griffith University, Southport 4215, Australia;
- Gold Coast Hospital and Health Service, Southport 4215, Australia
- Correspondence:
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22
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A free mailed naloxone program in Philadelphia amidst the COVID-19 pandemic. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 94:103199. [PMID: 33765515 DOI: 10.1016/j.drugpo.2021.103199] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Access to naloxone is essential as the overdose crisis persists. We described barriers to accessing naloxone among individuals who requested and received the medication from a free mailed program and explored the relationship between how individuals with and without personal proximity to overdose learned about the program. METHODS Secondary analysis of data from a web-based form collected 1st March 2020 to 31st January 2021. Access barriers, personal proximity to overdose (broadly defined as personally overdosing or witnessing/worrying about others overdosing), and method of learning about the program were categorized and described. RESULTS Among 422 respondents, the most frequently reported barriers to accessing naloxone were: COVID quarantine (25.1%), lack of knowledge about access (13.2%), and cost (11.2%). Compared to those without personal proximity to overdose (38.2%), individuals with personal proximity (61.8%) heard about the program more often through an active online search (21.4% vs. 8.8%; p-value = 0.001) and less often through word of mouth (19.8% vs. 40.9%; p-value = <0.001). CONCLUSIONS Longstanding barriers to naloxone access are compounded by the COVID-19 pandemic, making mailing programs especially salient. Differences in ways that individuals with and without personal proximity to substance use and overdose learned about this program can inform how such programs can effectively reach their target audience.
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23
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Schneider KE, Dayton L, Winiker AK, Tobin KE, Latkin CA. The role of overdose reversal training in knowing where to get naloxone: Implications for improving naloxone access among people who use drugs. Subst Abus 2021; 42:438-443. [PMID: 33617733 DOI: 10.1080/08897077.2021.1875103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Naloxone distribution and training programs have been implemented to combat the opioid overdose crisis. While many individuals are trained, ongoing naloxone access is not ensured by these programs. We explored whether people who use drugs (PWUD) in Baltimore City, Maryland could identify a location where they would go to obtain naloxone and how training changed where they would be willing to access naloxone. Methods: We surveyed 574 PWUD as to whether they had heard of, been trained to use, and knew where to get naloxone. Among participants who had heard of naloxone, we tested for differences in knowing where to get naloxone by training. Results: The majority (95.3%) had heard of naloxone. Of these, 84.0% could name a location where they would access naloxone, but only 11.7% named multiple. Pharmacies (32.3%) and medical providers (excluding drug treatment providers) (22.9%) were the most commonly identified sources. Participants who had been trained to use naloxone were more likely to report that they would obtain naloxone from the needle exchange and were less likely to report they did not know where they would go to get it or that they would go to a medical provider (excluding drug treatment providers) for naloxone. Conclusions: Naloxone training was associated with participants' ability to name a location where they would obtain naloxone. Medicalized sources of naloxone remained the most commonly reported. These sources, however, may be associated with significant barriers to access, such as cost. Trainings should provide comprehensive education about low-cost/free sources to ensure ongoing naloxone access among people who use drugs.
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Affiliation(s)
- Kristin E Schneider
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lauren Dayton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Abigail K Winiker
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Karin E Tobin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carl A Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Antoniou T, Pritlove C, Shearer D, Martins D, Tadrous M, Munro C, Gomes T. A qualitative study of a publicly funded pharmacy-dispensed naloxone program. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 92:103146. [PMID: 33568317 DOI: 10.1016/j.drugpo.2021.103146] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 12/28/2022]
Abstract
AIMS To characterize the experiences of individuals accessing pharmacy-based naloxone and relate these experiences to the risk environments and discourses in which they are embedded. METHODS We conducted a qualitative study using in-depth interviews of 37 adults aged 18 years and over who had accessed pharmacy-dispensed naloxone. Participants were recruited from across Ontario, Canada, and comprised individuals taking opioids for chronic pain, those taking opioids for reasons other than chronic pain, and individuals acquiring naloxone to act as bystanders in an opioid overdose setting. We drew upon risk environment theory to interpret participants' accounts. RESULTS Following analysis and interpretation, we generated five theoretically-informed themes characterizing the experiences of individuals accessing pharmacy-dispensed naloxone: 'intersection of naloxone narrative with pharmacy environment', 'individual risk environment and pharmacy-dispensed naloxone uptake', 'safe spaces: creating an enabling environment for pharmacy-dispensed naloxone', 'individuation: becoming a first responder' and 'beyond naloxone: the macro risk environment'. Specifically, participants described how judgement and stereotyping associated with the broader naloxone narrative can be amplified in the space of the pharmacy, leading to fears of reprisals and strategies to mitigate social risk. In addition, the social construction of naloxone as a drug for 'problematic' opioid use and a lack of pharmacist awareness regarding the risk environments in which opioid use occurs was perceived to limit opportunities for optimizing naloxone distribution and training. Finally, participants described approaches that could create enabling environments in the space of the pharmacy while remaining cognizant of the structural changes required in the macro risk environments of people who take opioids. CONCLUSIONS Despite increasing the availability of naloxone, participants characterized several social and environmental factors that could limit the accessibility of the drug from pharmacies. Strategies to address these factors could create enabling environments within pharmacies that optimize the reach and impact of pharmacy-dispensed naloxone.
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Affiliation(s)
- Tony Antoniou
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada; Department of Family and Community Medicine, Unity Health, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Ontario Drug Policy Research Network, Toronto, Ontario, Canada
| | - Cheryl Pritlove
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada; School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Dana Shearer
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada; Ontario Drug Policy Research Network, Toronto, Ontario, Canada
| | - Diana Martins
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada; Ontario Drug Policy Research Network, Toronto, Ontario, Canada
| | - Mina Tadrous
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada; Ontario Drug Policy Research Network, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Toronto, Ontario, Canada
| | - Charlotte Munro
- Ontario Drug Policy Research Network, Toronto, Ontario, Canada
| | - Tara Gomes
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada; Ontario Drug Policy Research Network, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
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What Is Known about Community Pharmacy-Based Take-Home Naloxone Programs and Program Interventions? A Scoping Review. PHARMACY 2021; 9:pharmacy9010030. [PMID: 33540676 PMCID: PMC7931101 DOI: 10.3390/pharmacy9010030] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/29/2021] [Accepted: 01/29/2021] [Indexed: 12/13/2022] Open
Abstract
A variety of new sources describing community pharmacy-based take-home naloxone (THN) programs have emerged recently in the literature. There is a need to define the types of take-home naloxone programs being offered to support future research designs in implementing and evaluating standardized programs that fill pharmacist and patient knowledge gaps and lift current barriers for optimal community pharmacy naloxone provision. The objective of this paper is to summarize the literature on community pharmacy-based THN programs, including specific program interventions used to increase naloxone dispensing, naloxone availability and dispensing patterns, facilitators and barriers for the THN programs, and knowledge gaps. Online databases such as PubMed, EMBASE, Scopus, and International Pharmaceutical Abstracts (IPA) and a search of the grey literature were used to identify eligible sources. Sources were screened by two reviewers for eligibility in COVIDENCE software. Both reviewers compared screening results and resolved conflicts through discussion. A data extraction form for all identified full texts was completed by both reviewers and results were compiled through reviewer discussion. Fifty-two sources met the eligibility criteria. The top three barriers identified were: cost/coverage of naloxone, stigma, and education/training for pharmacists. THN program interventions included screening tools, checklists, pocket cards, patient brochures, and utilizing the pharmacy management system to flag eligible patients. Patient knowledge gaps included naloxone misinformation and lack of awareness, while pharmacists demonstrated administrative, clinical, and counselling knowledge gaps. Naloxone availability was found to be highly variable, where independent and rural pharmacies were less likely to stock or dispense naloxone. Further, pharmacies located in districts with higher rates of opioid overdose deaths and lower household income were also less likely to have naloxone available. This review identified multiple new programs, showcasing that the implementation and evaluation of THN programs are an expanding area of research. Future research should focus on implementing and evaluating a THN program through a randomized controlled trial design that incorporates solutions for the barriers and knowledge gaps identified in this study.
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Hincapie AL, Hegener M, Heaton PC, Fish G, Fetters K, Sneed GT, Koechlin K, DeFiore-Hyrmer J, Holthusen A, MacKinnon NJ. Challenges and Facilitators of Implementing a Physician-approved Naloxone Protocol: A Mixed-methods Study. J Addict Med 2021; 15:40-48. [PMID: 33534508 DOI: 10.1097/adm.0000000000000672] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES In 2015, the State of Ohio passed legislation to allow pharmacists to dispense naloxone under a physician-approved protocol. The legislation allows all individuals authorized under a physician-approved protocol to personally furnish naloxone without requiring clients to be seen by a licensed prescriber, thus expanding the capacity of Ohio's community distribution programs. We aimed to evaluate the implementation of legislation allowing for a physician-approved protocol in pharmacies and other naloxone distribution sites in Ohio, and to compare barriers and facilitators of implementing the law changes among sites that implemented a physician-approved protocol versus sites that did not. METHODS The study used a convergent parallel mixed-method design. Random samples from all pharmacies registered with the State of Ohio Board of Pharmacy and community naloxone distribution sites were selected. Quantitative data were collected via survey (n = 168) and qualitative data were collected via semi-structured interviews (n = 17). RESULTS Most survey respondents agreed that the policy has expanded access to naloxone at their site for individuals who want or need the medication. Both pharmacies and other naloxone distribution sites identified that leadership and organizational support facilitated protocol implementation and cost, stigma, and lack of naloxone demand challenged protocol implementation. CONCLUSIONS The study identified barriers and facilitators to the implementation of a physician-approved protocol within Ohio. The majority of respondents stated they could implement a protocol. However, barriers of cost, lack of public awareness of naloxone availability, and stigma remain for pharmacies and other naloxone distribution sites.
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Affiliation(s)
- Ana L Hincapie
- University of Cincinnati James L. Winkle College of Pharmacy, 3255 Eden Ave, Cincinnati, OH 45267 (ALH, MHP, PCH, GF, KF, GTS, NJMK); Ohio Department of Health, 246 N. High St. Columbus, OH 43215 (KK, JDF-H)
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Pharmacy Students' Perceptions and Stigma Surrounding Naloxone Use in Patients with Opioid Use Disorder: A Mixed Methods Evaluation. PHARMACY 2020; 8:pharmacy8040205. [PMID: 33153144 PMCID: PMC7712231 DOI: 10.3390/pharmacy8040205] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 11/25/2022] Open
Abstract
Pharmacists represent a key group of healthcare professionals that can increase awareness and destigmatize naloxone use. The objective of this study was to investigate pharmacy student perceptions of the use, dispensing, and stigma surrounding naloxone. An electronic survey was administered to pharmacy students that included questions about demographics, work history, naloxone use, and naloxone stigma. Separate qualitative interviews were performed to identify themes surrounding naloxone use. Two-hundred sixty-two participants completed the survey. The majority of participants were “highly willing” (74%) to fill a naloxone prescription for a patient and “somewhat comfortable” (38%) in counseling on naloxone; most were “somewhat comfortable” (38%) administering naloxone. Naloxone is “very rarely” (87%) recommended in community workplace settings, and the majority (64%) reported that patients never request information about naloxone availability. Seventy-six percent of respondents reported that naloxone-associated interactions have an influence on the way they communicate with patients in community pharmacy settings. Thematic analyses found that pharmacy students identify the importance of naloxone as a life-saving medication and the need for naloxone training, but patient-perceived stigma and limited access to naloxone remain prevalent. Pharmacy students are generally well-versed and inclined toward distributing, counseling on, and administering naloxone. Naloxone is rarely dispensed and patient conversations involving naloxone are infrequent in community settings. Future efforts focused on approaches toward difficult patient conversations and normalization of naloxone are needed to destigmatize and facilitate use.
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Donovan E, Bratberg J, Baird J, Burstein D, Case P, Walley AY, Green TC. Pharmacy leaders' beliefs about how pharmacies can support a sustainable approach to providing naloxone to the community. Res Social Adm Pharm 2020; 16:1493-1497. [PMID: 31983625 DOI: 10.1016/j.sapharm.2020.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 01/11/2020] [Accepted: 01/13/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Naloxone is an antidote to opioid overdose, and community pharmacies nationwide now provide broad access to this medication. OBJECTIVE The aim of this qualitative study was to understand how leaders in pharmacy organizations perceive pharmacies and pharmacy staff can optimize dispensing of naloxone. METHODS In-depth interviews were conducted with 12 pharmacy leaders in Massachusetts and Rhode Island. Participants were recruited from three types of community pharmacies: (1) chain; (2) independent; and (3) hospital outpatient. Theory-driven immersion crystallization, using Brownlee et al.'s model of healthcare quality improvement, was used to inform coding of the interview data, with predetermined categories of staff; organization; and process. RESULTS Five main themes were identified: (1) Importance of staff training to increase comfort; (2) Strength through coordination of efforts; (3) Pharmacy as a community leader in the opioid crisis; (4) Persisting stigma; and (5) Ongoing workflow challenges. CONCLUSIONS The results uniquely reflect the experiences and insights of pharmacy leaders implementing public health initiatives during the opioid crisis and can be used for gaining insight into how pharmacists can efficiently provide naloxone to their communities.
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Affiliation(s)
| | | | - Janette Baird
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Dina Burstein
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Patricia Case
- Institute for Urban Health Research and Practice, Northeastern University, Boston, MA, USA
| | - Alexander Y Walley
- Clinical Addiction Research Education Unit, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Traci C Green
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA; Department of Epidemiology, Alpert Medical School of Brown University, Providence, RI, USA; Boston Medical Center Injury Prevention Center, Boston University School of Medicine, Department of Emergency Medicine, Boston, MA, USA
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Varisco TJ, Downs CG, Rathburn KR, Fleming ML, Thornton JD. Applying the capability, opportunity, motivation, and behavior model to identify opportunities to increase pharmacist comfort dispensing naloxone in Texas: A structural equation modeling approach. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 83:102827. [DOI: 10.1016/j.drugpo.2020.102827] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 05/14/2020] [Accepted: 06/07/2020] [Indexed: 11/25/2022]
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Hall EA, Cernasev A, Nasritdinova U, Veve MP, Hohmeier KC. Stigma of Opioid Use Disorder and Its Indirect Effects on Student Pharmacists' Perceptions and Attitudes. PHARMACY 2020; 8:E144. [PMID: 32823836 PMCID: PMC7559077 DOI: 10.3390/pharmacy8030144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Pharmacists play a vital role in serving patients during the ongoing nationwide opioid epidemic, and so it is also critical to educate the next generation of pharmacists on opioids and opioid use disorder (OUD). The primary objective of this study was to quantitatively characterize student perceptions of opioid use and the stigma associated with OUD. Secondary aims were to determine whether differences in perceptions exist based upon the student's year in the Doctor of Pharmacy program or employment in a community pharmacy. METHODS First-, second-, third-, and fourth-year student pharmacists voluntarily completed an electronic survey regarding perceptions of opioid use and stigma associated with OUD. RESULTS Of the 9 survey items, students were most uncomfortable referring patients to community resources for addiction support and/or treatment (25.3% comfortable or very comfortable). Students working in a community pharmacy were significantly more comfortable talking to patients attempting to refill opioids early and providing opioid counseling as compared to their peers not working in community pharmacy. Fourth-year students reported a higher level of comfort talking to a patient attempting to refill an opioid prescription early, counseling a patient on an opioid prescription, and providing information about alternatives to opioids. Third-year students responded most favorably to the items regarding how well the curriculum has prepared them to interact with patients taking opioids and those with OUD. CONCLUSIONS These findings reveal that students are comfortable counseling on opioids and discussing alternative options. Differences in perceptions were observed based upon the student's year in the program and whether or not they were employed in a community pharmacy setting.
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Affiliation(s)
| | - Alina Cernasev
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, The University of Tennessee Health Science Center, Nashville, TN 37211, USA; (E.A.H.); (U.N.); (M.P.V.); (K.C.H.)
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"You've got to care to carry this stuff" Community implications from take-home naloxone use: A qualitative study. J Subst Abuse Treat 2020; 115:108030. [PMID: 32600618 DOI: 10.1016/j.jsat.2020.108030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 04/09/2020] [Accepted: 05/06/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND In New Mexico, drug overdose rates have been among the highest in the nation for the past two decades, with 332 overdose deaths involving opioids in 2017. While interventions aimed at enhancing distribution and uptake of take-home naloxone (THN) have identified people who use opioids as viable candidates, there exists a gap in applying these findings to underserved, ethnic minority women. METHODS We conducted qualitative interviews with participants recruited from a parent study which recruited 395 women diagnosed with OUD who participated in a two year study (April 2016-May 2018) during which they received opioid overdose education and two free THN kits for their use. RESULTS Findings characterize the social dynamics of persistent opioid exposure, accidental overdose, and take home naloxone use to reverse overdose, and we identified three overarching themes: 1) Crisis management and community responsibility; 2) Complex social networks as informal channels for family to family and peer to peer naloxone distribution and education; and 3) Participant preferences and strategies for THN distribution and education. CONCLUSIONS Participants in the ASAP program demonstrated an unquestionable willingness to distribute naloxone when they had access to it, and the ability to replace it. Further research is warranted to apply these findings in interventional contexts to refine strategies toward prioritizing distribution of THN, enhance training tools and optimize community locations for engagement.
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Fatal overdose prevention and experience with naloxone: A cross-sectional study from a community-based cohort of people who inject drugs in Baltimore, Maryland. PLoS One 2020; 15:e0230127. [PMID: 32160244 PMCID: PMC7065783 DOI: 10.1371/journal.pone.0230127] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 02/22/2020] [Indexed: 01/13/2023] Open
Abstract
Introduction Overdose is a leading cause of death in the United States, especially among people who inject drugs (PWID). Improving naloxone access and carrying among PWID may offset recent increases in overdose mortality associated with the influx of synthetic opioids in the drug market. This study characterized prevalence and correlates of several naloxone outcomes among PWID. Methods During 2018, a survey to assess experience with naloxone was administered to 915 participants in the AIDS Linked to the IntraVenous Experience (ALIVE) study, an ongoing community-based observational cohort of people who currently inject or formerly injected drugs in Baltimore, Maryland. We examined the associations of naloxone outcomes (training, supply, use, and regular possession) with socio-demographic, substance use and healthcare utilization factors among PWID in order to characterize gaps in naloxone implementation among this high-risk population. Results Median age was 56 years, 34% were female, 85% were African American, and 31% recently injected. In the past six months, 46% (n = 421) reported receiving training in overdose prevention, 38% (n = 346) had received a supply of naloxone, 9% (n = 85) had administered naloxone, and 9% (n = 82) reported usually carrying a supply of naloxone. Recent non-fatal overdose was not associated with any naloxone outcomes in adjusted analysis. Active opioid use (aOR = 2.10, 95% CI: 1.03, 4.28) and recent treatment of alcohol or substance use disorder (aOR = 2.01, 95% CI: 1.13, 3.56) were associated with regularly carrying naloxone. Conclusion Further work is needed to encourage PWID to carry and effectively use naloxone to decrease rates of fatal opioid overdose. While accessing treatment for substance use disorder was positively associated with carrying naloxone, EMS response to 911 calls for overdose, the emergency department, and syringe services programs may be settings in which naloxone access and carrying could be encouraged among PWID.
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Abstract
Across all care environments, pharmacists play an essential role in the care of people who use and misuse psychoactive substances, including those diagnosed with substance use disorders. To optimize, sustain, and expand these independent and collaborative roles, the Association for Multidisciplinary Education and Research in Substance Use and Addiction (AMERSA) has developed core competencies for pharmacists to address substance use in the 21st century. Key concepts, skills, and attitudes are outlined, with links to entrustable professional activities to assist with integration into a variety of ideally interdisciplinary curricular activities.
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Affiliation(s)
- Jeffrey Bratberg
- Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston, Rhode Island, USA
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Lajam CM, Cenname J, Hutzler LH, Bosco JA. Ethics of Opioid Prescriber Regulations: Physicians, Patients, and Pain. J Bone Joint Surg Am 2019; 101:e128. [PMID: 31800432 DOI: 10.2106/jbjs.19.00437] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Opioid addiction affects patients of every race, sex, and socioeconomic status. Overprescribing is a known cause of the opioid crisis. Various agencies have implemented requirements and programs to combat practitioner overprescribing; however, there can be adverse ethical consequences when regulations are used to influence physician behavior. We aimed to explore the ethical aspects of some of these interventions. METHODS We reviewed various interventions for opioid prescribing through the lens of ethical inquiry. Specifically, we evaluated (1) requirements for educational programs for prescribers and patients, (2) prescription monitoring programs, (3) prescription limits, (4) development of condition-specific pain management guidelines, (5) increased utilization of naloxone, and (6) opioid disposal programs. We also evaluated patient satisfaction survey questions relating to pain. RESULTS The present analysis demonstrated that the following regulatory interventions are ethically sound: requirements for educational programs for prescribers and patients, robust prescription monitoring programs that cross state lines, increased prescribing of naloxone for at-risk patients, development of condition-specific pain management guidelines, improvement of opioid disposal programs, and elimination of pain-control questions from patient satisfaction surveys. However, implementation of strict prescribing limits without accommodation for procedure and patient characteristics may have negative ethical consequences. CONCLUSIONS Although the importance of addressing the current opioid crisis cannot be understated, as surgeons, we must examine ethical implications of any new regulations that affect musculoskeletal patient care.
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Affiliation(s)
| | - John Cenname
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | | | - Joseph A Bosco
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
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Follman S, Arora VM, Lyttle C, Moore PQ, Pho MT. Naloxone Prescriptions Among Commercially Insured Individuals at High Risk of Opioid Overdose. JAMA Netw Open 2019; 2:e193209. [PMID: 31050777 PMCID: PMC6503491 DOI: 10.1001/jamanetworkopen.2019.3209] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
IMPORTANCE As opioid-related mortality continues to increase, naloxone remains a critical intervention in preventing overdose death. Opportunities to expand access through the health care setting should be optimized. OBJECTIVE To determine the characteristics of naloxone prescribing for US patients at high risk of opioid overdose. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used Truven Health MarketScan data from October 1, 2015, through December 31, 2016, of individuals with International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes related to opioid use, misuse, dependence, and overdose. The cohort included 138 108 commercially insured individuals aged 15 years or older in the United States with claims related to opioid misuse or dependence, opioid-related overdose, or both. EXPOSURES Outpatient naloxone pharmacy claims. MAIN OUTCOMES AND MEASURES Demographic characteristics, clinical characteristics, health care service use, and proportion prescribed naloxone were included in multivariable logistic regression analyses to test the association of opioid risk group with naloxone claim. RESULTS Of 138 108 high-risk individuals (mean [SD] age, 43.4 [0.4] years; 72 435 [52.4%] men), 2135 (1.5%) were prescribed naloxone. Having prior diagnoses of both opioid misuse or dependence and overdose was associated with a greater likelihood of receiving naloxone (odds ratio [OR], 2.32; 95% CI, 1.98-2.72; P < .001) compared with having a prior diagnosis of opioid misuse or dependence without overdose. Having a prior diagnosis of opioid overdose alone was associated with a decreased likelihood of receiving naloxone (OR, 0.73; 95% CI, 0.57-0.94; P = .01) compared with having a prior diagnosis of opioid misuse or dependence without overdose. Factors associated with lower naloxone prescription included being aged 30 to 44 years (OR, 0.72; 95% CI, 0.62-0.84; P < .001) and being from the Midwest (OR, 0.62; 95% CI, 0.54-0.71; P < .001) or West (OR, 0.85; 95% CI, 0.74-0.98; P = .03). Opioid use disorder treatment, such as use of medication-assisted therapy (OR, 1.68; 95% CI, 1.53-1.86; P < .001), visiting a detoxification facility (OR, 1.51; 95% CI, 1.31-1.76; P < .001), or receiving other substance use disorder treatment (OR, 1.16; 95% CI, 1.04-1.30; P = .01), were associated with increased likelihood of receiving naloxone, as were receiving outpatient care from a pain specialist (OR, 1.57; 95% CI, 1.40-1.76; P < .001), psychologist (OR, 1.49; 95% CI, 1.29-1.70; P < .001), or surgeon (OR, 1.19; 95% CI, 1.08-1.32; P < .001). Overall, 98.5% (n = 135 973) of high-risk patients did not received naloxone, despite many interactions with the health care system, including 88 618 hospitalizations, 229 680 emergency department visits, 298 058 internal medicine visits, and 568 448 family practice visits. CONCLUSIONS AND RELEVANCE Patients at high risk of opioid overdose rarely received prescriptions for naloxone despite numerous interactions with the health care system. Prescribing in emergency, inpatient, and outpatient settings represents an opportunity to improve access.
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Affiliation(s)
- Sarah Follman
- University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Vineet M. Arora
- Section of General Internal Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Chris Lyttle
- Center for Health and the Social Sciences, University of Chicago Medicine, Chicago, Illinois
| | - P. Quincy Moore
- Section of Emergency Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Mai T. Pho
- Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, Illinois
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