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Osinski K, Afseth J. A systematic review exploring healthcare professionals' perceptions of take-home naloxone dispensing in acute care areas. J Adv Nurs 2024. [PMID: 38563492 DOI: 10.1111/jan.16181] [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: 08/09/2023] [Revised: 03/13/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
AIMS To explore healthcare professionals' perceptions and experiences of take-home naloxone initiatives in acute care settings to gain an understanding of issues facilitating or impeding dispensing. DESIGN Systematic literature review. DATA SOURCES Cochrane, MEDLINE and CINAHL were searched from 15/03/2021 to 18/03/2021, with a follow-up search performed via PubMed on 22/03/2021. The years 2011 to 2021 were included in the search. REVIEW METHODS A systematic literature review focused on qualitative studies and quantitative survey designs. Synthesis without meta-analysis was undertaken using a thematic analysis approach. RESULTS Seven articles from the United States of America (5), Australia (1) and Canada (1) with 750 participants were included in the review. Results indicate ongoing stigma towards people who use drugs with preconceived moral concerns regarding take-home naloxone. There was confusion regarding roles and responsibilities in take-home naloxone dispensing and patient education. Similarly, there was a lack of clarity over logistical and financial issues. CONCLUSION Take-home naloxone is a vital harm reduction initiative. However, barriers exist that prevent the optimum implementation of these initiatives. IMPACT What is already known: Deaths due to opioid overdose are a global health concern, with take-home naloxone emerging as a key harm reduction scheme. Globally, less than 10% of people who use drugs have access to treatment initiatives, including take-home naloxone. An optimum point of distribution of take-home naloxone is post-acute hospital care. WHAT THIS PAPER ADDS There is role confusion regarding responsibility for the provision of take-home naloxone and patient education. This is exacerbated by inconsistent provision of training and education for healthcare professionals. Logistical or financial concerns are common and moral issues are prevalent with some healthcare professionals questioning the ethics of providing take-home naloxone. Stigma towards people who use drugs remains evident in some acute care areas which may impact the use of this intervention. Implications for practice/policy: Further primary research should examine what training and education methods are effective in improving the distribution of take-home naloxone in acute care. Education should focus on reduction of stigma towards people who use drugs to improve the distribution of take-home naloxone. Standardized care guidelines may ensure interventions are offered equally and take-home naloxone 'champions' could drive initiatives forward, with support from harm reduction specialists. REPORTING METHOD This has adhered to the PRISMA reporting guidelines for systematic reviews. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Karen Osinski
- National Poisons Information Service, NHS Lothian, Edinburgh Napier University, Edinburgh, UK
| | - Janyne Afseth
- Edinburgh Napier University, Robert Gordon University, Aberdeen, UK
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Rawal S, Osae SP, Tackett RL, MacKinnon NJ, Soiro FD, Young HN. Community pharmacists' naloxone counseling: A theory-informed qualitative study. J Am Pharm Assoc (2003) 2023; 63:1743-1752.e2. [PMID: 37633453 DOI: 10.1016/j.japh.2023.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Opioid-related overdose (ORO) deaths have reached a record high in the United States. Naloxone is an opioid antagonist that can rapidly reverse an opioid overdose. Pharmacists are in an ideal position to provide naloxone and related counseling, given their accessibility and expertise. However, minimal research is available on community pharmacists' naloxone counseling. OBJECTIVES The aim of this study was to investigate Georgia community pharmacists' naloxone counseling as well as explore their attitudes, subjective norms, and perceived behavioral control toward counseling. METHODS Semi-structured telephone interviews were conducted to elicit pharmacists' beliefs and practices regarding naloxone counseling. The interviews were guided by open-ended questions based on the theory of planned behavior (TPB). Thematic analysis was performed to identify the modal salient beliefs expressed by the pharmacists. The Consolidated Criteria for Reporting Qualitative Research was used to report the study findings. RESULTS A total of 12 community pharmacists participated. Pharmacists held mixed attitudes toward naloxone counseling. While they recognized it as a vital part of their profession to prevent ORO deaths, they also expressed concerns about offending patients. Regarding normative beliefs, pharmacists identified several groups, including regulatory agencies (e.g., Board of Pharmacy, CDC), managers, news/media, patients, and doctors, influencing their provision of naloxone counseling. Facilitators to counseling included receiving naloxone training and having access to counseling guidelines and resources. Reimbursement issues, high costs of naloxone, and lack of patient awareness were the most commonly cited barriers. Pharmacists reported participating in counseling and providing information on identifying signs of opioid overdose and administering naloxone. CONCLUSIONS The TPB is a useful framework for understanding community pharmacists' beliefs and practices regarding naloxone counseling. Capitalizing on facilitators and targeting barriers related to pharmacists' reimbursement issues, high costs of naloxone, and increasing patients' awareness of naloxone use and benefits may enhance pharmacists' naloxone counseling.
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Floyd AS, Silcox J, Cousin E, Irwin AN, Gray M, Bolivar D, Bratberg J, Arnold J, Al-Jammali Z, Hansen RN, Hartung DM, Green TC. Readiness of community pharmacies to implement an opioid safety intervention. J Am Pharm Assoc (2003) 2023; 63:275-283.e1. [PMID: 36496310 PMCID: PMC9870924 DOI: 10.1016/j.japh.2022.10.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 10/31/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND We report on efforts to measure readiness to adopt opioid safety initiatives in community pharmacies within 2 large chains. Previous studies identified lack of knowledge, confidence, or enthusiasm in addressing harm reduction efforts. We implemented an intervention that provided training to improve opioid safety. The goal was to increase naloxone prescribing and nonprescription syringe sales, reduce stigma, and decrease opioid overdoses among patients and customers. OBJECTIVES To assess pharmacy readiness for intervention delivery, by characterizing pharmacy culture around opioid safety; describing current practices and challenges interacting with patients and customers on naloxone, nonprescription syringe sales, and buprenorphine; and determining pharmacy defined goals for implementing the intervention. METHODS The sample included pharmacy managers and staff pharmacists from 2 large chains who completed a brief phone interview. Interviews consisted of Likert-scale and open-ended, theoretically driven questions. Questions focused on workplace culture, patient engagement, naloxone and buprenorphine prescribing, nonprescription syringe sales, and intervention goals. Coding categories for the open-ended questions were derived using a thematic review of responses. RESULTS A total of 163 respondents described both workplace culture and how they encourage patient opioid safety as including public health awareness, patient engagement, and naloxone prescribing. Sale of nonprescription syringes exhibited high variability: no sales barriers (53.9%), sales with barriers (21.5%), and no sales (20.9%). Half of pharmacists (50.3%) interacted with buprenorphine prescribers outside of medication fills. Most respondents (68.7%) endorsed being ready to promote the intervention. Pharmacists named goals in adopting the intervention of wanting more knowledge and educational materials, talking points with patients, and best practices for offering naloxone. CONCLUSION Community pharmacists, before implementation, described awareness of and receptiveness to opioid safety initiatives, with substantial barriers around nonprescription syringe sales. Assessed knowledge level, culture, and identified barriers that emerged in the readiness assessments can be used to tailor future pharmacy-specific programming.
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Sandhu RK, Heller MV, Buckanavage J, Haslund-Gourley B, Leckron J, Kupersmith B, Goss NC, Samson K, Gadegbeku AB. A longitudinal study of naloxone opioid overdose awareness and reversal training for first-year medical students: specific elements require reinforcement. Harm Reduct J 2022; 19:70. [PMID: 35780103 PMCID: PMC9250225 DOI: 10.1186/s12954-022-00656-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/08/2022] [Indexed: 11/21/2022] Open
Abstract
Background The opioid epidemic is a progressively worsening public health crisis that continues to impact healthcare system strategies such as overdose reversal and destigmatization. Even among healthcare professionals, there remains a lack of confidence in naloxone administration and a prevalence of stigma. While training can play a major impact in reducing these shortcomings, the long-term effectiveness has yet to be characterized in training healthcare professionals. This study examined the long-term retention of opioid overdose awareness and reversal training (OOART) by evaluating performance at two-time intervals, immediately post-training and at a 3-month follow-up. Methods Voluntary training was offered to first-year (M1) medical students at the Drexel University College of Medicine in 2021. At this training, 118 students completed training, 95 completed the post-training survey, and 42 completed the 3-month follow-up. Results Opioid reversal knowledge questions assessed significantly increased scores post-training and at the 3-month follow-up. In three of the attitude questions, scores were improved at both follow-up timepoints. In addition, three attitude questions indicating a participant’s confidence to respond to an opioid overdose situation increased directly after the training, but regressed at the 3-month follow-up. The remaining questions did not show any statistical difference across the survey intervals. Conclusions This study establishes that while OOART provides participants with the knowledge of how to respond to an opioid overdose, the retention of this knowledge at a 3-month interval is reduced. The results were mixed for longitudinal assessment of participant’s attitudes toward people with opioid use disorder. Some positive increases in attitudes were retained at the 3-month interval, while others trended back toward pre-training levels. These results support the effectiveness of the training but also provide evidence that OOART must be reinforced often. Supplementary Information The online version contains supplementary material available at 10.1186/s12954-022-00656-y.
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Affiliation(s)
- Reena K Sandhu
- Drexel University College of Medicine, Philadelphia, PA, USA.
| | | | | | | | - Joshua Leckron
- Drexel University College of Medicine, Philadelphia, PA, USA
| | | | | | - Kyle Samson
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Annette B Gadegbeku
- Department of Family, Community and Preventive Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
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Musco S, Kicklighter J, Arnett A. Expanding naloxone education in the doctor of pharmacy curriculum. CURRENTS IN PHARMACY TEACHING & LEARNING 2022; 14:310-317. [PMID: 35307090 DOI: 10.1016/j.cptl.2022.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/22/2021] [Accepted: 01/09/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Pharmacists are well-positioned to provide patients with access to the opioid-induced breathing emergency reversal agent naloxone, but many do not feel they have received adequate training to do so. The purpose of this project was to develop, implement, and evaluate an enhanced teaching approach to naloxone education in the doctor of pharmacy (PharmD) curriculum. METHODS The educational intervention incorporated active learning, technology, and interprofessional education components. Surveys were developed and administered pre-intervention and at one-week, six-month, and one-year post-intervention to evaluate changes in knowledge, perceptions, and confidence in clinical skills related to opioid-induced breathing emergencies and naloxone. RESULTS After participating, students' confidence (rated 0 to 5) in their ability to administer both intranasal (2.54 vs. 4.37, P < .001) and intramuscular (IM) (2.8 vs. 4.02, P < .001) naloxone increased, which was reflected in their improved performance on an opioid-induced breathing emergency simulation activity. Students ≤25 years old and females experienced significantly greater increases in their confidence to administer IM naloxone than those >25 years old and male. Most of these effects persisted at six months and one-year post-intervention. CONCLUSIONS The educational intervention increased pharmacy students' skills and confidence related to opioid-induced breathing emergency and naloxone. Improvements observed were in line with results of similar pedagogical studies. Age and gender differences in self-reported confidence levels also reflected previously reported findings. Materials and methods have been made available for other PharmD programs to utilize in expanding their curricula in these areas.
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Affiliation(s)
- Shaina Musco
- Department of Clinical Sciences, High Point University Fred Wilson School of Pharmacy, One University Parkway, High Point, NC 27268, United States.
| | - Jackson Kicklighter
- High Point University Fred Wilson School of Pharmacy, One University Parkway, High Point, NC 27268, United States.
| | - Addison Arnett
- High Point University Fred Wilson School of Pharmacy, One University Parkway, High Point, NC 27268, United States.
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Cruz TH, Bachyrycz A, Rodriguez DE, Ma X, Roberts MH, Chambers S, Rafi J, Sanchez A, Bakhireva L. CONSIDER New Mexico: Effects of naloxone training among pharmacists and pharmacy technicians. J Am Pharm Assoc (2003) 2021; 62:757-765. [PMID: 35016857 DOI: 10.1016/j.japh.2021.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Pharmacists serve a critical role in providing health care, especially in medically underserved areas. Despite the opioid crisis and legislation in most states allowing pharmacists to dispense naloxone without a prescription from another provider, pharmacists face multiple barriers to dispensing naloxone. OBJECTIVE This study tested the effectiveness of CONSIDER New Mexico, an innovative educational initiative designed to increase naloxone dispensing by pharmacies. METHODS A quasi-experimental study was conducted in New Mexico in 2019-2020. Community pharmacists and pharmacy technicians were recruited from a purposive sample of pharmacies. Data were collected through pre- and postintervention surveys with 65 pharmacists and 44 technicians from 49 pharmacies. Data analysis included hybrid fixed-effects regression models of variables associated with pre-post intervention change in intent to dispense naloxone and generalized least squares with maximum likelihood estimation for pre-post intervention change in naloxone dispensing. RESULTS Positive intervention effects were observed for measures of normative beliefs, self-efficacy, and intent to dispense naloxone (P < 0.05). Changes in normative beliefs and self-efficacy were associated with greater intent to offer naloxone to patients (P < 0.05). In addition, the median number of naloxone prescriptions dispensed per month increased 3.5 times after intervention. A statistically significant positive association was observed between the intervention and naloxone dispensing after adjusting for other factors (P < 0.001). Pharmacies providing more than 4 additional health services were more likely to increase naloxone dispensing postintervention than pharmacies offering not more than 2 services (P < 0.01). This difference averaged 19 naloxone prescriptions per month. Estimated change in dispensing postintervention was statistically significantly lower at independent, clinic-based, and other pharmacies where an average of 36 fewer naloxone prescriptions were dispensed per month compared with chain drug stores (P = 0.03). CONCLUSION The CONSIDER New Mexico intervention effectively increased self-efficacy, intent to dispense, and naloxone dispensing. Findings will inform future research examining widespread dissemination and implementation of the intervention and the sustainability of intervention effects.
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Gilbert L, Elliott J, Beasley L, Oranu E, Roth K, Nguyễn J. Naloxone availability in independent community pharmacies in Georgia, 2019. Subst Abuse Treat Prev Policy 2021; 16:63. [PMID: 34419089 PMCID: PMC8379837 DOI: 10.1186/s13011-021-00402-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increasing the availability of naloxone among people who use opioids, and friends and family of past and present people who use opioids is a vitally important mission to reduce the occurrence of opioid-related overdose deaths. The purpose of this study was to determine the availability of naloxone in independent community pharmacies in Georgia. Secondary objectives include determining pharmacists' knowledge regarding the standing order and ability to counsel regarding naloxone. METHODS A cross-sectional study using a secret shopper approach with phone contact was conducted over a period of 10 months. The study was population based and was conducted at all independent pharmacies in the state of Georgia. All independent community pharmacies in the state of Georgia were contacted and asked the naloxone questions with a 96% response rate (n = 520). RESULTS Five hundred fifty-eight independent community pharmacies were called, with a 96% response rate (n = 520 pharmacies). Two hundred-twenty pharmacies reported having naloxone in stock. Of the 335 pharmacists asked, 174 (51.9%) incorrectly said that a prescription was required. The mean (SD) cash price was $148.02 (27.40), with a range of $0 to $300. Of 237 pharmacists asked who had naloxone in stock or who stated they could get naloxone in stock, 212 stated that they could demonstrate how to use it, 8 stated they could not, and 17 said that they possibly could or were unsure how to use it. CONCLUSIONS This study provided insight into the limited availability of naloxone at independent community pharmacies in Georgia after the standing order was issued. The majority of pharmacists at independent pharmacies in Georgia were not using the publicly available state naloxone standing order. Additionally, the low availability of naloxone and its high cost for uninsured individuals are significant structural barriers for reducing opioid-related mortality.
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Affiliation(s)
- Lauren Gilbert
- University of Houston College of Medicine, Houston, TX, USA
| | - Jennifer Elliott
- Mercer University College of Pharmacy, 3001 Mercer University Drive, Atlanta, GA, USA
| | - Lauren Beasley
- Mercer University College of Pharmacy, 3001 Mercer University Drive, Atlanta, GA, USA
| | - Ekene Oranu
- Mercer University College of Pharmacy, 3001 Mercer University Drive, Atlanta, GA, USA
| | - Kimberly Roth
- Mercer University School of Medicine, Savannah, GA, USA
| | - Jennifer Nguyễn
- Mercer University College of Pharmacy, 3001 Mercer University Drive, Atlanta, GA, USA.
- Mercer University School of Medicine, Savannah, GA, USA.
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Evoy KE, Hill LG, Davis CS. Considering the Potential Benefits of Over-the-Counter Naloxone. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2021; 10:13-21. [PMID: 33623754 PMCID: PMC7894851 DOI: 10.2147/iprp.s244709] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/27/2021] [Indexed: 01/30/2023] Open
Abstract
Since 1999, annual opioid-related overdose (ORO) mortality has increased more than six-fold. In response to this crisis, the US Department of Health and Human Services outlined a 5-point strategy to reduce ORO mortality which included the widespread distribution of naloxone, an opioid antagonist that can rapidly reverse an opioid overdose. Increased distribution has been facilitated by the implementation of naloxone access laws in each US state aimed at increasing community access to naloxone. While these laws differ from state-to-state, most contain mechanisms to enable pharmacists to dispense naloxone without a patient-specific prescription. These laws have enhanced community naloxone distribution, both from pharmacies and overdose education and naloxone distribution programs, and produced positive effects on ORO mortality. However, a growing body of evidence has revealed that significant barriers to naloxone access from pharmacies remain, and annual ORO deaths have continued to climb. Given these concerns, there has been a push among some clinicians and policymakers for the US Food and Drug Administration to re-classify naloxone as an over-the-counter (OTC) medication as a means to further increase its accessibility. If an OTC transition occurs, educational outreach and funding for clinical innovations will continue to be crucial given the important role of health professionals in recommending naloxone to people at risk for experiencing or witnessing an ORO. Recognizing the severity of the ORO public health crisis, we believe transitioning formulations of naloxone approved for layperson use to OTC status would result in a net benefit through increased access. However, such a change should be combined with measures to ensure affordability.
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Affiliation(s)
- Kirk E Evoy
- University Health, Department of Pharmacy, The University of Texas at Austin College of Pharmacy, San Antonio, TX, USA
| | - Lucas G Hill
- Pharmacy Practice, The University of Texas at Austin College of Pharmacy, Austin, TX, USA
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Kennedy AG, Wood M, Starecheski G, Belcher R, Cote E. Academic detailing with ambulatory pharmacists to support naloxone counseling. J Am Pharm Assoc (2003) 2021; 61:e133-e137. [PMID: 33622559 DOI: 10.1016/j.japh.2021.01.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pharmacists are critical to public health in supporting safe use of prescription opioids by ensuring that all patients are offered and counseled on naloxone. Academic detailing may be an effective educational outreach strategy for improving pharmacists' knowledge and behavior related to naloxone. OBJECTIVE To describe an academic detailing program to pharmacists on the topic of counseling and promoting naloxone to patients. METHODS Pharmacists were recruited by convenience sampling. Three pharmacists who were experienced with academic detailing techniques provided the education. Survey data were collected to evaluate the program. RESULTS Thirty-three pharmacists participated, including 16 sessions that were delivered virtually. The pharmacists worked in a variety of ambulatory settings, including chain or corporate-owned pharmacies (58%), hospital-owned specialty pharmacies (15%), hospital-owned community pharmacies (15%), and independently owned or other pharmacies (12%). Twenty-eight pharmacists (85%) completed an immediate post-session evaluation survey. Twenty-seven pharmacists (96%) indicated they felt the information presented will impact their practice or patient care. Eleven pharmacists (33%) completed a second post-session survey, self-reporting improvements related to counseling patients about naloxone. CONCLUSION Participating in academic detailing supports community pharmacists' providing patient counseling about naloxone. Further study, particularly related to virtual academic detailing, is necessary to understand the full potential of academic detailing to pharmacists.
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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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Napoli K, Grant M, Remines J, Nadpara P, Goode JVR. Impact of pharmacist counseling to enhance the accessibility of naloxone nasal spray to patients in a community pharmacy setting. J Am Pharm Assoc (2003) 2021; 61:S127-S134. [PMID: 33441280 DOI: 10.1016/j.japh.2020.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 11/30/2020] [Accepted: 12/05/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Centers for Disease Control and Prevention guidelines recommend naloxone for every high-dose opioid prescription; in 2018, only 1 naloxone prescription was dispensed for every 69 high-dose opioid prescriptions. In Virginia, strategies for creating awareness and availability include the REVIVE! training and the standing protocol for pharmacists to dispense naloxone. OBJECTIVES To evaluate if a proactive offer for counseling by pharmacists improves the percent change of patients who receive a prescription for naloxone nasal spray compared with the previous year's naloxone nasal spray fill history and to determine if the pharmacist's counseling affects a patient's confidence with opioid overdose and naloxone use. METHODS Prospective 4-month, interventional study in southwest Virginia conducted at 5 geographically similar large community chain pharmacies. A National Drug Code activity report within each store was used to identify patients, aged 18-64 years, filling opioid medication without naloxone. A pharmacist recommended naloxone to patients at the point of care. Patients accepting the recommendation for naloxone received pharmacist counseling from a standardized counseling script and by using a naloxone nasal spray demo kit. All eligible patients were provided a postintervention survey assessing their confidence with naloxone, if naloxone had been recommended before, and if they were picking up naloxone on the basis of the pharmacist's recommendation. Results were analyzed using univariate and bivariate analyses. RESULTS A total of 121 naloxone prescriptions were dispensed; an increase of 36% compared with the same period during the previous year. In total, 38 patients completed the postintervention survey. After receiving pharmacist counseling, patients indicated being very confident with administering naloxone correctly and for recognizing an opioid overdose, 73.9% and 65.2%, respectively. Of the patients who completed the survey, 60.5% received naloxone and accepted counseling from the pharmacist. CONCLUSION After pharmacist counseling, naloxone dispensing increased, and patients were confident with both administration and recognition.
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Contreras J, Baus C, Brandt C, Witry M, Peters J, Evoy KE. Pharmacist counseling when dispensing naloxone by standing order: A secret shopper study of 4 chain pharmacies. J Am Pharm Assoc (2003) 2020; 61:e94-e99. [PMID: 33153912 DOI: 10.1016/j.japh.2020.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/11/2020] [Accepted: 10/12/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Texas has passed legislation to increase access to naloxone, the opioid overdose antidote, allowing pharmacists to dispense by standing order without an outside prescription. Given this added responsibility, there is a need to assess real-world counseling provided by pharmacists when dispensing naloxone. OBJECTIVES Assess naloxone accessibility and counseling provided by community pharmacists when dispensing naloxone by standing order. METHODS A total of 11 student pharmacists (mean age 25 years; 63.6% female; primarily Hispanic [36.4%], Asian [27.3%], and white [27.3%]) audited community pharmacies by presenting to purchase naloxone. Variables included naloxone availability and price, counseling duration, and whether 13 predetermined counseling points were provided unprompted. Shoppers were prepared with a background story if asked so that each answered questions consistently. All shoppers participated in two 1-hour training sessions, including verification of their ability to accurately assess naloxone counseling. Pharmacies in Bexar County, TX were selected randomly from 4 pharmacy chains, each of which have implemented statewide standing orders within their chain. Descriptive statistics were calculated. A Fisher exact test and linear mixed-effects regression model were used to assess variation across chains in whether naloxone was dispensed and the mean total number of counseling points provided, respectively. RESULTS The shoppers audited 45 pharmacies. Naloxone was dispensed in 31 of 45 (68.9%) encounters (mean cost: $129.59). The mean counseling duration was 89 seconds. The most common counseling points included: administration technique (24 of 31), readministration of second dose (22 of 31), and calling 9-1-1 (20 of 31). All other points were included in less than one-third of pharmacists' counseling. Across the 4 chains, there was significant variation in naloxone dispensing and the number of counseling points provided. CONCLUSION Secret shoppers were unable to access naloxone from nearly one-third of pharmacies. Counseling often excluded concepts pertinent to patient safety and effectiveness, suggesting opportunities remain to promote consistent, high-quality naloxone counseling in community pharmacies.
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Flores MW, Lê Cook B, Mullin B, Halperin-Goldstein G, Nathan A, Tenso K, Schuman-Olivier Z. Associations between neighborhood-level factors and opioid-related mortality: A multi-level analysis using death certificate data. Addiction 2020; 115:1878-1889. [PMID: 32061139 PMCID: PMC7734613 DOI: 10.1111/add.15009] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/02/2019] [Accepted: 02/11/2020] [Indexed: 01/08/2023]
Abstract
AIM To identify associations between opioid-related mortality and neighborhood-level risk factors. DESIGN Cross-sectional study. SETTING Massachusetts, USA. PARTICIPANTS Using 2011-14 Massachusetts death certificate data, we identified opioid-related (n = 3089) and non-opioid-related premature deaths (n = 8729). MEASUREMENTS The independent variables consisted of four sets of neighborhood-level factors: (1) psychosocial, (2) economic, (3) built environment and (4) health-related. At the individual level we included the following compositional factors: age at death, sex, race/ethnicity, marital status, education, veteran status and nativity. The primary outcome of interest was opioid-related mortality. FINDINGS Multi-level models identified number of social associations per 10 000 [odds ratio (OR) = 0.84, P = 0.002, 95% confidence interval (CI) = 0.75-0.94] and number of hospital beds per 10 000 (OR = 0.78, P < 0.001, 95% CI = 0.68-0.88) to be inversely associated with opioid-related mortality, whereas the percentage living in poverty (OR = 1.01, P = 0.008, 95% CI = 1.00-1.01), food insecurity rate (OR = 1.21, P = 0.002, 95% CI = 1.07-1.37), number of federally qualified health centers (OR = 1.02, P = 0.028, 95% CI = 1.02-1.08) and per-capita morphine milligram equivalents of hydromorphone (OR = 1.05, P = 0.003, 95% CI = 1.01-1.08) were positively associated with opioid-related mortality. CONCLUSIONS Opioid-related deaths between 2011 and 2014 in the state of Massachusetts appear to be positively associated with the percentage living in poverty, food insecurity rate, number of federally qualified health centers and per-capita morphine milligram equivalents of hydromorphone, but inversely associated with number of social associations per 10 000 and number of hospital beds per 10 000.
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Affiliation(s)
- Michael William Flores
- Health Equity Research Laboratory, Cambridge Health Alliance, Cambridge, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Benjamin Lê Cook
- Health Equity Research Laboratory, Cambridge Health Alliance, Cambridge, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Brian Mullin
- Health Equity Research Laboratory, Cambridge Health Alliance, Cambridge, MA, USA
| | | | - Aparna Nathan
- Department of Bioinformatics, Harvard Medical School, Boston, MA, USA
| | - Kertu Tenso
- Health Equity Research Laboratory, Cambridge Health Alliance, Cambridge, MA, USA
- Boston University School of Public Health, Boston, MA, USA
| | - Zev Schuman-Olivier
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Addiction Services, Cambridge Health Alliance, Cambridge, MA, USA
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Renfro ML, Moczygemba LR, Baumgartner J, Baumgart G, Hill LG. Opioid-Related Education Provided by Continuing Education Divisions at US Pharmacy Schools. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2020; 84:ajpe8001. [PMID: 33149331 PMCID: PMC7596601 DOI: 10.5688/ajpe8001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 05/17/2020] [Indexed: 05/28/2023]
Abstract
Objective. To quantify the number and type of new opioid-related continuing pharmacy education (CPE) activities offered by continuing education divisions (CEDs) at US schools and colleges of pharmacy from 2015 through 2018, and to determine the number of pharmacists who completed opioid-related CPE activities. Methods. Data was derived from the database of CPE activities maintained by the Accreditation Council for Pharmacy Education (ACPE), which is the sole accreditation agency for all providers of CPE, including pharmacy schools. Data were filtered to include only pharmacy school CPE providers. A search for six keywords (opiates, opioids, pain, pain management, drug overdose, and opioid antagonist) was conducted for the years 2015-2018. The data extracted included title of the CPE activity, contact hours, activity type, activity format, and the number of pharmacists who participated in the activity. Descriptive statistics were used. A content analysis of activity titles was performed. Results. Overall, the CEDs of US schools and colleges of pharmacy delivered 20.3% of all ACPE-approved opioid-related CPE activities from 2015-2018. A total of 1,237 unique opioid-related CPE activities were identified. The number of new CPE activities increased from 249 in 2015 to 297 in 2016 to 349 in 2017, then decreased to 342 in 2018. These activities reached 149,373 pharmacists and were most commonly affiliated with the following keywords: opioids (34.8%) and pain management (30.2%). Conclusion. The opioid epidemic creates an opportunity for pharmacists to increase their role in public health, but education and training are necessary. The study findings indicate that many pharmacists participate in opioid-related CPE provided by ACPE-accredited CEDs of pharmacy schools. This number is likely to increase as a growing number of states are beginning to require opioid-related CPE for pharmacist license renewal.
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Affiliation(s)
- Mandy L. Renfro
- The University of Texas at Austin College of Pharmacy, Austin, Texas
| | | | | | - Glen Baumgart
- The University of Texas at Austin College of Pharmacy, Austin, Texas
| | - Lucas G. Hill
- The University of Texas at Austin College of Pharmacy, Austin, Texas
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Assessing pharmacy-based naloxone access using an innovative purchase trial methodology. J Am Pharm Assoc (2003) 2020; 60:853-860. [PMID: 32651116 DOI: 10.1016/j.japh.2020.05.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/21/2020] [Accepted: 05/26/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Massachusetts was among the first states to allow standing orders to facilitate pharmacy-based naloxone purchases and reduce opioid overdose deaths. We conducted a unique purchase trial to establish a valid measure of standing order naloxone in Massachusetts, using purchasers from 2 high priority populations to determine whether naloxone is less accessible to those who use illicit opioids than other potential purchasers. DESIGN Purchase trial. SETTING AND PARTICIPANTS The study used a stratified random sample of 200 chain and independent retail pharmacies across Massachusetts. Each pharmacy underwent 2 purchase attempts-1 by a person who used illicit opioids (PWUIO) and 1 by a potential bystander who did not use illicit opioids but had a relationship with someone at risk of opioid overdose. OUTCOME MEASURE Successful or unsuccessful naloxone purchase attempt. RESULTS Overall, 322 of 397 purchase attempts (81%) were successful, with no statistically significant difference between PWUIO and bystanders (P = 0.221). Most purchases (93%) resulted in the acquisition of single-step nasal naloxone (Narcan; median cost $133.38). Forty percent of the purchases included state-mandated verbal counseling, and PWUIO were significantly less likely to receive counseling than bystanders (30% vs. 51%, P < 0.001). Common reasons for failed purchase were not stocking naloxone (47%), price > $150 (25%), and requiring a prescription (15%). Chain pharmacies were significantly more likely to sell naloxone than independent pharmacies (86% vs. 53%, P < 0.001). CONCLUSION We documented high levels of naloxone access for both PWUIO and bystanders, suggesting Massachusetts could serve as a model for states seeking to improve pharmacy-based naloxone access. Additional implementation efforts should focus on expanding availability at independent pharmacies and supporting pharmacies in proactively offering naloxone to PWUIO and other high-risk individuals.
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Naloxone availability and dispensing in Indiana pharmacies 2 years after the implementation of a statewide standing order. J Am Pharm Assoc (2003) 2020; 60:470-474. [DOI: 10.1016/j.japh.2019.11.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/15/2019] [Accepted: 11/20/2019] [Indexed: 11/20/2022]
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Gandhi N, Hanes S, Candelario DM, Clough C, Highland J. Impact of a communication technique training on rates of naloxone dispensing. J Am Pharm Assoc (2003) 2020; 60:S37-S40.e1. [DOI: 10.1016/j.japh.2020.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 02/03/2020] [Accepted: 02/03/2020] [Indexed: 12/26/2022]
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Luli AJ, Bounthavong M, Watanabe JH. Pharmacists on the front-line of solving a public health crisis: Increasing access to medications for opioid use disorder. J Am Pharm Assoc (2003) 2019; 60:297-303. [PMID: 31889651 DOI: 10.1016/j.japh.2019.10.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/24/2019] [Accepted: 10/28/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To demonstrate the advantages of pharmacist involvement to increase the accessibility of medication treatment for opioid use disorder (OUD). SUMMARY OUD continues to be a mounting public health crisis in the United States. Medications for OUD treatment have been reported to be safe and effective. Yet, underutilization and poor accessibility remain critical challenges. As the most accessible health care provider, pharmacists have the capability to help overcome these barriers and positively affect patient care. Preliminary strategies have been documented in the United States and abroad that can serve as a blueprint for expanded pharmacist involvement. CONCLUSION Pharmacists must expand efforts to increase patient accessibility to medications for OUD and become a key part of the solution to this epidemic.
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Hill LG, Evoy KE, Reveles KR. Pharmacists are missing an opportunity to save lives and advance the profession by embracing opioid harm reduction. J Am Pharm Assoc (2003) 2019; 59:779-782. [PMID: 31402146 DOI: 10.1016/j.japh.2019.06.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 06/17/2019] [Accepted: 06/24/2019] [Indexed: 02/06/2023]
Abstract
More than 70,000 Americans died as a result of a drug overdose in 2017, and a substantial majority of those deaths involved an opioid. Supply-reduction interventions, such as prescription monitoring programs, tamper-resistant formulations, and prescribing limits have failed to reverse rising rates of opioid-related morbidity and mortality. Instead, they may be contributing to this trend by forcing people with opioid use disorder to an increasingly potent illicit market with scant resources for sterile injection. Pharmacists are recognized by governmental authorities, public health experts, and other health professionals as key partners in opioid harm reduction. This is reflected by the proliferation of state laws supporting pharmacy-based access to naloxone, an opioid antagonist that can rapidly reverse the effects of an opioid overdose. Expanded authority to distribute naloxone without an outside prescription, coupled with the provision of sterile syringes and evidence-based medications for opioid use disorder, represents a powerful opportunity for pharmacists to save lives while advancing the role of the profession. However, numerous studies have documented a lack of readiness among pharmacists to dispense naloxone and little willingness to provide sterile syringes. As a profession, it is imperative that we ensure all pharmacists receive adequate education regarding opioid harm reduction interventions and ongoing support to implement these interventions within their practices.
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