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Barnett MJ, Clubbs B, Woodyard A, Wasem V, Prinze J, Tirupasur A, Hosseini S, Kim M, Gallardo F, Polich N, Desselle S. Barriers and motivational factors for engaging in novel opioid and medication disposal-related services in community pharmacies. Res Social Adm Pharm 2024; 20:713-722. [PMID: 38719767 DOI: 10.1016/j.sapharm.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/20/2024] [Accepted: 03/23/2024] [Indexed: 06/17/2024]
Abstract
OBJECTIVE This study aimed to explore and identify motivational factors and barriers for pharmacy personnel participation in specific opioid mitigation programs, using the Theory of Planned Behavior (TPB) as an investigational framework. METHODS A naturalistic inquiry method was employed involving semi-structured interviews with pharmacy personnel to assess their intentions, attitudes, normative beliefs, and behaviors towards participating in naloxone dispensing and provision of at-home drug disposal solutions. Purposive sampling was utilized to recruit participants, with saturation achieved after 12 interviews. Interviews were transcribed and coded to identify recurring themes. RESULTS Four primary themes emerged: 1) the value and benefits of helping others, emphasizing societal, patient, and environmental benefits; 2) limits and barriers to participation, including financial concerns, management support, and time constraints; 3) pharmacists' intrinsic motivators, highlighting personal motivations and differentiation between programs for specific patient types; and 4) program implementation challenges and strategies. CONCLUSION The findings underscore the applicability of the TPB in understanding pharmacy engagement in opioid abatement programs. Despite facing barriers such as financial considerations and time constraints, the overall positive attitudes towards the programs indicate a strong motivation to contribute to public health efforts. Addressing identified barriers and leveraging motivators could enhance participation, potentially mitigating the opioid crisis. Future research should incorporate patient perspectives to fully understand the impact and effectiveness of pharmacy-led interventions, such as naloxone dispensing and disposal solutions, in opioid misuse prevention.
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Affiliation(s)
- Mitchell J Barnett
- Touro University California College of Pharmacy, 1310 Club Dr, Vallejo, CA, 94592, USA.
| | - Brooke Clubbs
- Southeast Missouri State University, One University Plaza, Cape Girardeau, MO, 63701, USA.
| | - Ashley Woodyard
- Touro University California College of Pharmacy, 1310 Club Dr, Vallejo, CA, 94592, USA.
| | - Valerie Wasem
- Touro University California College of Pharmacy, 1310 Club Dr, Vallejo, CA, 94592, USA.
| | - Joyce Prinze
- Touro University California College of Pharmacy, 1310 Club Dr, Vallejo, CA, 94592, USA.
| | - Anuradha Tirupasur
- Touro University California College of Pharmacy, 1310 Club Dr, Vallejo, CA, 94592, USA.
| | - Sina Hosseini
- Touro University California College of Pharmacy, 1310 Club Dr, Vallejo, CA, 94592, USA.
| | - Madison Kim
- Touro University California College of Pharmacy, 1310 Club Dr, Vallejo, CA, 94592, USA.
| | - Faviola Gallardo
- University of Iowa, College of Pharmacy, 180 S Grand Ave, Iowa City, IA, 52242, USA.
| | - Natalie Polich
- Drake University College of Pharmacy & Health Sciences, 2507 University Avenue, Des Moines, IA, 50311, USA.
| | - Shane Desselle
- Touro University California College of Pharmacy, 1310 Club Dr, Vallejo, CA, 94592, USA.
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Irwin AN, Gray M, Ventricelli D, Boggis JS, Bratberg J, Floyd AS, Silcox J, Hartung DM, Green TC. "I go out of my way to give them an extra smile now:" A study of pharmacists who participated in Respond to Prevent, a community pharmacy intervention to accelerate provision of harm reduction materials. Res Social Adm Pharm 2024; 20:512-519. [PMID: 38395644 PMCID: PMC10981567 DOI: 10.1016/j.sapharm.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 02/03/2024] [Accepted: 02/04/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Community pharmacies are well-positioned to improve the health of people with opioid use disorder and who use drugs by providing naloxone and other essential public health supplies. Respond to Prevent (R2P) is a clinical trial which sought to accelerate provision of harm reduction materials through a multicomponent intervention that included in-store materials, online training, and academic detailing. OBJECTIVES The objective of this study was to explore pharmacists' attitudes, knowledge, and experiences in providing naloxone, dispensing buprenorphine, and selling nonprescription syringes following participation in the R2P program. METHODS Two online asynchronous focus groups were conducted with community-based chain pharmacists across Massachusetts, New Hampshire, Oregon, and Washington who had participated in the R2P program. Participants accessed an online repository of group interview items and responded to questions over a short period. Each pharmacist participated anonymously for approximately 30 min over 2 ½ days. Pharmacists answered questions on experiences with pharmacy-based harm reduction care and R2P intervention implementation barriers and facilitators. Qualitative data analysis was conducted by a multidisciplinary team using an immersion-crystallization approach. RESULTS A total of 32 pharmacists participated in the two focus groups. Most participants were female (n = 18, 56%), non-Hispanic (n = 29, 91%), and white (n = 17, 53%). Four major themes were identified related to (1) addressing bias and stigma toward people with opioid use disorder and who use drugs, (2) familiarity and comfort with naloxone provision, (3) perspective and practice shifts in nonprescription syringe sales, (4) structural challenges to harm reduction care in the pharmacy. CONCLUSIONS Community pharmacists across the four states identified attitudes, knowledge, and experiences that create barriers to providing care to people with opioid use disorder and who use drugs. R2P approaches and tools were effective at reducing stigma and changing attitudes but were less effective at addressing structural challenges from the pharmacists' perspective.
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Affiliation(s)
- Adriane N Irwin
- Department of Pharmacy Practice, Oregon State University College of Pharmacy, Corvallis, OR, USA
| | | | - Daniel Ventricelli
- Indivior, Inc., North Chesterfield, VA, USA; Department of Clinical Pharmacy, Philadelphia College of Pharmacy at University of the Sciences, Philadelphia, PA, USA
| | - Jesse S Boggis
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA; Opioid Policy Research Collaborative, Heller School for Social Policy & Management at Brandeis University, Waltham, MA, USA
| | - Jeffrey Bratberg
- Department of Pharmacy Practice and Clinical Research, University of Rhode Island College of Pharmacy, Kingston, RI, USA
| | - Anthony S Floyd
- Department of Psychiatry and Behavioral Sciences, Addictions, Drug & Alcohol Institute, University of Washington School of Medicine, Seattle, WA, USA
| | - Joseph Silcox
- Opioid Policy Research Collaborative, Heller School for Social Policy & Management at Brandeis University, Waltham, MA, USA; Department of Sociology, University of Massachusetts, Boston, MA, USA
| | - Daniel M Hartung
- Department of Pharmacy Practice, Oregon State University College of Pharmacy, Corvallis, OR, USA
| | - Traci C Green
- Opioid Policy Research Collaborative, Heller School for Social Policy & Management at Brandeis University, Waltham, MA, USA; Departments of Emergency Medicine and Epidemiology, Brown Schools of Medicine and Public Health, Providence, RI, USA.
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McDowell L, Hohmann L, Maxson R. Impact of a Didactic-Experiential Naloxone Learning Model to Improve Student Pharmacist Skills and Patient Care. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100576. [PMID: 37459914 DOI: 10.1016/j.ajpe.2023.100576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/29/2023] [Accepted: 07/11/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To assess the impact of an integrated didactic-experiential learning model on student pharmacists' knowledge, confidence, comfort, and intention regarding provision of naloxone for patients receiving opioid therapy. METHODS An integrated didactic-experiential learning model was developed to bridge learning in the classroom and laboratory with application in the experiential setting. Student knowledge, confidence, comfort, and intentions regarding provision of naloxone services were measured via online survey at predidactic, postdidactic, and postexperiential time points, and analyzed using Friedman's analysis of variance. RESULTS A total of 280 first-year student pharmacists completed the baseline survey. The learning model increased student knowledge, confidence, comfort, and intention regarding naloxone services implementation. Specifically, students reported an increase in mean (SD) knowledge score from 60.85% (17.40%) in the predidactic to 81.47% (13.57%) in the postdidactic period. Similarly, mean (SD) confidence (2.49 [0.75] to 3.56 [0.45]), comfort (2.06 [0.74] to 3.57 [0.45]), and intention (3.46 [0.70] to 3.66 [0.44]) increased from pre- to postdidactic period, and these changes were maintained from postdidactic to postexperiential period. CONCLUSION The didactic-experiential learning model increased student knowledge, confidence, comfort, and intentions regarding naloxone services implementation. We believe that the model fills gaps in student pharmacist education and is the first step in enhancing and sustaining community pharmacy-based naloxone services. Although this study was limited to a single college, it shows the effectiveness of linking didactic and experiential training in improving students' knowledge and skills.
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Affiliation(s)
- Lena McDowell
- Auburn University, Harrison College of Pharmacy, Auburn, AL, USA.
| | - Lindsey Hohmann
- Auburn University, Harrison College of Pharmacy, Auburn, AL, USA
| | - Rebecca Maxson
- Auburn University, Harrison College of Pharmacy, Auburn, AL, USA
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Moullin JC, Ely P, Uren H, Staniland L, Nielsen S, Lenton S. Developing a single-session strategy for the implementation of take-home naloxone by community pharmacists using COM-B and design-thinking. FRONTIERS IN HEALTH SERVICES 2023; 3:1227360. [PMID: 37600924 PMCID: PMC10434522 DOI: 10.3389/frhs.2023.1227360] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/14/2023] [Indexed: 08/22/2023]
Abstract
Background Despite the overwhelming evidence of its effectiveness, there is poor implementation of take-home naloxone by pharmacists. Barriers have been explored and mapped to the capability, opportunity, motivation-behaviour (COM-B) model of behaviour change, yet no theoretically informed implementation strategies that target known barriers have been developed. Single-session implementation strategies have been proposed as a simple, scalable way to target multiple barriers. Methods Qualitative participatory methods, incorporating design-thinking principles, were used to develop the key messages of a single-session implementation strategy. The key messages were drafted against COM-B mapped implementation barriers identified in the literature. A participatory workshop involving a pre-mortem exercise and incorporating design-thinking principles were used to refine the messages and generate methods for dissemination. Messages were mapped to interview questions to naturally illicit stories and delivered via storytelling from a pharmacist, a general practitioner, and a person with lived experience of using naloxone. Results A 3 minute 40 second video and a two-page printable infographic were developed and hosted on a website, with links to additional downloadable resources as a single-session implementation strategy. Email was the preferred method for receiving simple professional development communications, with social media also widely accessed. Discussion Implementation science, behavioural change theory, and participatory design methods are a complementary combination to develop implementation strategies. Some pharmacists questioned the participatory design approach to developing an implementation strategy, as it was outside of their comfort zone. However, the participatory process involving end-users resulted in unique ideas that are unlikely to have been generated using more traditional consultative approaches. The delivery as a single-session implementation strategy allows for widespread dissemination and delivery at scale.
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Affiliation(s)
- Joanna C. Moullin
- School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- enAble Institute, Curtin University, Bentley, WA, Australia
| | - Philip Ely
- School of Design and the Built Environment, Faculty of Humanities, Curtin University, Bentley, WA, Australia
| | - Hannah Uren
- School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | - Lexy Staniland
- enAble Institute, Curtin University, Bentley, WA, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, Frankston, VIC, Australia
| | - Simon Lenton
- enAble Institute, Curtin University, Bentley, WA, Australia
- National Drug Research Institute, Curtin University, Bentley, WA, Australia
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Ling-I Tseng O, Lakzadeh P, Conte T, Naumann T, Kuo IF, Mitton C. Barriers and facilitators influencing the management of academic detailing programs: A descriptive analysis of four programs. J Am Pharm Assoc (2003) 2023; 63:1017-1025.e3. [PMID: 37121511 DOI: 10.1016/j.japh.2023.04.023] [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: 10/22/2022] [Revised: 04/23/2023] [Accepted: 04/23/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Educating prescribers is a key strategy to reduce inappropriate prescribing in selection, dose, type, timing, and duration. Academic detailing (AD) is a form of continuing medical education to educate prescribers. AD programs have been established in Canada, Australia, the United States, and other countries. Each program operates uniquely to reflect its local context and resources. It remains unclear how AD programs in universal health care systems differ from each other in their program components and experiences. OBJECTIVES To compare AD programs focusing on components of resources, activities, and services and to identify factors influencing program efficiency during the processes of program management, topic development, and service delivery among the selected Canadian and international AD programs. METHODS We adopted a process evaluation methodology with semistructured interviews and documents. We selected 4 well-established AD programs through an iterative discussion with the BC Ministry of Health: three provincial AD programs in the Canadian provinces of British Columbia, Ontario, and Saskatchewan, and an Australian program based in the State of South Australia. We invited one leader from each program to attend a 1-hour teleconferencing interview. RESULTS The 4 programs shared similarities of public government funding while differed in their operation models (centralized vs. decentralized), employment of detailers (part-time vs. full-time; hired by AD programs vs. hired by partnered multidisciplinary primary care teams) and staff who developed topics (detailers vs. nondetailers). The most common barriers were funding and reaching new participants, followed by team connection, detailer training resources, summarizing skills, and AD session scheduling. The most common facilitators were participant retention, participant recruitment through partnership, and easy access sessions. CONCLUSION AD programs can potentially guide a prescriber's choice of drug. A program's operation can be impacted by its access to resources and participants, activities, and service design.
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Appaneal HJ, Lesniak K, LaPlante KL, Feret B. Student pharmacists delivering academic detailing on adult pneumococcal vaccination to community pharmacists. J Am Pharm Assoc (2003) 2023; 63:1064-1069.e2. [PMID: 37031953 DOI: 10.1016/j.japh.2023.04.003] [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: 01/31/2023] [Revised: 03/21/2023] [Accepted: 04/03/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Academic detailing is an educational outreach approach to disseminate evidence-based information to health care professionals and improve clinical decision making. Pharmacists and physicians are recognized as the most qualified individuals to perform academic detailing; however, trained student pharmacists may also serve as suitable academic detailers. OBJECTIVES To describe our academic detailing intervention that used trained student pharmacists to disseminate an updated pneumococcal vaccination clinical pathway (i.e., decision-support tool) and education to community pharmacists in Rhode Island and Massachusetts. METHODS We updated an academic detailing initiative that included a pneumococcal vaccination clinical pathway and education for community pharmacists in 2021. Two University of Rhode Island (URI) College of Pharmacy pharmacist faculty members trained 6 student pharmacists to perform academic detailing. Student pharmacists visited URI-affiliated community pharmacies throughout Rhode Island and Massachusetts. After each session, each participant received a 6-question anonymous paper survey to assess the effectiveness of the updated pathway and academic detailing session. The survey used a 5-point Likert-type scale. We assessed the percentage agreement with each question. RESULTS Academic detailing was delivered to 76 community pharmacists from May to August 2021. Most respondents agreed (89.2%, 58/65) that their knowledge of which patient populations met eligibility for the pneumococcal conjugate vaccine or pneumococcal polysaccharide vaccine improved. Respondents were confident they could apply the knowledge gained (93.8%, 61/65) and intended to apply the pathway (93.8%, 61/65) to clinical practice. Most respondents expected vaccination practices to change because of the academic detailing and education materials received (83.6%, 51/61). Almost all respondents (95.4%, 62/65) found the educational materials easy to understand. CONCLUSION Trained student pharmacists can deliver academic detailing regarding adult pneumococcal vaccination to community pharmacists. Enlisting the help of student pharmacists may be a sustainable approach to academic detailing and provides students with valuable opportunities to practice delivering educational outreach to community pharmacists.
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Hill LG, Light AE, Green TC, Burns AL, Sanaty Zadeh P, Freeman PR. Perceptions, policies, and practices related to dispensing buprenorphine for opioid use disorder: A national survey of community-based pharmacists. J Am Pharm Assoc (2003) 2023; 63:252-260.e6. [PMID: 36202711 DOI: 10.1016/j.japh.2022.08.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/29/2022] [Accepted: 08/18/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Increasing buprenorphine prescribing for opioid use disorder (OUD) has been a major focus of U.S. opioid response efforts. However, concerns related to dispensing buprenorphine have been identified among pharmacists. OBJECTIVES This study aimed to describe perceptions, policies, and practices reported by community-based pharmacists in relation to dispensing buprenorphine for OUD and to compare these responses by practice setting. METHODS A cross-sectional online survey was administered to a random sample of 6376 pharmacists. Responses were collected anonymously from October 16, 2021, to November 7, 2021. RESULTS A response rate of 5.1% was achieved with 325 responders, and 281 were eligible to complete the survey. Most reported practicing in a chain (50.9%) or independent pharmacy (34.7%) as a staff pharmacist (39.7%) or pharmacist-in-charge (37.0%). Most (68.1%) indicated they could usually or always fill a buprenorphine prescription promptly. The most common pharmacy policies related to buprenorphine dispensing were checking the prescription drug monitoring program (71.3%), validating the prescriber's X-waiver (44.9%), accepting only local prescribers (37.4%), and prohibiting refills more than one day early (35.8%). Policies limiting buprenorphine access to local prescribers, local patients, and established patients varied by practice setting and were most common in independent pharmacies. The strongest barriers to buprenorphine dispensing were insurance prior authorization, difficulty reaching prescribers with questions, and concerns about buprenorphine diversion. The strongest facilitators of buprenorphine dispensing were increased communication with prescribers, increased trust with prescribers, increased trust with patients, and increased education for pharmacists. CONCLUSION Most respondents indicated they were willing and able to dispense buprenorphine products for OUD promptly. However, they also reported discomfort dispensing when factors representing potential risk of diversion are present. Mitigating this hypersensitivity to diversion risk among pharmacists should be a focus of regulatory agencies and professional organizations. Efforts to address the unique concerns of independent pharmacists will also be essential to improve access.
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Irwin AN, Bratberg JP, Al-Jammali Z, Arnold J, Gray M, Floyd AS, Bolivar D, Hansen R, Hartung DM, Green TC. Implementation of an academic detailing intervention to increase naloxone distribution and foster engagement in harm reduction from the community clinician. J Am Pharm Assoc (2003) 2023; 63:284-294.e1. [PMID: 36567216 PMCID: PMC9933140 DOI: 10.1016/j.japh.2022.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/10/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Respond to Prevent (R2P) is a randomized clinical trial which sought to accelerate distribution of naloxone and other harm reduction materials from community pharmacies. R2P combined an online continuing education course with in-store materials, specifically designed for use in community pharmacies, and then supported implementation through the one-on-one educational technique of academic detailing. OBJECTIVE The objective of this paper is to describe and synthesize our experiences providing academic detailing as part of the R2P randomized trial. METHODS Closed-ended items from standardized post detailing questionnaires were analyzed with descriptive statistics. Open-ended items were content analyzed for key themes using immersion-crystallization qualitative methods. RESULTS A total of 176 pharmacies participated in R2P with 175 receiving their initial academic detailing visit between August 2019 and May 2021. Initial visits were in-person and lasted a median of 35 minutes (interquartile range, 20-45 minutes). The R2P naloxone guide was the most common topic covered (n = 162, 92.6%). Following a fidelity check to assess adequacy of the R2P program implementation, 80 pharmacies (45.7%) required secondary academic detailing. Secondary detailing was more targeted and most frequently focused on the sale of nonprescription syringes (n = 28; 35.2%) or disposal container distribution (n = 30; 37.5%). Analysis of the open-ended items identified factors that the detailers perceived to affect the quality of academic detailing sessions, including the pharmacy environment, participant knowledge of and attitudes toward the subject matter, and ability of the detailer to remain flexible yet consistent. CONCLUSION R2P provided a standardized process to foster naloxone distribution and engagement in harm reduction with demonstrated implementation in 175 community pharmacies across 4 states. Academic detailing was perceived to be well-received and effective at providing education and promoting distribution of naloxone and nonprescription syringes in community pharmacies. Additional research is needed to confirm these perceptions through evaluation post-intervention behavioral and attitude changes.
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Pharmacists and Naloxone: Barriers to Dispensing and Effectiveness of an Educational Outreach Program. J Am Pharm Assoc (2003) 2022; 63:608-613.e3. [PMID: 36631342 DOI: 10.1016/j.japh.2022.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/10/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The Illinois Naloxone Standing Order allows community pharmacists to dispense naloxone; however, this policy initiative may be underutilized. OBJECTIVE Our study aims to characterize naloxone dispensing barriers, overall and by pharmacy type, make recommendations that can inform future policies to improve naloxone access, and evaluate outreach initiative effectiveness from academic detailers' perspectives. METHODS We conducted a retrospective analysis of semistructured data collected as part of an educational outreach program targeting Illinois community pharmacists in 2021. Academic detailers conducted educational outreach visits across community pharmacy settings (i.e., primary pharmacy, grocery pharmacy, or independent pharmacy) to promote standing order use and discuss barriers pharmacists face when dispensing naloxone. Following each visit, detailers recorded visit characteristics, pharmacist-identified obstacles impacting naloxone dispensing, and visit effectiveness. RESULTS Detailers performed in-person visits at 270 (78%) of 348 targeted sites. A lower proportion of independent pharmacies (61%) routinely stock naloxone than primary (95%, P < 0.001) or grocery (98%, P < 0.001) pharmacies. Among pharmacists at independent pharmacies, 43% indicated they were highly or extremely comfortable dispensing naloxone, a significantly lower proportion than pharmacists at grocery (79%, P < 0.001) or primary (68%, P < 0.001) pharmacies. The prevalence of salient barriers to naloxone dispensing was: cost/insurance issues (primary pharmacy = 38% vs. grocery pharmacy = 36% vs. independent pharmacy = 28%, P = 0.46), stigma (36% vs. 49% vs. 16%, P < 0.05), and lack of standing order enrollment (0% vs. 0% vs. 49%, P < 0.05). On average, detailers perceived visits as less useful to pharmacists working at independent pharmacies than those at primary or grocery pharmacies. CONCLUSIONS Over 80% of pharmacists reported facing greater than one naloxone dispensing barrier. While cost/insurance issues appear ubiquitous, patient stigma-related factors were prevalent in primary and grocery pharmacies. Although many pharmacists are comfortable dispensing naloxone under the standing order, pharmacists at independent pharmacies are less comfortable, potentially secondary to lower standing order enrollment.
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Coffin PO, Martinez RS, Wylie B, Ryder B. Primary care management of Long-Term opioid therapy. Ann Med 2022; 54:2451-2469. [PMID: 36111417 PMCID: PMC9487960 DOI: 10.1080/07853890.2022.2121417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The United States underwent massive expansion in opioid prescribing from 1990-2010, followed by opioid stewardship initiatives and reduced prescribing. Opioids are no longer considered first-line therapy for most chronic pain conditions and clinicians should first seek alternatives in most circumstances. Patients who have been treated with opioids long-term should be managed differently, sometimes even continued on opioids due to physiologic changes wrought by long-term opioid therapy and documented risks of discontinuation. When providing long-term opioid therapy, clinicians should document opioid stewardship measures, including assessments, consents, medication reconciliation, and offering naloxone, along with the rationale to continue opioid therapy. Clinicians should screen regularly for opioid use disorder and arrange for or directly provide treatment. In particular, buprenorphine can be highly useful for co-morbid pain and opioid use disorder. Addressing other substance use disorders, as well as preventive health related to substance use, should be a priority in patients with opioid use disorder. Patient-centered practices, such as shared decision-making and attending to related facets of a patient's life that influence health outcomes, should be implemented at all points of care.Key messagesAlthough opioids are no longer considered first-line therapy for most chronic pain, management of patients already taking long-term opioid therapy must be individualised.Documentation of opioid stewardship measures can help to organise opioid prescribing and protect clinicians from regulatory scrutiny.Management of resultant opioid use disorder should include provision of medications, most often buprenorphine, and several additional screening and preventive measures.
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Affiliation(s)
- Phillip O Coffin
- San Francisco Department of Public Health, Center on Substance Use and Health, San Francisco, CA, USA
| | - Rebecca S Martinez
- San Francisco Department of Public Health, Center on Substance Use and Health, San Francisco, CA, USA
| | - Brian Wylie
- San Francisco Department of Public Health, Center on Substance Use and Health, San Francisco, CA, USA
| | - Bunny Ryder
- San Francisco Department of Public Health, Center on Substance Use and Health, San Francisco, CA, USA
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Availability of buprenorphine/naloxone films and naloxone nasal spray in community pharmacies in 11 U.S. states. Drug Alcohol Depend 2022; 237:109518. [PMID: 35691255 DOI: 10.1016/j.drugalcdep.2022.109518] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 05/23/2022] [Accepted: 05/28/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Prompt access to prescribed buprenorphine/naloxone films (BUP/NX) and naloxone nasal spray (NNS) is vital for patients with opioid use disorder (OUD), but multiple studies have documented pharmacy-level barriers. METHODS A cross-sectional secret shopper telephone audit was conducted in a sample of 5734 actively licensed pharmacies in 11 U.S. states from May 2020-April 2021. Primary outcomes included availability of 14 generic BUP/NX 8/2 mg and one unit of NNS 4 mg. Outcomes were compared by pharmacy type, county metropolitan status, state Medicaid expansion status, and state drug overdose death rate. RESULTS Data from 4984 pharmacies (3402 chain and 1582 independent) were analyzed. Both medications were available in 41.2 % of pharmacies, BUP/NX was available in 48.3%, and NNS was available in 69.5%. Chain pharmacies were significantly more likely than independent pharmacies to have both medications available, to have each medication available individually, and to be willing to order BUP/NX. Pharmacies in metropolitan counties were more likely to have BUP/NX available than pharmacies in non-metropolitan counties, pharmacies in Medicaid expansion states were more likely to have both medications available and to have NNS available than pharmacies in non-expansion states, and pharmacies in states with high drug overdose death rates were more likely to have NNS available than pharmacies in states with low drug overdose death rates. CONCLUSIONS BUP/NX and NNS are not readily accessible in many U.S. pharmacies. Deficits in access are most pronounced in independent pharmacies, though county- and state-level factors may also influence availability of these essential medications.
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Lai RK, Friedson KE, Reveles KR, Bhakta K, Gonzales G, Hill LG, Evoy KE. Naloxone Accessibility Without an Outside Prescription from U.S. Community Pharmacies: A Systematic Review. J Am Pharm Assoc (2003) 2022; 62:1725-1740. [DOI: 10.1016/j.japh.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 10/16/2022]
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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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Pollini RA, Slocum S, Ozga J, Joyce R, Xuan Z, Green TC, Walley AY. Pharmacists' experiences with a statewide naloxone standing order program in Massachusetts: a mixed methods study. J Am Pharm Assoc (2003) 2022; 62:157-166. [PMID: 34511372 PMCID: PMC8742759 DOI: 10.1016/j.japh.2021.08.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/15/2021] [Accepted: 08/17/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES In a prior statewide naloxone purchase trial conducted in Massachusetts, we documented a high rate of naloxone dispensing under the state's standing order program. The purpose of this study was to understand the factors that facilitate naloxone access under the Massachusetts naloxone standing order (NSO) program and identify any remaining barriers amenable to intervention. DESIGN Mixed methods design involving a pharmacist survey and 3 pharmacist focus groups. SETTING AND PARTICIPANTS Focus groups were conducted at 3 separate professional conferences for pharmacists (n = 27). The survey was conducted among Massachusetts pharmacists (n = 339) working at a stratified random sample chain and independent retail pharmacies across Massachusetts. All data were collected between September 2018 and November 2019. OUTCOME MEASURES Facilitators and barriers to NSO implementation and naloxone dispensing and pharmacists' attitudes and beliefs regarding naloxone and opioid use. RESULTS Most pharmacists described NSO implementation as being straightforward, although differences were reported by pharmacy type in both the survey and focus groups. Facilitators included centralized implementation at chain pharmacies, access to Web-based resources, regularly stocking naloxone, and use of naloxone-specific intake forms. Barriers included patient confidentiality concerns and payment/cost issues. Only 31% of surveyed pharmacists reported always providing naloxone counseling; the most commonly cited barriers were perceived patient discomfort (21%) and time limitations (14%). Confidential space was also more of a concern for independent (vs. chain) pharmacists (18% vs. 6%, P = 0.008). A majority of pharmacists held supportive attitudes toward naloxone, although some reported having moral/ethical concerns about naloxone provision. CONCLUSION We documented several facilitators to NSO implementation and naloxone dispensing. Areas for improvement include addressing stigma and misconceptions around opioids and naloxone use. These remain important targets for improving pharmacy-based naloxone dispensing, although our overall positive results suggest Massachusetts' experience with NSO implementation can inform other states' efforts to expand pharmacy-based naloxone access.
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Affiliation(s)
- Robin A. Pollini
- Associate Professor (Pollini), Research Associate (Slocum), Postdoctoral Fellow (Ozga), and Project Coordinator (Joyce), Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown WV,Associate Professor, Department of Epidemiology, School of Public Health, West Virginia University
| | - Susannah Slocum
- Associate Professor (Pollini), Research Associate (Slocum), Postdoctoral Fellow (Ozga), and Project Coordinator (Joyce), Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown WV
| | - Jenny Ozga
- Associate Professor (Pollini), Research Associate (Slocum), Postdoctoral Fellow (Ozga), and Project Coordinator (Joyce), Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown WV
| | - Rebecca Joyce
- Associate Professor (Pollini), Research Associate (Slocum), Postdoctoral Fellow (Ozga), and Project Coordinator (Joyce), Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown WV
| | - Ziming Xuan
- Associate Professor, Department of Community Health Sciences, School of Public Health, Boston University, Boston MA
| | - Traci C. Green
- Professor, The Opioid Policy Research Collaborative, Institute of Behavioral Health, Heller School for Policy and Management, Brandeis University, Waltham, MA
| | - Alexander Y. Walley
- Associate Professor, Grayken Center for Addiction, Boston Medical Center, Boston University School of Medicine, Boston MA
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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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16
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Kulbokas V, Hanson KA, Smart MH, Mandava MR, Lee TA, Pickard AS. Academic detailing interventions for opioid-related outcomes: a scoping review. Drugs Context 2021; 10:2021-7-7. [PMID: 34970320 PMCID: PMC8687092 DOI: 10.7573/dic.2021-7-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/01/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Academic detailing (AD) is a tailored, interactive educational outreach intervention that may improve patient outcomes. Insight into the design of AD interventions and the extent to which they are effective can help inform future AD-based programmes. The objective of this scoping review was to characterize opioid-focused AD interventions and describe their findings. METHODS A scoping review focused on AD interventions for opioids was conducted in PubMed, EMBASE and CINAHL databases through July 1, 2021. Studies were eligible for inclusion if written in English, included interactive opioid-focused educational interventions, and were conducted either in person, virtually or via telephone. Four independent reviewers reviewed titles and abstracts. Data extraction from full-text publications was completed using a standardized form. RESULTS Of 6086 articles initially identified, 22 articles met the inclusion criteria and 20 unique interventions were identified. The AD intervention was either delivered one-on-one (n=16) or in a small, interactive group setting (n=4). AD interventions varied in design. Effectiveness was evaluated in terms of opioid and naloxone prescribing rates, provider knowledge gaps, provider adherence to guidelines, and intervention feasibility. Sixteen (80%) interventions resulted in statistically significant improvement in one or more outcomes. CONCLUSION Generally, opioid-related AD was effective and programmes were primarily conducted one-on-one between pharmacists and primary care providers for 16-30 minutes. A variety of metrics and outcomes were used to assess the success/effectiveness of AD interventions, which is an important consideration in future studies as no single metric captures the effectiveness of an educational outreach-based intervention for pain management.
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Affiliation(s)
- Victoria Kulbokas
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago College of Pharmacy, Chicago, IL, USA
| | - Kent A Hanson
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago College of Pharmacy, Chicago, IL, USA
| | - Mary H Smart
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago College of Pharmacy, Chicago, IL, USA
| | - Monika Rao Mandava
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago College of Pharmacy, Chicago, IL, USA
| | - Todd A Lee
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago College of Pharmacy, Chicago, IL, USA
| | - A Simon Pickard
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago College of Pharmacy, Chicago, IL, USA
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17
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Coffman R, Johnson A, Frede S, Pleiman M, Johnson K. The evaluation of mandatory alerts on long-acting opioid prescriptions and the use of a community pharmacy naloxone protocol. J Am Pharm Assoc (2003) 2021; 62:S35-S40.e1. [PMID: 34930681 DOI: 10.1016/j.japh.2021.11.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/19/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Opioid overdose deaths accounted for approximately 69.5% of the total drug overdoses in the United States in 2018. In the same year, the Centers for Disease Control and Prevention estimates that around 9 million opportunities to dispense naloxone to high-risk patients were missed. Community pharmacists are equipped to help all patients obtain naloxone to prevent opioid-related overdoses. OBJECTIVES The purpose of this study was to determine the impact of mandatory alerts on the dispensing of naloxone by pharmacists using a physician-approved protocol. The primary objective of this study was to evaluate the change in the number of dispensed naloxone prescriptions via physician-approved protocol compared with the same time period in the previous year. The secondary objective was to evaluate the pharmacists' knowledge and confidence dispensing naloxone via physician-approved protocol. PRACTICE DESCRIPTION A system-generated mandatory alert that prompted pharmacists to assess the need for naloxone and initiate and dispense as appropriate via a physician-approved protocol was implemented in 5 pharmacies of a large community pharmacy chain between June and July 2020. PRACTICE INNOVATION A technology enhancement was designed that automatically created a mandatory alert in the pharmacy management system for all patients who were dispensed a long-acting opioid medication to prompt pharmacists to initiate and dispense naloxone as appropriate. EVALUATION METHODS The impact of the mandatory alert was evaluated by assessing patients' medication fill history in the pharmacy management system to determine the change in naloxone prescriptions dispensed. RESULTS During the intervention period, pharmacists initiated and dispensed 34 incremental naloxone prescriptions via a physician-approved protocol compared with the same time period in the previous year. CONCLUSION The results illustrated that system-generated mandatory alerts prompting pharmacist intervention can effectively increase pharmacist utilization of a physician-approved protocol, resulting in increased naloxone prescriptions dispensed to high-risk patients.
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18
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Kavanaugh R, Yerks M, Feldman R, Stanton M. Combining simulated academic detailing with naloxone training to prepare student pharmacists for opioid risk mitigation strategies. CURRENTS IN PHARMACY TEACHING & LEARNING 2021; 13:1679-1682. [PMID: 34895678 DOI: 10.1016/j.cptl.2021.09.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 07/08/2021] [Accepted: 09/15/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND PURPOSE Academic detailing (AD) is an educational outreach intervention designed to provide clinicians with current evidenced-based education to improve patient care and is effective in mitigating opioid risks. Student pharmacists' abilities to apply naloxone training can benefit from concomitant AD training by highlighting skills needed to effectively assess patient and provider needs and handle objections in a non-biased, evidence-supported manner while reinforcing the application of naloxone administration. Most states have a standing order for pharmacist prescribed naloxone. School of pharmacy clinical science faculty sought to create a combined educational activity teaching naloxone AD in conjunction with hands-on naloxone training to better prepare students to apply the standing order in their future careers. EDUCATIONAL ACTIVITY AND SETTING Students in an accelerated pharmacy program applied their AD skills during pharmaceutical skills laboratory activities, emphasizing the use of naloxone administration under the standing order. Students then demonstrated their ability to administer naloxone to a "patient" who experienced an emergency after opioid use. FINDINGS While many schools of pharmacy offer either naloxone or AD training to students, none were identified that offered both trainings combined for use with mitigation strategies for opioid management. SUMMARY The combination of simulated AD with naloxone administration training was designed as a unique opportunity to foster naloxone education and enhance student understanding and demonstration of naloxone administration. School of pharmacy programs should recognize the opportunity to combine these activities to prepare students for application of statewide naloxone standing orders.
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Affiliation(s)
- Rachel Kavanaugh
- Clinical Sciences, Medical College of Wisconsin School of Pharmacy, 8701 Watertown Plank Road, Milwaukee, WI 53226, United States.
| | - McKenzie Yerks
- Medical College of Wisconsin School of Pharmacy, 8701 Watertown Plank Road, Milwaukee, WI 53226, United States.
| | - Ryan Feldman
- Clinical Sciences, Medical College of Wisconsin School of Pharmacy, 8701 Watertown Plank Road, Milwaukee, WI 53226, United States.
| | - Matthew Stanton
- Clinical Sciences, Medical College of Wisconsin School of Pharmacy, 8701 Watertown Plank Road, Milwaukee, WI 53226, United States.
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19
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Dunphy C, Zhang K, Guy GP, Jones CM. Naloxone dispensing among the commercially insured population in the United States from 2015 to 2018. Prev Med 2021; 153:106820. [PMID: 34599923 PMCID: PMC9086913 DOI: 10.1016/j.ypmed.2021.106820] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 09/08/2021] [Accepted: 09/26/2021] [Indexed: 11/16/2022]
Abstract
The Centers for Disease Control and Prevention's (CDC) Guideline for Prescribing Opioids for Chronic Pain recommends that providers consider co-prescribing naloxone when factors that increase the risk of overdose are present. Naloxone is an opioid receptor antagonist that counteracts the effects of an opioid overdose. This paper explores trends in naloxone dispensing and out-of-pocket costs among commercially insured individuals in the United States. Administrative claims data from the IBM Watson Health MarketScan database are analyzed to assess trends in naloxone dispensing from 2015 to 2018. Descriptive statistics on concurrent dispensing of naloxone with opioid analgesics are performed among several at-risk populations. The rate of commercially insured individuals being co-dispensed naloxone increased between 2015 and 2018 across all population sub-groups. In 2018, 16.2 individuals were co-dispensed naloxone for every 1000 receiving an opioid dosage ≥ 90 MME/day compared to 0.9 in 2015, 27.6 individuals were co-dispensed naloxone for every 1000 concurrently dispensed benzodiazepines and an opioid dosage ≥ 90 MME/day compared to 7.6 in 2015, and 43.7 individuals were co-dispensed naloxone for every 1000 receiving an opioid dosage ≥90 MME/day with a past overdose compared to 17.6 in 2015. Median out-of-pocket cost for naloxone increased from $12 in 2015 to $25 in 2018. Despite increases in naloxone dispensing from 2015 to 2018, the provision of naloxone to the commercially insured population remains low. Opportunities remain to increase the supply of naloxone to at-risk populations. Considering ways to reduce out-of-pocket costs associated with naloxone may be a potential strategy to increase access to this life-saving drug.
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Affiliation(s)
- Christopher Dunphy
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Overdose Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341, USA.
| | - Kun Zhang
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Overdose Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341, USA
| | - Gery P Guy
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Overdose Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341, USA
| | - Christopher M Jones
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Overdose Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341, USA
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20
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DiPaula BA, Cooke CE, Boyle CJ, Love RC. Implementation of academic detailing for pharmacists on opioid use disorder and harm reduction. J Am Pharm Assoc (2003) 2021; 62:241-246. [PMID: 34690080 DOI: 10.1016/j.japh.2021.09.012] [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: 02/25/2021] [Revised: 08/04/2021] [Accepted: 09/24/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND The US is experiencing an opioid crisis, substantially worsened by the pandemic. Pharmacists play a critical role in expanding access to care through harm reduction efforts and medications to treat opioid use disorder (mOUD), yet lack necessary education and resources. Academic detailing is a one-on-one technique, which can effectively address educational gaps. OBJECTIVE The purpose was to assess needs and equip pharmacy staff to address the health of people with substance use disorders (SUD). PRACTICE DESCRIPTION Community pharmacists provide ongoing care for patients with SUD. PRACTICE INNOVATION Based on needs' assessment findings, an academic detailing program was designed to provide education and resources for community pharmacies. The project sought to assess current practice and needs and address pharmacists' skills in managing patients with opioid use disorder (OUD) and/or at risk for overdose (OD). Visits were scheduled in high-risk regions. Coaching and materials were provided. EVALUATION METHODS Detailers completed visits reports. Discrete variables were reported using descriptive statistics. Associations between discrete variables were detected with Chi-square or Fisher's exact test. RESULTS Detailers visited 136 pharmacies. Most stocked naloxone (86.8%), mOUD (94.9%) and would sell syringes (64%) per state law. Fifty-seven percent of pharmacies provided all of these services. However, additional education and resources were needed. Only 27.9% had naloxone signage and/or handouts; 22.1% had supplemental materials; and 25% had referral information. When asked to explain barriers, frequently cited themes included providing resources/help, financial issues, stigma, and transportation. CONCLUSION Pharmacists routinely care for patients at risk for OD and diagnosed with OUD. Academic detailing is a well-received strategy to disseminate education and materials, while gathering information about pharmacist needs and barriers. However, there remains room for expansion of services and opportunities for improved care. Further efforts should incorporate ongoing training and access to materials with visual cues, as well as referral and cost savings information.
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21
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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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22
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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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23
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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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Carr-Lopez SM, Strohecker L, Miyahara R, Mai Y, Shek A. Remote introductory pharmacy practice experiences focused on veterans prescribed chronic opioid therapy. Am J Health Syst Pharm 2021; 78:242-248. [PMID: 33354705 DOI: 10.1093/ajhp/zxaa375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE The Department of Veterans Affairs (VA) Northern California Health Care System (NCHCS) uses a dashboard to identify monitoring needs for veterans prescribed chronic opioid therapy (COT). Schools of pharmacy require introductory pharmacy practice experiences (IPPEs); however, resources for providing IPPEs at medical facilities are limited. This article describes collaboration by a primary care service and a school of pharmacy to provide services for patients prescribed COT through remote access to the VA electronic health record (EHR) system. SUMMARY Pharmacy students in a required population health IPPE provided clinical services for veterans remotely. Students were supervised by VA clinical pharmacists and granted remote EHR access privileges. Using personally owned laptops and VA cell phones, students performed prescription drug monitoring program (PDMP) activities, reviewed urine drug screening (UDS) results, called patients to assess pain, and documented progress notes. Students completed an assessment on the first and final days of the experience; a retrospective analysis was conducted to examine differences in student knowledge of and confidence in providing COT-focused services. The dashboard scorecard and student workload were tracked over a 1-year period. In that year, 143 students wrote 7,001 PDMP notes, reviewed 6,130 UDS results, and documented 202 pain assessments. Statistically significant improvements were reported in students' level of confidence in performing population health activities for patients prescribed COT, including interpreting PDMP and UDS results and talking with patients. CONCLUSION The ongoing collaboration provides real-world population management experiences for future pharmacists and supports monitoring requirements for veterans prescribed COT. The program has helped NCHCS accomplish its teaching mission without dedicating clinic workspace or computers and gain an additional team to address quality measures and support population health activities.
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Affiliation(s)
- Sian M Carr-Lopez
- Department of Pharmacy Practice, University of the Pacific Thomas J. Long School of Pharmacy, Stockton, CA.,Primary Care Service, VA Northern California Health Care System, Mather, CA
| | - Lorrie Strohecker
- Department of Pharmacy Practice, University of the Pacific Thomas J. Long School of Pharmacy, Stockton, CA
| | - Randell Miyahara
- Department of Pharmacy Practice, University of the Pacific Thomas J. Long School of Pharmacy, Stockton, CA.,Primary Care Service, VA Northern California Health Care System, Mather, CA
| | - Yvonne Mai
- Department of Pharmacy Practice, University of the Pacific Thomas J. Long School of Pharmacy, Stockton, CA.,Primary Care Service, VA Northern California Health Care System, Mather, CA
| | - Allen Shek
- Department of Pharmacy Practice, University of the Pacific Thomas J. Long School of Pharmacy, Stockton, CA.,Primary Care Service, VA Northern California Health Care System, Mather, CA
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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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Tran T, Ball J, Bratberg JP, DeSimone EM, Franko TS, Hill LG, Sharp CPKK, Palombi L, Ventricelli D, Farrell D, Gandhi N, Moore T. Report of the 2020 Special Committee on Substance Use and Pharmacy Education. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2020; 84:8421. [PMID: 34283760 PMCID: PMC7712728 DOI: 10.5688/ajpe8421] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
EXECUTIVE SUMMARYThe 2020 Special Committee on Substance Use and Pharmacy Education was charged to update the work of the 2010 Special Committee on Substance Abuse and Pharmacy Education Report (SAPER) specifically with recommendations on core curricular content and delivery processes on substance misuse and substance use disorder (SUD). This report provides information on the committee's process to address the charges, background information and resources pertaining to the charges, and rationale for SUD being a critical topic for curriculum at colleges and schools of pharmacy. This committee offers several recommendations to the Association of Colleges of Pharmacy (AACP) pertaining to the committee charges.
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Affiliation(s)
- Tran Tran
- Midwestern University Chicago, College of Pharmacy, Downers Grove, Illinois
| | - Jennifer Ball
- South Dakota State University, College of Pharmacy and Allied Health Professions, Brookings, South Dakota
| | | | - Edward M DeSimone
- Creighton University, School of Pharmacy and Health Professions, Omaha, Nebraska
| | | | - Lucas G Hill
- The University of Texas at Austin College of Pharmacy, Austin, Texas
| | | | - Laura Palombi
- University of Minnesota, College of Pharmacy, Duluth, Minnesota
| | | | - Dorothy Farrell
- American Association of Colleges of Pharmacy, Arlington, Virginia
| | - Nidhi Gandhi
- American Association of Colleges of Pharmacy, Arlington, Virginia
| | - Terri Moore
- American Association of Colleges of Pharmacy, Arlington, Virginia
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Coon SA, Hill LG, Hutchison RW, Arnold LM, Jarrett JB, Ottney AR, Oung AB, Painter NA, Smith MA, Stranges PM, Tran TH, McFee Winans AR, Bratberg JP. Mobilizing pharmacists to address the opioid crisis: A joint opinion of the ambulatory care and adult medicine practice and research networks of the American College of Clinical Pharmacy. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1331] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Scott A. Coon
- Department of Pharmacotherapeutics & Clinical Research University of South Florida, Taneja College of Pharmacy, Morsani College of Medicine Tampa Florida USA
| | - Lucas G. Hill
- Division of Pharmacy Practice The University of Texas at Austin College of Pharmacy Austin Texas USA
| | - Robert W. Hutchison
- Department of Pharmacy Practice Texas A&M Irma Lerma Rangel College of Pharmacy Round Rock Texas USA
| | - Lindsay M. Arnold
- Department of Pharmacy Services St. Elizabeth's Medical Center Brighton Massachusetts USA
| | - Jennie B. Jarrett
- Department of Pharmacy Practice University of Illinois at Chicago, College of Pharmacy Chicago Illinois USA
| | - Anne R. Ottney
- Department of Pharmacy Practice Ferris State University, College of Pharmacy Big Rapids Michigan USA
| | - Alvin B. Oung
- Department of Pharmacy Practice University of Wyoming School of Pharmacy Laramie Wyoming USA
| | - Nathan A. Painter
- Division of Clinical Pharmacy University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences San Diego California USA
| | - Michael A. Smith
- Department of Clinical Pharmacy University of Michigan College of Pharmacy Ann Arbor Michigan USA
| | - Paul M. Stranges
- Department of Pharmacy Practice University of Illinois at Chicago, College of Pharmacy Chicago Illinois USA
| | - Tran H. Tran
- Department of Pharmacy Practice Midwestern University Chicago College of Pharmacy Downers Grove Illinois USA
| | - Amanda R. McFee Winans
- Section of Clinical Pharmacy, Department of Pharmaceutical Care Services Bassett Medical Center Cooperstown New York USA
| | - Jeffrey P. Bratberg
- Department of Pharmacy Practice University of Rhode Island College of Pharmacy Kingston Rhode Island USA
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