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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: 5] [Impact Index Per Article: 2.5] [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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Skoy E, Frenzel O, Eukel H, Lothspeich E, Steig J, Strand M, Werremeyer A. Evaluation of a Program to Screen Patients in Community Pharmacies for Opioid Misuse and Accidental Overdose. Prev Chronic Dis 2022; 19:E41. [PMID: 35834737 PMCID: PMC9336191 DOI: 10.5888/pcd19.220028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction Community pharmacies nationwide have adopted new strategies to combat the opioid epidemic. One strategy to prevent opioid misuse and accidental overdose is patient screening to identify those at risk. The purpose of our study was to determine whether such screening in community pharmacies led pharmacy personnel to intervene with patients at risk and to describe the proportion of patients they identified as at risk. Methods We implemented the Opioid and Naloxone Education (ONE) program in North Dakota to give community pharmacies and pharmacists training and tools to provide preventive screening for opioid misuse and accidental overdose before dispensing a prescribed opioid. Data were collected and analyzed from September 15, 2018, through May 15, 2021, to evaluate overall patient risk characteristics for opioid misuse and accidental overdose. Results Of 8,217 patients screened, 3.9% were identified as at high risk for opioid misuse, and 18.3% at risk for accidental overdose. Nearly 1 of 3 screenings (31.7%) indicated opioid medication use in the past 60 days. Pharmacists delivered 1 or more risk-factor–dependent interventions to 41.1% of patients in the study. Following screening, naloxone dispensing in pharmacies increased to 6 times the national average. Conclusion Pharmacy-based patient screening for risk of opioid misuse and accidental overdose led to risk-dependent interventions targeted to individual patients. The tools and risk-dependent interventions applied in the ONE program increased patient awareness of opioid risks and ways to reduce risk. Future studies should examine long-term outcomes, including reduction in overdose, treatment of opioid use disorder, and reduced opioid-related acute care.
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Affiliation(s)
- Elizabeth Skoy
- North Dakota State University School of Pharmacy, PO Box 6050, Dept 2660, Fargo, ND 58108.
| | - Oliver Frenzel
- North Dakota State University School of Pharmacy, Fargo, North Dakota.,North Dakota State University School of Public Health, Fargo, North Dakota
| | - Heidi Eukel
- North Dakota State University School of Pharmacy, Fargo, North Dakota
| | - Emily Lothspeich
- North Dakota State University School of Pharmacy, Fargo, North Dakota
| | - Jayme Steig
- North Dakota State University School of Pharmacy, Fargo, North Dakota
| | - Mark Strand
- North Dakota State University School of Pharmacy, Fargo, North Dakota.,North Dakota State University School of Public Health, Fargo, North Dakota
| | - Amy Werremeyer
- North Dakota State University School of Pharmacy, Fargo, North Dakota
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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: 7] [Impact Index Per Article: 3.5] [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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Gondora N, Versteeg SG, Carter C, Bishop LD, Sproule B, Turcotte D, Halpape K, Beazely MA, Dattani S, Kwong M, Nissen L, Chang F. The role of pharmacists in opioid stewardship: A scoping review. Res Social Adm Pharm 2021; 18:2714-2747. [PMID: 34261590 DOI: 10.1016/j.sapharm.2021.06.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/26/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The opioid epidemic is an international public health concern. Pharmacists are in a strategic position to promote and implement effective opioid stewardship due to both their central role on health care teams and frequent interaction with patients. Despite this integral role, pharmacists do not have harmonized scopes of practice in opioid stewardship. OBJECTIVES This scoping review was conducted to identify and critically review the role of pharmacists in opioid stewardship and identify future areas of study. METHODS The scoping review was conducted according to the methodological framework proposed by Arksey and O'Malley, which was further modified by the Joanna Briggs Institute. Six databases were searched for original, peer-reviewed research; PubMed (MEDLINE), Ovid Embase, Ovid International Pharmaceutical Abstracts, Scopus, Cochrane Library, and APA PsycInfo. RESULTS In 92% of the included studies (n = 77), opioid stewardship interventions led by either a pharmacist or in an interdisciplinary team resulted in improvements in at least one outcome measure, with education and medication therapy adjustments being the most predominant activities. Other areas supported by evidence include community stakeholder education, policy and guideline setting, and risk assessment. CONCLUSION This scoping review provides valuable insight into the various roles pharmacists can have in opioid stewardship. The findings from this review identified opioid stewardship activities that can make significant contributions towards reducing the impact of the opioid crisis. This review informs future research and has the potential to influence pharmacy practice on a national and international scale.
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Affiliation(s)
- Nyasha Gondora
- School of Pharmacy, University of Waterloo, Ontario, Canada
| | | | - Caitlin Carter
- School of Pharmacy, University of Waterloo, Ontario, Canada
| | - Lisa D Bishop
- School of Pharmacy, Memorial University, Newfoundland and Labrador, Canada
| | - Beth Sproule
- Centre for Addiction and Mental Health & Leslie Dan Faculty of Pharmacy, University of Toronto, Ontario, Canada
| | - Dana Turcotte
- College of Pharmacy, University of Manitoba, Manitoba, Canada
| | - Katelyn Halpape
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatchewan, Canada
| | | | - Shelita Dattani
- Neighborhood Pharmacy Association of Canada, Ottawa, Ontario, Canada
| | - Mona Kwong
- British Columbia Centre on Substance Use, British Columbia, Canada
| | - Lisa Nissen
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Feng Chang
- School of Pharmacy, University of Waterloo, Ontario, Canada.
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Antoniou T, Pritlove C, Shearer D, Martins D, Tadrous M, Munro C, Gomes T. A qualitative study of a publicly funded pharmacy-dispensed naloxone program. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 92:103146. [PMID: 33568317 DOI: 10.1016/j.drugpo.2021.103146] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 12/28/2022]
Abstract
AIMS To characterize the experiences of individuals accessing pharmacy-based naloxone and relate these experiences to the risk environments and discourses in which they are embedded. METHODS We conducted a qualitative study using in-depth interviews of 37 adults aged 18 years and over who had accessed pharmacy-dispensed naloxone. Participants were recruited from across Ontario, Canada, and comprised individuals taking opioids for chronic pain, those taking opioids for reasons other than chronic pain, and individuals acquiring naloxone to act as bystanders in an opioid overdose setting. We drew upon risk environment theory to interpret participants' accounts. RESULTS Following analysis and interpretation, we generated five theoretically-informed themes characterizing the experiences of individuals accessing pharmacy-dispensed naloxone: 'intersection of naloxone narrative with pharmacy environment', 'individual risk environment and pharmacy-dispensed naloxone uptake', 'safe spaces: creating an enabling environment for pharmacy-dispensed naloxone', 'individuation: becoming a first responder' and 'beyond naloxone: the macro risk environment'. Specifically, participants described how judgement and stereotyping associated with the broader naloxone narrative can be amplified in the space of the pharmacy, leading to fears of reprisals and strategies to mitigate social risk. In addition, the social construction of naloxone as a drug for 'problematic' opioid use and a lack of pharmacist awareness regarding the risk environments in which opioid use occurs was perceived to limit opportunities for optimizing naloxone distribution and training. Finally, participants described approaches that could create enabling environments in the space of the pharmacy while remaining cognizant of the structural changes required in the macro risk environments of people who take opioids. CONCLUSIONS Despite increasing the availability of naloxone, participants characterized several social and environmental factors that could limit the accessibility of the drug from pharmacies. Strategies to address these factors could create enabling environments within pharmacies that optimize the reach and impact of pharmacy-dispensed naloxone.
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Affiliation(s)
- Tony Antoniou
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada; Department of Family and Community Medicine, Unity Health, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Ontario Drug Policy Research Network, Toronto, Ontario, Canada
| | - Cheryl Pritlove
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada; School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Dana Shearer
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada; Ontario Drug Policy Research Network, Toronto, Ontario, Canada
| | - Diana Martins
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada; Ontario Drug Policy Research Network, Toronto, Ontario, Canada
| | - Mina Tadrous
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada; Ontario Drug Policy Research Network, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Toronto, Ontario, Canada
| | - Charlotte Munro
- Ontario Drug Policy Research Network, Toronto, Ontario, Canada
| | - Tara Gomes
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada; Ontario Drug Policy Research Network, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
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What Is Known about Community Pharmacy-Based Take-Home Naloxone Programs and Program Interventions? A Scoping Review. PHARMACY 2021; 9:pharmacy9010030. [PMID: 33540676 PMCID: PMC7931101 DOI: 10.3390/pharmacy9010030] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/29/2021] [Accepted: 01/29/2021] [Indexed: 12/13/2022] Open
Abstract
A variety of new sources describing community pharmacy-based take-home naloxone (THN) programs have emerged recently in the literature. There is a need to define the types of take-home naloxone programs being offered to support future research designs in implementing and evaluating standardized programs that fill pharmacist and patient knowledge gaps and lift current barriers for optimal community pharmacy naloxone provision. The objective of this paper is to summarize the literature on community pharmacy-based THN programs, including specific program interventions used to increase naloxone dispensing, naloxone availability and dispensing patterns, facilitators and barriers for the THN programs, and knowledge gaps. Online databases such as PubMed, EMBASE, Scopus, and International Pharmaceutical Abstracts (IPA) and a search of the grey literature were used to identify eligible sources. Sources were screened by two reviewers for eligibility in COVIDENCE software. Both reviewers compared screening results and resolved conflicts through discussion. A data extraction form for all identified full texts was completed by both reviewers and results were compiled through reviewer discussion. Fifty-two sources met the eligibility criteria. The top three barriers identified were: cost/coverage of naloxone, stigma, and education/training for pharmacists. THN program interventions included screening tools, checklists, pocket cards, patient brochures, and utilizing the pharmacy management system to flag eligible patients. Patient knowledge gaps included naloxone misinformation and lack of awareness, while pharmacists demonstrated administrative, clinical, and counselling knowledge gaps. Naloxone availability was found to be highly variable, where independent and rural pharmacies were less likely to stock or dispense naloxone. Further, pharmacies located in districts with higher rates of opioid overdose deaths and lower household income were also less likely to have naloxone available. This review identified multiple new programs, showcasing that the implementation and evaluation of THN programs are an expanding area of research. Future research should focus on implementing and evaluating a THN program through a randomized controlled trial design that incorporates solutions for the barriers and knowledge gaps identified in this study.
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Antoniou T, McCormack D, Campbell T, Sutradhar R, Tadrous M, Lum-Wilson N, Leece P, Munro C, Gomes T. Geographic variation in the provision of naloxone by pharmacies in Ontario, Canada: A population-based small area variation analysis. Drug Alcohol Depend 2020; 216:108238. [PMID: 32891910 DOI: 10.1016/j.drugalcdep.2020.108238] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/15/2020] [Accepted: 08/11/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Regional variation in pharmacy-dispensed naloxone rates could create access disparities that undermine the effectiveness of this approach. We explored individual and public health unit (PHU)-level determinants of regional variation in naloxone distribution through the Ontario Naloxone Program for Pharmacies. METHODS We conducted a population-based study between April 1, 2017 and March 31, 2018. We calculated age- and sex-standardized pharmacy-dispensed naloxone rates for the 35 Ontario PHUs, and identified determinants of these rates using generalized estimating equations negative binomial regression. RESULTS The age- and sex-standardized pharmacy-dispensed naloxone rate in Ontario was 5.5 (range 1.8-11.6) kits per 1000 population. Variables associated with higher naloxone dispensing rates included opioid use disorder history [rate ratio (RR) 2.27; 95% confidence interval (CI) 1.75-2.96], opioid agonist therapy (RR 11.17; 95% CI 7.15-17.44), and PHU opioid overdose rate (RR 1.09 per 10 deaths; 95% CI 1.06-1.13). Pharmacy-dispensed naloxone rates were lower in rural areas (RR 0.83; 95% CI 0.73-0.94) and among individuals dispensed one (RR 0.72; 95% CI 0.65-0.79), two to five (RR 0.67; 95% CI 0.54-0.84) or 6-10 (RR 0.92; 95% CI 0.74-1.14) opioids in the prior year relative to those receiving no opioids. CONCLUSION Pharmacy-dispensed naloxone programs are important components of a public health response to the opioid overdose crisis. We found considerable variation in pharmacy-dispensed naloxone rates that could limit program effectiveness, particularly in rural settings with limited access to health and harm reduction services..
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Affiliation(s)
- Tony Antoniou
- ICES, Toronto, Ontario, Canada; Department of Family and Community Medicine, St. Michael's Hospital, Canada; Unity Health Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Ontario Drug Policy Research Network, Canada
| | | | | | - Rinku Sutradhar
- ICES, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Mina Tadrous
- ICES, Toronto, Ontario, Canada; Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Women's College Hospital, Toronto, Ontario, Canada; Ontario Drug Policy Research Network, Canada
| | | | - Pamela Leece
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Public Health Ontario Toronto, Ontario, Canada
| | | | - Tara Gomes
- ICES, Toronto, Ontario, Canada; Unity Health Toronto, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Ontario Drug Policy Research Network, Canada.
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Skoy E, Werremeyer A, Steig J, Eukel H, Frenzel O, Strand M. Patient acceptance of naloxone resulting from targeted intervention from community pharmacists to prevent opioid misuse and accidental overdose. Subst Abus 2020; 42:672-677. [PMID: 33044896 DOI: 10.1080/08897077.2020.1827126] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Community pharmacists are in a unique position to prevent opioid-related deaths through the provision of naloxone. However, for those identified as candidates for take-home naloxone, the acceptance rate remains low. Value would be gained from knowing what patient demographics and pharmacist actions are associated with increased patient acceptance of naloxone. Methods: Through a state-wide program, community pharmacists screened all patients receiving an opioid prescription for risk of opioid misuse and/or accidental overdose. Pharmacists prescribed and/or dispensed take-home naloxone to patients at elevated risk. Naloxone acceptance rates were stratified based on risk factors for misuse and overdose to determine which patients are most likely to accept naloxone. Patient acceptance of naloxone and risks were captured electronically. Results: Pharmacist-initiated naloxone recommendations based on risk screening resulted in a 5.81% take-home naloxone acceptance rate. Individuals that were taking multiple opioid medications were most likely to accept the naloxone (20.45%). Concurrent disease states or medications (COPD, concurrent anxiety/depression medication, concurrent sleep aid) were associated with a statistically significant increase in the rate of naloxone acceptance. Acceptance of take-home naloxone increased as a patient risk for opioid misuse and/or accidental overdose increased. Conclusion: Patient acceptance of naloxone at the community pharmacy level was notably higher compared to national naloxone dispensing rates when pharmacists implemented a patient screening and systematic risk-based approach to identify candidates in need of take-home naloxone.
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Affiliation(s)
- Elizabeth Skoy
- Pharmacy Practice Department, North Dakota State University, Fargo, North Dakota, USA
| | - Amy Werremeyer
- Pharmacy Practice Department, North Dakota State University, Fargo, North Dakota, USA
| | - Jayme Steig
- Quality Health Associates of North Dakota, Minot, North Dakota, USA
| | - Heidi Eukel
- Pharmacy Practice Department, North Dakota State University, Fargo, North Dakota, USA
| | - Oliver Frenzel
- Pharmacy Practice Department, North Dakota State University, Fargo, North Dakota, USA
| | - Mark Strand
- Pharmacy Practice Department, North Dakota State University, Fargo, North Dakota, USA
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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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Spivey CA, Wilder A, Chisholm-Burns MA, Stallworth S, Wheeler J. Evaluation of naloxone access, pricing, and barriers to dispensing in Tennessee retail community pharmacies. J Am Pharm Assoc (2003) 2020; 60:694-701.e1. [PMID: 32146134 DOI: 10.1016/j.japh.2020.01.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/16/2020] [Accepted: 01/29/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Tennessee has one of the highest rates of opioid prescribing in the United States; therefore, the objectives of this study were to examine availability, pricing, and pharmacist-initiated recommendations of naloxone in retail community pharmacies in Eastern and Western Tennessee; to identify the most common barriers to naloxone dispensing and strategies to improve access; and to determine regional differences in access to naloxone. DESIGN A cross-sectional survey conducted via telephone. SETTING AND PARTICIPANTS All retail community pharmacies located in the most populous counties in the eastern and western regions of Tennessee were eligible for inclusion, as were all retail community pharmacies in the 5 counties in each region that had the highest rates of opioid prescriptions (316 pharmacies identified in 12 counties). OUTCOME MEASURES Outcome measures included availability, price, and pharmacist-initiated recommendations of naloxone products, barriers to dispensing, and suggestions to improve naloxone access. Survey responses were summarized as descriptive statistics. Chi-square, independent samples t test, and inductive content analysis were conducted. RESULTS Response rate was 56.3%. Most participants (92.7%) reported that naloxone (Narcan) was available from their pharmacies at a mean cash price of $132.49, with no statistically significant differences between regions. The most commonly reported barrier was cost (70.2%). When queried about recommendations to various groups at a high risk of overdose, as advised by the U.S. Department of Health and Human Services, 42.1% to 69.1% of pharmacies reported recommending naloxone to at least 50% of high-risk patients. Suggestions to increase naloxone access included lowering the cost and improving naloxone-related education for patients, pharmacists, and other providers. CONCLUSION Although Narcan was widely available, cost was a frequently cited barrier to dispensing. Pharmacist-initiated recommendations for coprescribing and dispensing naloxone to patients at a high risk of overdose were limited. Addressing cost issues in addition to increasing patient and pharmacist education concerning the use and benefit of naloxone were suggested to improve naloxone access.
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