Assessing pharmacists’ readiness to dispense naloxone and counsel on responding to opioid overdoses

Melaragni, Francis; Levy, Carly; Pedrazzi, Jennifer; Andersen, Merissa

doi:10.1016/j.japh.2019.04.012

Cited by 20 publications

(12 citation statements)

References 4 publications

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“…In addition to this belief about naloxone, a telephone survey found additional negative beliefs held by pharmacists, including the notion that it allows opioid users to avoid seeking substance use treatment and avoid emergency treatment after an overdose [46]. Another two studies demonstrated a lack of understanding of cases in which naloxone is clinically appropriate [45,63]. Both showcased a lack of understanding with respect to the existence of a minimum age requirement [35,45], while one of them further demonstrated confusion regarding naloxone's appropriateness in pregnancy or in patients who are undergoing an alcohol or barbiturate overdose [63].…”

Section: Facilitatorsmentioning

confidence: 99%

“…Another two studies demonstrated a lack of understanding of cases in which naloxone is clinically appropriate [45,63]. Both showcased a lack of understanding with respect to the existence of a minimum age requirement [35,45], while one of them further demonstrated confusion regarding naloxone's appropriateness in pregnancy or in patients who are undergoing an alcohol or barbiturate overdose [63]. Counselling knowledge gaps existed for topics such as when to call 9-1-1 when witnessing an overdose and placing the patient in the recovery position [63].…”

Section: Facilitatorsmentioning

confidence: 99%

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What Is Known about Community Pharmacy-Based Take-Home Naloxone Programs and Program Interventions? A Scoping Review

2021

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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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Section: Facilitatorsmentioning

confidence: 99%

Section: Facilitatorsmentioning

confidence: 99%

What Is Known about Community Pharmacy-Based Take-Home Naloxone Programs and Program Interventions? A Scoping Review

2021

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“…However, caution should be exercised, as increased surveillance may lead people who misuse prescription opioids to shift to illicit opioids, such as fentanyl-laced heroin, further increasing the risk of fatal overdose. As a means to combat both legal and illicit opioid misuse Massachusetts has made naloxone, an opioid antagonist used to counter the effects of opioid overdose, widely available without a prescription [72]. Future research should assess the impact of expanding naloxone availability on opioid-related overdose and mortality.…”

Section: Discussionmentioning

confidence: 99%

Associations between neighborhood‐level factors and opioid‐related mortality: A multi‐level analysis using death certificate data

et al. 2020

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Aim To identify associations between opioid‐related mortality and neighborhood‐level risk factors. Design Cross‐sectional study. Setting Massachusetts, USA. Participants Using 2011–14 Massachusetts death certificate data, we identified opioid‐related (n = 3089) and non‐opioid‐related premature deaths (n = 8729). Measurements The independent variables consisted of four sets of neighborhood‐level factors: (1) psychosocial, (2) economic, (3) built environment and (4) health‐related. At the individual level we included the following compositional factors: age at death, sex, race/ethnicity, marital status, education, veteran status and nativity. The primary outcome of interest was opioid‐related mortality. Findings Multi‐level models identified number of social associations per 10 000 [odds ratio (OR) = 0.84, P = 0.002, 95% confidence interval (CI) = 0.75–0.94] and number of hospital beds per 10 000 (OR = 0.78, P < 0.001, 95% CI = 0.68–0.88) to be inversely associated with opioid‐related mortality, whereas the percentage living in poverty (OR = 1.01, P = 0.008, 95% CI = 1.00–1.01), food insecurity rate (OR = 1.21, P = 0.002, 95% CI = 1.07–1.37), number of federally qualified health centers (OR = 1.02, P = 0.028, 95% CI = 1.02–1.08) and per‐capita morphine milligram equivalents of hydromorphone (OR = 1.05, P = 0.003, 95% CI = 1.01–1.08) were positively associated with opioid‐related mortality. Conclusions Opioid‐related deaths between 2011 and 2014 in the state of Massachusetts appear to be positively associated with the percentage living in poverty, food insecurity rate, number of federally qualified health centers and per‐capita morphine milligram equivalents of hydromorphone, but inversely associated with number of social associations per 10 000 and number of hospital beds per 10 000.

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“… 59 , 78 However, studies continue to document gaps in both pharmacist-reported knowledge regarding naloxone and its actual practice behaviors related to its dispensing, indicating that these educational efforts must remain a high priority. 51 , 56 , 59 , 78 , 79 It is possible that converting naloxone to OTC status could remove a powerful incentive for pharmacists to seek, and colleges of pharmacy to provide, opioid-related education. However, this need not and should not be the case, especially since we envision that some formulations would likely remain prescription-only even if more user-friendly versions are moved OTC.…”

Section: Potential Benefits and Risks Of Otc Transitionmentioning

confidence: 99%

Considering the Potential Benefits of Over-the-Counter Naloxone

Evoy¹,

Hill²,

Davis³

2021

IPRP

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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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Assessing pharmacists’ readiness to dispense naloxone and counsel on responding to opioid overdoses

Cited by 20 publications

References 4 publications

What Is Known about Community Pharmacy-Based Take-Home Naloxone Programs and Program Interventions? A Scoping Review

What Is Known about Community Pharmacy-Based Take-Home Naloxone Programs and Program Interventions? A Scoping Review

Associations between neighborhood‐level factors and opioid‐related mortality: A multi‐level analysis using death certificate data

Considering the Potential Benefits of Over-the-Counter Naloxone

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