Community pharmacists in Virginia dispensing naloxone under a standing order: A qualitative study

Ijioma, Stephen C.; Fernández, E.; Gatewood, Sharon B.S.; Carroll, Norman V.; Salgado, Teresa M.

doi:10.1016/j.japh.2021.06.004

Cited by 7 publications

(4 citation statements)

References 28 publications

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“…Naloxone is readily accessible at Massachusetts pharmacies to both people at risk of overdose and potential opioid overdose bystanders [16], yet many bystanders are uncomfortable due to fear of being stigmatized and have easy access to it through other more acceptable sources. Previous research indicates that bystanders who access and are trained to use naloxone have positive outcomes in terms of increased knowledge, confidence, and frequency of overdose reversals [33,59,60]. A majority of participants in this study reported having naloxone; however, few had obtained it from a pharmacy despite broad awareness of the NSO.…”

Section: Discussionmentioning

confidence: 74%

“…In addition, although existing US research has explored perspectives on naloxone from pharmacists and pharmacy staff [21,[28][29][30][31][32][33][34][35][36], other healthcare providers [37][38][39][40][41], law enforcement [42][43][44][45][46][47][48], and the general public [49][50][51], there remains a gap in knowledge regarding the perspectives of family members and friends of people who use illicit opioids (particularly those who do not currently use illicit opioids themselves), despite US Surgeon General guidelines [8], and the high likelihood that they will be called upon to respond to an overdose [52]. One study reported that as many as 35% of parents of children who use illicit opioids (PWUIO) have been witness to an opioid overdose [53].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

If We Build It, Will They Come? Perspectives on Pharmacy-Based Naloxone Among Family and Friends of People who use Opioids: A Mixed Methods Study

Slocum

Ozga

Walley

et al. 2021

Preprint

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Background: Expanding access to the opioid antagonist naloxone to reduce overdose mortality is a public health priority in the United States. Naloxone standing orders (NSOs) have been established in many states to increase naloxone dispensing at pharmacies, but increased pharmacy access does not ensure optimal uptake among those likely to witness an overdose. In a prior statewide purchase trial, we documented high levels of naloxone access at Massachusetts pharmacies under a statewide NSO. In this study, we characterize barriers to pharmacy-based naloxone uptake among potential opioid overdose “bystanders” (friends or family of people who use opioids) that may be amenable to intervention.Methods: Eligible bystanders were Massachusetts residents >18 years of age, did not use illicit opioids in the past 30 days, and knew someone who currently uses illicit opioids. We used a sequential mixed methods approach, in which a series of semi-structured qualitative interviews (N=22) were conducted to inform the development of a subsequent quantitative survey (N=260). Results: Most survey participants (77%) reported ever obtaining naloxone but few (21%) attempted to purchase it at a pharmacy. Qualitative participants revealed that barriers to utilizing the NSO included low perceived risk of overdose, which was rooted in misconceptions regarding the risks of prescription opioid misuse, denial about their loved one’s drug use, and drug use stereotypes; inaccurate beliefs about the impact of naloxone on riskier opioid use; and concerns regarding anticipated stigma and confidentiality. Many participants had engaged in mutual support groups, which served as a source of free naloxone for half (50%) of those who had ever obtained naloxone.Conclusions: Despite high levels of pharmacy naloxone access in Massachusetts, few bystanders in our study had attempted to obtain naloxone under the NSO. Low perceived risk of overdose, misinformation, stigma and confidentiality were important barriers to pharmacy naloxone uptake, all of which are amenable to intervention. Support groups provided a setting for addressing stigma and misinformation and provided a discreet and comfortable setting for naloxone access. Where these groups do not exist and for bystanders who do not participate in such groups, pharmacies are well-positioned to fill gaps in naloxone availability.

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Section: Discussionmentioning

confidence: 74%

Section: Introductionmentioning

confidence: 99%

If We Build It, Will They Come? Perspectives on Pharmacy-Based Naloxone Among Family and Friends of People who use Opioids: A Mixed Methods Study

Slocum

Ozga

Walley

et al. 2021

Preprint

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show abstract

“…Although California state law allows pharmacies to furnish naloxone without a prescription, about 40% of pharmacies surveyed in our study did not provide this service. Pharmacist barriers to naloxone dispensing include inadequate training in identifying and educating patients at risk of overdose, limited time to educate patients, lack of confidence communicating with patients about naloxone, and uncertainty about naloxone access laws [9][10][11]. Most of the chain pharmacies in our study had both naloxone or buprenorphine in stock, or at least one of the two, likely due to company-wide policy.…”

Section: Discussionmentioning

confidence: 94%

“…Pharmacists in some states must have specific training on naloxone as well as providing education on administration of the drug to the recipient which may be time-consuming and costly [9]. Pharmacists may also have stigma towards people who use drugs, may be concerned with liability issues, lack the confidence to dispense naloxone and communicate with patients, be misinformed about legal and pharmacological aspects of naloxone, and have inadequate staffing and time to ensure proper naloxone distribution protocol [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Buprenorphine and naloxone access in pharmacies within high overdose areas of Los Angeles during the COVID-19 pandemic

et al. 2022

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Background Buprenorphine and naloxone are first-line medications for people who use opioids (PWUO). Buprenorphine can reduce opioid use and cravings, help withdrawal symptoms, and reduce risk of opioid overdose. Naloxone is a life-saving medication that can be administered to reverse an opioid overdose. Despite the utility of these medications, PWUO face barriers to access these medications. Downtown Los Angeles has high rates, and number, of opioid overdoses which could potentially be reduced by increasing distribution of naloxone and buprenorphine. This study aimed to determine the accessibility of these medications in a major urban city by surveying community pharmacies regarding availability of buprenorphine and naloxone, and ability to dispense naloxone without a prescription. Methods Pharmacies were identified in the Los Angeles downtown area by internet search and consultation with clinicians. Phone calls were made to pharmacies at two separate time points–September 2020 and March 2021 to ask about availability of buprenorphine and naloxone. Results were collected and analyzed to determine percentage of pharmacies that had buprenorphine and/or naloxone in stock, and were able to dispense naloxone without a prescription. Results Out of the 14 pharmacies identified in the downtown LA zip codes, 13 (92.9%) were able to be reached at either time point. The zip code with one of the highest rates of opioid-related overdose deaths did not have any pharmacies in the area. Most of the pharmacies were chain stores (69.2%). Eight of the 13 (61.5%) pharmacies were stocked and prepared to dispense buprenorphine upon receiving a prescription, and an equivalent number was prepared to dispense naloxone upon patient request, even without a naloxone prescription. All of the independent pharmacies did not have either buprenorphine or naloxone available. Conclusions There is a large gap in care for pharmacies in high overdose urban zip codes to provide access to medications for PWUO. Unavailability of medication at the pharmacy-level may impede PWUO ability to start or maintain pharmacotherapy treatment. Pharmacies should be incentivized to stock buprenorphine and naloxone and encourage training of pharmacists in harm reduction practices for people who use opioids.

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Pharmacy naloxone codispensing: A mixed methods study of practices and perspectives under a statewide standing order program

Pollini¹,

Slocum²,

Ozga³

et al. 2022

Journal of the American Pharmacists Association

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Community pharmacists in Virginia dispensing naloxone under a standing order: A qualitative study

Cited by 7 publications

References 28 publications

If We Build It, Will They Come? Perspectives on Pharmacy-Based Naloxone Among Family and Friends of People who use Opioids: A Mixed Methods Study

If We Build It, Will They Come? Perspectives on Pharmacy-Based Naloxone Among Family and Friends of People who use Opioids: A Mixed Methods Study

Buprenorphine and naloxone access in pharmacies within high overdose areas of Los Angeles during the COVID-19 pandemic

Pharmacy naloxone codispensing: A mixed methods study of practices and perspectives under a statewide standing order program

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