Pharmacist involvement in combating the opioid crisis: A mixed‐methods approach revealing conflicting perceptions

Abstract

Introduction Although the opioid crisis has been acknowledged as a public health emergency that requires collaboration and engagement from pharmacists, the perceptions of pharmacists on their role in harm reduction strategies and their views on opioid use have not been well established. Objectives The primary objective of this study was to understand Minnesota pharmacists' attitudes about the profession's role in the opioid crisis, including perceptions on the pharmacist's public health and clinical roles within the crisis, views on the dispensing of naloxone, and attitudes toward harm reduction strategies including syringe access. Methods This was a mixed‐method study that utilized an anonymous email survey containing Likert‐type responses which were quantitatively analyzed, as well as open comment boxes evaluated using Consensual Qualitative Research (CQR) methods. Pharmacists with a Minnesota license from all practice settings were invited to participate in the survey. Results While the majority of participating pharmacists acknowledged a need within their communities to address the opioid epidemic agreeing that the profession should have a role in the community response, including provision of patient education and naloxone distribution, a small number of pharmacists believed that either the epidemic was not pertinent to their practice or pharmacy as a profession should not be involved. Concerns regarding naloxone included lack of support from other health professionals, time constraints in practice, and safety and liability concerns with naloxone. Conclusion Considerable opportunity for increased pharmacist education on both opioid use disorder and the role of the pharmacist in harm reduction initiatives exists. Pharmacists from a wide variety of clinical practice settings have appreciable potential to influence the opioid crisis by embracing their clinical and public health roles.

Using qualitative, community-based input to steer post–coronavirus disease 2019 pharmacy practice in substance use

“…Areas of focus including increased medication counseling, especially with opioids, HR access (e.g., naloxone education/prescriptions and syringe access), and community-level education were all cited by SUD professionals and are consistent with published literature. 14 Emphasizing pharmacist engagement in patient and community education, specifically in naloxone education, has been shown to destigmatize SUD and decrease fatal overdose events. 10,[30][31][32][33] Efficacious strategies of HR include naloxone education and distribution, improved syringe access, provision of safe injection sites, and pharmacist-led discussion on drug interactions.…”

“…An important first step in preparing pharmacists to take on increased responsibility for patients with SUD will be to address pharmacist stigmada problematic issue cited during our study and one that has been mentioned in previous literature. 14,31,33,40 Previous literature has detailed prejudiced attitudes clinicians may have toward individuals with SUD such as viewing them as more violent and manipulative than other patient subgroups. 41 Experience of stigma and discrimination may deter those with SUD from seeking recovery and HR services during the pandemic, which emphasizes the…”

“…A 2019 survey focused on naloxone dispensing by pharmacists noted that considerable barriers still exist, such as liability concerns, a lack of training, and time constraints. 14,15 Additional studies found that most pharmacists are apprehensive dispensing opioids and believed their counseling practices to be "policing" opioid prescriptions despite pharmacists being viewed as responsible for medication safety by both patients and pharmacists. 16,17 To illustrate the need for expanded SUD education, surveyed pharmacists perceived a larger percentage of patients (41%) to be misusing opioid pain relievers compared with prescribers(17%).…”

Pharmacists and opioid use disorder care during COVID‐19: Call for action

“…26,34 Pharmacists can implement interprofessional opioid education and naloxone distribution (OEND) services from emergency departments using program toolkits. 51 Public distribution of naloxone offers no cost, low stigma access in communities with high rates of opioid overdoses, yet does not provide in-person training or assistance. 27 Individuals receiving MOUD are at an elevated risk of overdose and frequently encounter a pharmacist.…”

Clinical pharmacy initiative to increase naloxone prescribing in patients with opioid use disorder

“…11 With the recent increase in opioid overdoses being primarily driven by illicit opioids, demand and supply reduction may have limited impact on curbing deaths, and the focus has shifted to harm reduction. 9 Pharmacists have been recognized as integral in addressing the opioid crisis [12][13][14] ; however, literature evaluating outcomes from multifaceted clinical pharmacy specialist (CPS) interventions and involvement is lacking. Thus, this quality improvement initiative aimed to implement a strategy to improve patient safety and patient access to care.…”