Pharmacists’ Attitudes toward Dispensing Naloxone and Medications for Opioid Use Disorder: A Scoping Review of the Literature

Abstract

Background Pharmacists are on the frontline caring for patients at risk of an opioid overdose and for patients with an opioid use disorder (OUD). Dispensing naloxone and medications for OUD and counseling patients about these medications are ways pharmacists can provide care. Key to pharmacists’ involvement is their willingness to take on these practice responsibilities. Methods The purpose of this scoping review is to identify, evaluate, and summarize published literature describing pharmacists’ attitudes toward naloxone and medications for OUD, i.e., methadone, buprenorphine, and naltrexone. All searches were performed on December 7, 2018, in 5 databases: Embase.com , PubMed.gov , Cumulative Index to Nursing and Allied Health Literature (CINAHL) via EBSCOhost, Cochrane Central Register of Controlled Trials via Wiley, and Clarivate Web of Science. Articles included original research conducted in the United States, described attitude-related language toward naloxone and medications for OUD, and pharmacists. Results A total of 1323 articles were retrieved, 7 were included. Five studies reported on pharmacists’ attitudes toward naloxone dispensing, 1 study reported on attitudes toward naloxone, buprenorphine, and buprenorphine/naloxone, and 1 reported on attitudes toward buprenorphine/naloxone. Respondents were diverse, including pharmacists from different practice specialties. Studies found that pharmacists agreed with a naloxone standing order, believed that naloxone should be dispensed to individuals at risk of an opioid overdose, and were supportive of dispensing buprenorphine. A minority of pharmacists expressed negative attitudes. Barriers cited to implementation included education and training, workflow, and management support. Conclusions Pharmacists were positive in their attitudes toward increased practice responsibilities for patients at risk of an opioid overdose or with an OUD. Pharmacists must receive education and training to be current in their understanding of OUD medications, and they must be supported in order to provide effective care to this patient population.

Indiana community pharmacist preceptors’ knowledge and perceptions of medication-assisted treatment

“…This study is the first to look at these pharmacists outside of a medical office and report what they know and think regarding MAT for OUD, especially for methadone and naltrexone. 20 These findings demonstrate an opportunity for education in specific content areas. Most respondents demonstrated an understanding regarding MAT access for OUD.…”

“…Existing U.S.-based research has demonstrated success in primary careebased MAT with documented treatment access improvement for SUDs, but potential pharmacist roles have not been well studied. 18,19 Muzyk et al 20 conducted a literature review for U.S.-based research that reported pharmacists' attitudes toward OUD medications and identified 2 studies evaluating buprenorphine products. 20 In the first study, most pharmacists and technicians involved in an office-based opioid dependence treatment program using buprenorphine-naloxone expressed positive attitudes and perceptions regarding patients treated in that setting.…”

“…18,19 Muzyk et al 20 conducted a literature review for U.S.-based research that reported pharmacists' attitudes toward OUD medications and identified 2 studies evaluating buprenorphine products. 20 In the first study, most pharmacists and technicians involved in an office-based opioid dependence treatment program using buprenorphine-naloxone expressed positive attitudes and perceptions regarding patients treated in that setting. 21 In the second study, researchers assessed West Virginia community-based pharmacy practices regarding buprenorphine product stocking and dispensing.…”

“…Continuing education could include content such as the chronic disease model of addiction and SAMHSA TIP 63. 5,20 Further research is warranted to examine the impact a targeted educational intervention would have on community-based pharmacist preceptors' knowledge and perceptions of MAT for OUD. This research could provide evidence supporting daily dispensing of methadone through pharmacies instead of only through certified OTPs as Compton et al 11 suggest.…”

Impact of a communication technique training on rates of naloxone dispensing

“…6 Despite efforts to increase naloxone access nationwide, pharmacist-initiated dispensing remains low. 7,8 Limited naloxone dispensing suggests the presence of barriers for pharmacists, and studies assessing these barriers are sparse. Carpenter et al, 7 in a study of community pharmacists in North Carolina, examined factors related to how frequently pharmacists offered and dispensed naloxone.…”