Why aren’t Australian pharmacists supplying naloxone? Findings from a qualitative study

Olsen, Anna; Lawton, Belinda; Dwyer, Robyn; Taing, Meng‐Wong; Chun, Ka Lai Joyce; Hollingworth, Samantha; Nielsen, Suzanne

doi:10.1016/j.drugpo.2019.03.020

Cited by 28 publications

(31 citation statements)

References 47 publications

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“…The non‐dispensed naloxone supply increased slightly in most states around the time of rescheduling, which may reflect pharmacies stockpiling naloxone in anticipation of future demand, but these increases were not statistically significant and were not maintained after rescheduling. These patterns in population level data accord with qualitative data from interviews during 2016–2017 with Australian pharmacists, who reported they were not receiving requests for take home naloxone, and that naloxone ordered prior to rescheduling had passed its expiry date and had not been replaced …”

Section: Discussionsupporting

confidence: 62%

Community pharmacy naloxone supply, before and after rescheduling as an over‐the‐counter drug: sales and prescriptions data, 2014–2018

Tse

Sanfilippo

Lam

et al. 2020

Medical Journal of Australia

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Objectives: To characterise the community pharmacy supply of naloxone by supply type -individual prescription, prescriber bag, and non-dispensed (supplied over the counter or expired) -during 2014-2018; to examine whether the 2016 rescheduling of naloxone as an over-the-counter drug influenced non-dispensed naloxone supply volume.Design, setting: Analysis of monthly naloxone prescriptions (Pharmaceutical Benefits Scheme) and sales data (IQVIA), 2014-2018, for Australia and by state and territory; time series analysis of non-dispensed naloxone supply to assess effect of rescheduling on naloxone supply. Major outcomes:Total naloxone supply to community pharmacies; prescribed and non-dispensed naloxone supply. Results:During 2014-2018, 372 351 400 μg units of naloxone were sold to community pharmacies: non-dispensed naloxone accounted for 205 866.5 units (55.3%), prescriber bags for 155 841 units (41.8%), and individual prescriptions for 10 643.5 units (2.9%). Populationadjusted national naloxone sales to community pharmacies increased between 2014 and 2018 (per year: incidence rate ratio [IRR], 1.15; 95% CI, 1.09-2.22). This increase was primarily attributable to increased volumes of prescriber bag naloxone (IRR, 1.63; 95% CI, 1.50-1.78) and, to a lesser extent, increased individual prescription supply (IRR, 2.04; 95% CI, 1.85-2.26). Non-dispensed naloxone supply volume was unchanged at the national level (IRR, 0.93; 95% CI, 0.85-1.01); changes in non-dispensed supply immediately following rescheduling and subsequently were not statistically significant in time series analyses for most jurisdictions. Conclusions:Total naloxone supply to community pharmacies in Australia increased between 2014 and 2018, but rescheduling that enabled over-the-counter access did not significantly influence the volume of non-dispensed naloxone.The known: Take home naloxone programs are effective for preventing opioid overdose deaths. Most overdoses in Australia involve pharmaceutical opioids, but little is known about how much naloxone is supplied in primary care, where most pharmaceutical opioids are prescribed.The new: The volume of naloxone supplied on individual prescriptions accounted for less than 3% of all naloxone supplied to pharmacies. Further, despite the 2016 scheduling change that permits naloxone supply without prescription, the over-thecounter supply of naloxone did not increase between 2014 and 2018.The implications: Although prescriptions are no longer a barrier to obtaining naloxone, further strategies are required to increase the supply of take home naloxone.

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Section: Discussionsupporting

confidence: 62%

Community pharmacy naloxone supply, before and after rescheduling as an over‐the‐counter drug: sales and prescriptions data, 2014–2018

Tse

Sanfilippo

Lam

et al. 2020

Medical Journal of Australia

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“…This includes fear of potential change in the pharmacist's attitude towards the patient if they were to ask for a naloxone kit, or fear of any consequences of being labelled as an "addict" for having a history of naloxone dispensing in their patient profile [52]. From the pharmacist's perspective, pharmacists reported being afraid of offending a patient when offering them a naloxone kit [52,53]. For example, in Olsen et al, some pharmacists mentioned that they were uncomfortable introducing the subject of naloxone with patients whom they felt were at risk of opioid overdose [53].…”

Section: Barriers: Stigmamentioning

confidence: 99%

“…From the pharmacist's perspective, pharmacists reported being afraid of offending a patient when offering them a naloxone kit [52,53]. For example, in Olsen et al, some pharmacists mentioned that they were uncomfortable introducing the subject of naloxone with patients whom they felt were at risk of opioid overdose [53]. The pharmacists stated that they were not sure how to introduce the topic of opioid overdose and naloxone to patients taking prescription opioids as they felt that it would make the patient feel judged [53].…”

Section: Barriers: Stigmamentioning

confidence: 99%

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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“…People taking part in THN interventions should be asked whether they have previously had an intervention, and have sufficient knowledge and confidence to respond to a suspected overdose and use naloxone, and if so, then naloxone should be supplied without repeat training. This is relevant given the increasing emphasis upon THN interventions being delivered in community pharmacies, with inconsistent pharmacist training and stigma concerns have been identified [15].…”

Section: Discussionmentioning

confidence: 99%

The role of repeat training in participants undertaking take home naloxone interventions

Bravo

Monds

Mills

et al. 2020

Preprint

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Introduction and Aims: Training of consumers is seen as a necessary component of take home naloxone (THN) interventions, with demonstrated improvements in consumer knowledge, attitudes and self-efficacy. However, we query whether re-training is necessary component for individuals renewing naloxone supplies who have previously completed a THN intervention. Design and Methods: A secondary analysis of the Overdose Response and Take Home Naloxone (ORTHN) project, comparing participant characteristics, and changes in knowledge, attitudes and self-efficacy regarding overdose and response, following a brief THN intervention in participants who had previously undertaken THN interventions, compared to those with no prior THN interventions. Data was analysed for those completing both baseline (pre-ORTHN intervention) and follow up (3-months later). Results: Ninety-four participants completed both research interviews, of whom 29 (31%) had previously completed a THN intervention. There were few differences in baseline demographics or overdose histories between the two groups. Knowledge regarding overdose response and naloxone use indicated high baseline levels in both groups. Those with no prior THN training had lower rates of self-efficacy at baseline, and significantly improved following the ORTHN intervention, whereas those with prior THN training had higher baseline levels of self-efficacy, which was maintained following the intervention. Discussion and Conclusions: Individuals who have previously undertaken a THN intervention may not require repeat training when renewing naloxone supplies, increasing the efficiency of THN interventions.

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Why aren’t Australian pharmacists supplying naloxone? Findings from a qualitative study

Cited by 28 publications

References 47 publications

Community pharmacy naloxone supply, before and after rescheduling as an over‐the‐counter drug: sales and prescriptions data, 2014–2018

Community pharmacy naloxone supply, before and after rescheduling as an over‐the‐counter drug: sales and prescriptions data, 2014–2018

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

The role of repeat training in participants undertaking take home naloxone interventions

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