Challenges and Facilitators of Implementing a Physician-approved Naloxone Protocol: A Mixed-methods Study

Abstract

Objectives: In 2015, the State of Ohio passed legislation to allow pharmacists to dispense naloxone under a physician-approved protocol. The legislation allows all individuals authorized under a physician-approved protocol to personally furnish naloxone without requiring clients to be seen by a licensed prescriber, thus expanding the capacity of Ohio's community distribution programs. We aimed to evaluate the implementation of legislation allowing for a physician-approved protocol in pharmacies and other naloxone distribution sites in Ohio, and to compare barriers and facilitators of implementing the law changes among sites that implemented a physician-approved protocol versus sites that did not. Methods: The study used a convergent parallel mixed-method design. Random samples from all pharmacies registered with the State of Ohio Board of Pharmacy and community naloxone distribution sites were selected. Quantitative data were collected via survey (n = 168) and qualitative data were collected via semi-structured interviews (n = 17). Results: Most survey respondents agreed that the policy has expanded access to naloxone at their site for individuals who want or need the medication. Both pharmacies and other naloxone distribution sites identified that leadership and organizational support facilitated protocol implementation and cost, stigma, and lack of naloxone demand challenged protocol implementation. Conclusions: The study identified barriers and facilitators to the implementation of a physician-approved protocol within Ohio. The majority of respondents stated they could implement a protocol. However, barriers of cost, lack of public awareness of naloxone availability, and stigma remain for pharmacies and other naloxone distribution sites.

The policy landscape for naloxone distribution in four states highly impacted by fatal opioid overdoses

“…This provision can be delivered via a countywide mechanism through the local board of health, and has been associated with increased naloxone dispensing rates, especially in low socioeconomic areas, and the majority of community pharmacies are registered to dispense naloxone without a prescription ( Gangal et al, 2020 ). However, barriers were identified in implementing this provision, such as cost, stigma, and lack of public knowledge ( Hincapie et al, 2021 ). The NAL in Ohio allows healthcare professionals to establish a protocol to authorize an employee, volunteer, or contractor of a service entity to furnish and administer naloxone to individuals so long as certain criteria are met by the protocol.…”

A survey of Alberta pharmacists’ attitudes, comfort and perceived barriers to a community-based naloxone program

“…The survey was adapted from a similar survey used in Ohio, designed by 2 members of the research team. 17 It was initially tested by 2 PharmD P4 students at the University of Cincinnati, an expert in survey design, a pharmacist from RxA and a pharmacist from the ACP. Testers were directed to provide feedback via email or phone regarding survey logic, grammatical errors, instructions requiring clarification and terminology to ensure logical validity and reliability of the tool.…”

Perceived stigma toward naloxone among overdose education and naloxone distribution program participants: Implications for opioid overdose response.

“…Despite positive outcomes, stigma has been identified as a barrier to successful program implementation (Calabrese & Bell, 2019; Fomiatti et al, 2022; Hincapie et al, 2021). Broadly, stigma is a social construct wherein negative attitudes are assigned to a group of people, resulting in prejudice and discrimination (Link & Phelan, 2001).…”