Evaluation of naloxone furnishing community pharmacies in San Francisco

Abstract

Objectives: In 2017, the Centers for Disease Control and Prevention reported Q7 more than 47,600 deaths as a result of opioid overdose in the United States. In an effort to reduce these deaths, California passed legislation providing pharmacists with the ability to furnish naloxone without a prescription. Our study examined pharmacies in San Francisco that furnished naloxone and provided guidance for pharmacies seeking to develop similar programs. The study aims were to (1) identify the legal, structural, social-environmental, and financial components of a pharmacy model that allows for successful naloxone distribution, (2) evaluate the attitudes and beliefs of pharmacy staff members toward patients receiving or requesting naloxone, and (3) assess relationships between these attitudes and beliefs and naloxone furnishing at the pharmacy. Design and setting: This cross-sectional study used a series of semistructured interviews of pharmacy staff in San Francisco conducted April-October 2019. Through a thematic, inductive analysis of collected data, emerging themes were mapped to the primary study aims. Participants, outcomes, and results: We interviewed 14 pharmacists and pharmacy technicians at 4 community pharmacies. We identified 4 factors for success in implementing a naloxone furnishing protocol: administrative-led efforts, pharmacist-led efforts, increasing pharmacist engagement, and increasing patient engagement. The respondents also discussed the approaches they used to overcome previously identified barriers: cost, time, expectations of unwanted clientele, and patients' feelings of stigma. Conclusion: Pharmacists' approaches to implementing naloxone furnishing had common features across locations, suggesting many of these strategies could be replicated in other community pharmacies.

An observational survey assessing the extent of PrEP and PEP furnishing in San Francisco Bay Area pharmacies

“…We excluded retail chain pharmacies (companies with 4 locations: Walgreens, CVS, Raley's Pharmacy, Walmart, Costco, Rite-Aid, Safeway, Lucky's), given that previous research suggests that chain locations are likely to delay implementation at individual locations in favor of a system-wide protocol. [30][31][32] We also excluded medical system pharmacies, as well as those where the nature of the pharmacy or patient population excluded provision of PrEP and PEP: veterinary pharmacies, infusion center pharmacies, pediatric pharmacies, long-term care pharmacies, nuclear pharmacies, and compounding-only pharmacies. Four of the authors (N.N., J.P., R.B., S.M.)…”

“…The interview guide was based on a validated instrument from previous studies, modified to address PrEP and PEP. 30,31 It included 39 possible open-ended questions organized into general categories identified in previous studies, with options for choosing from additional questions and to address follow-up questions from respondents (see Appendix 1). Interviews ranged from 15-60 minutes in length and were recorded and transcribed.…”

Perspectives of Stakeholders of Equitable Access to Community Naloxone Programs: A Literature Review

“…Often mentioned as a facilitator to access was providing naloxone at no cost or as low a cost as possible [ 52 ]. One suggestion of a potential facilitator to access included working to create a non-judgmental space where naloxone can be provided [ 59 ]. Other literature suggested providing naloxone by default to anyone receiving any other supplies from harm reduction programs [ 52 ].…”

CONSIDER New Mexico: Effects of naloxone training among pharmacists and pharmacy technicians

“…14 However, stigma toward opioid-using patients is a substantial barrier. 15,16 Pharmacy technicians can benefit from training and professional development regarding opioid use disorder, implicit bias, and nonjudgmental approaches. 15,16 Many pharmacy technicians also face structural barriers to supporting naloxone dispensing.…”

“…15,16 Pharmacy technicians can benefit from training and professional development regarding opioid use disorder, implicit bias, and nonjudgmental approaches. 15,16 Many pharmacy technicians also face structural barriers to supporting naloxone dispensing. For example, Idaho policy allows pharmacy technicians to dispense naloxone, whereas New Mexico policy precludes both naloxone dispensing and counseling by technicians.…”