Limited access to pharmacy-based naloxone in West Virginia: Results from a statewide purchase trial

Pollini, Robin A.; Ozga, Jenny E.; Joyce, Rebecca; Xuan, Ziming; Walley, Alexander Y.

doi:10.1016/j.drugalcdep.2021.109259

Cited by 8 publications

(16 citation statements)

References 42 publications

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“…The device would be administered by health care professionals and would subsequently be on the patient’s person, obviating issues with access to naloxone, , and removing the need to find or carry intranasal naloxone delivery systems.…”

Section: Synthesis and Characterizationmentioning

confidence: 99%

“…T here are more than 40 000 deaths from opioid overdose each year in the U.S. 1 Timely treatment with an opioid antagonist such as naloxone (NLX) can be life-saving in opioid overdose. 2 Even though the importance of naloxone is recognized, factors limit access: 3 naloxone not being stocked by pharmacies, 4,5 restrictions to access by lay people, 6 affordability 7 and payment method, the stigma surrounding opioid use disorder, 8 and other socioeconomic factors. Even when acquired, naloxone may not be on the person needing it at the time of overdose.…”

mentioning

confidence: 99%

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On-Demand Opioid Effect Reversal with an Injectable Light-Triggered Polymer-Naloxone Conjugate

Zhang,

Wang,

Ostertag-Hill

et al. 2023

Nano Lett.

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Misuse of opioids can lead to a potential lethal overdose. Timely administration of naloxone is critical for survival. Here, we designed a polymer−naloxone conjugate that can provide on-demand phototriggered opioid reversal. Naloxone was attached to the polymer poly(lactic-co-glycolic acid) via a photocleavable coumarin linkage and formulated as injectable nanoparticles. In the absence of irradiation, the formulation did not release naloxone. Upon irradiation with blue (400 nm) light, the nanoparticles released free naloxone, reversing the effect of morphine in mice. Such triggered events could be performed days and weeks after the initial administration of the nanoparticles and could be performed repeatedly.

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Section: Synthesis and Characterizationmentioning

confidence: 99%

mentioning

confidence: 99%

On-Demand Opioid Effect Reversal with an Injectable Light-Triggered Polymer-Naloxone Conjugate

Zhang,

Wang,

Ostertag-Hill

et al. 2023

Nano Lett.

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“…When recruiting auditors, it is important to consider how potential stereotypes or implicit biases may affect the study results based on the auditors' demographic makeup. Many auditor‐related factors could potentially affect the response or actions of the person being studied, including demographic features (e.g., age, race, and gender); the presence of stigmatized conditions (e.g., illegal drug use); cultural factors (e.g., clothing, accents, and body art); and emotional states (e.g., nervousness) 7,13,24 . While it is likely not possible to completely mitigate this issue, there are potential strategies to reduce their impact, including providing auditors standardized backstories and training, conducting the audit by phone versus in‐person, and selectively recruiting auditors with this purpose in mind 10,11 .…”

Section: Planning and Conducting An Auditmentioning

confidence: 99%

“…Many recent audit studies have been conducted in the community pharmacy setting, 7,[10][11][12][13][16][17][18][19][20][21][22][23][24] which resembles secret shopper methodology commonly conducted in consumer settings unrelated to healthcare, such as investigating differing experiences in vehicle purchase negotiations based on race and gender. 25 Audit studies in community pharmacies may be easier to conduct, as compared to other healthcare settings, because they typically do not require an appointment or an encounter fee to be paid.…”

Section: Audit Settings and Outcomesmentioning

confidence: 99%

“…Many auditor-related factors could potentially affect the response or actions of the person being studied, including demographic features (e.g., age, race, and gender); the presence of stigmatized conditions (e.g., illegal drug use); cultural factors (e.g., clothing, accents, and body art); and emotional states (e.g., nervousness). 7,13,24 While it is likely not possible to completely mitigate this issue, there are potential strategies to reduce their impact, including providing auditors standardized backstories and training, conducting the audit by phone versus in-person, and selectively recruiting auditors with this purpose in mind. 10,11 One strategy to reduce the impact of bias on inter-rater reliability could be to utilize a smaller, more homogenous group of auditors, which may improve internal validity but reduce external validity.…”

Section: Recruiting Auditorsmentioning

confidence: 99%

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Research and scholarly methods: Audit studies

Loera

Hill

Evoy

et al. 2023

J Am Coll Clin Pharm

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Audit study methodologies have been utilized in pharmacy field research to obtain greater understanding of potential gaps in real‐world care and assess the accessibility of medications, services, and providers. Many audit studies utilize a secret‐shopper approach in which auditors follow specific assessment protocols and the subjects being audited are unaware of the audit taking place. The benefit of utilizing this approach, as compared to surveys or interviews, is that researchers are able to collect real‐world measures with minimized social desirability and recall biases. There are multiple audit study approaches investigators must consider. Additionally, successful audit studies often rely upon congruence of multiple auditors, and it is therefore essential to develop a study protocol that includes detailed guidance documents, data collection tools, and rigorous training and fidelity assessments. Audit methodologies must be conducted with meticulous auditor training and oversight, especially when investigators seek to audit a large sample and rely on auditors who may be participating on an unpaid volunteer basis. The purpose of this review is to provide an orientation to audit study methodologies and to describe best practices for conducting a successful audit study.

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Naloxone Availability and Cost After Transition to an Over-the-Counter Product

Marley,

Annis,

Egan

et al. 2024

JAMA Health Forum

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ImportanceThe US Food and Drug Administration approved Narcan, a nasal spray formulation of naloxone, for sale as an over-the-counter (OTC) medication in March 2023. The purpose of OTC approval was to improve naloxone accessibility to reduce opioid overdoses; however, research has not yet evaluated whether naloxone’s availability and cost changed since this policy was implemented.ObjectiveTo evaluate whether the accessibility and cost of naloxone at North Carolina community pharmacies changed after OTC naloxone became available and whether cost and availability varied by pharmacy type and urbanicity.Design, Setting, and ParticipantsThis longitudinal telephone-based secret shopper survey study included a stratified sample of 202 North Carolina community pharmacies, including health department, independent, and chain pharmacies. There were 2 separate data collection efforts from March to April 2023 (before OTC naloxone could be sold at pharmacies) and November 2023 to January 2024 (after OTC naloxone was sold at pharmacies).ExposureOTC naloxone first became available for sale at community pharmacies in September 2023.Main Outcomes and MeasuresThe main outcomes were same-day availability of naloxone without a clinician-issued prescription and the quoted out-of-pocket cost for cash-paying patients.ResultsData were collected from 192 pharmacies. Same-day naloxone availability increased from 42.2% (81 of 192) before OTC naloxone availability to 57.8% (111 of 192) after (P &lt; .001). The mean (SD) quoted out-of-pocket cost decreased from $90.93 ($42.6) pre-OTC availability to $62.67 ($41.0) post-OTC availability (P &lt; .001). Independent pharmacies had higher mean (SD) costs than chain pharmacies in both the pre-OTC phase ($109.47 [$37.90] vs $86.40 [$35.70]; P &lt; .001) and post-OTC phase ($77.59 [$38.90] vs $57.74 [$35.90]; P = .004). Out-of-pocket costs did not differ by urbanicity in the pre-OTC phase; however, mean (SD) costs were higher at suburban ($88.67 [$66.80]) and rural ($65.43 [$35.00]) pharmacies compared with urban pharmacies ($53.58 [$29.00]) in the post-OTC phase (P = .003).Conclusions and RelevanceThe Food and Drug Administration’s approval of OTC naloxone nasal spray contributed to an increase in pharmacy-based availability of naloxone and a reduction of its cost for cash-paying patients. Cost was higher at independent pharmacies compared with chain pharmacies and lower in urban pharmacies compared with suburban and rural pharmacies.

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Limited access to pharmacy-based naloxone in West Virginia: Results from a statewide purchase trial

Cited by 8 publications

References 42 publications

On-Demand Opioid Effect Reversal with an Injectable Light-Triggered Polymer-Naloxone Conjugate

On-Demand Opioid Effect Reversal with an Injectable Light-Triggered Polymer-Naloxone Conjugate

Research and scholarly methods: Audit studies

Naloxone Availability and Cost After Transition to an Over-the-Counter Product

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