Naloxone accessibility without an outside prescription from U.S. community pharmacies: A systematic review

Lai, Rachael K.; Friedson, Kelsie Ellis; Reveles, Kelly R.; Bhakta, Kajal; Gonzales, Gillian; Hill, Lucas G.; Evoy, Kirk E.

doi:10.1016/j.japh.2022.07.008

Cited by 13 publications

(26 citation statements)

References 64 publications

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“…While the standing order for naloxone exists across Mississippi, this study showed that less than half of all Mississippi pharmacies had naloxone immediately available for consumers under the state standing order. The proportion of pharmacies with naloxone available in this census was lower than most others found in literature and notably even lower than what was found in a study examining naloxone access across community pharmacies within Alabama, which is a socioeconomically comparable state. Notably, independent pharmacies were the pharmacy type with the lowest proportion of naloxone available, which is consistent with other literature .…”

Section: Discussioncontrasting

confidence: 82%

Naloxone Accessibility Under the State Standing Order Across Mississippi

et al. 2023

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ImportanceNaloxone is a life-saving medication for individuals experiencing an opioid overdose. Naloxone standing orders aim to make naloxone more available by allowing patients improved access to this medication at community pharmacies; however, lawful availability does not mean that this life-saving intervention is accessible to patients.ObjectiveTo characterize naloxone availability and out-of-pocket cost under the state standing order in Mississippi.Design, Setting, and ParticipantsThis telephone-based, mystery-shopper census survey study included Mississippi community pharmacies open to the general public in Mississippi at the time of data collection. Community pharmacies were identified using the Hayes Directories April 2022 complete Mississippi pharmacy database. Data were collected from February to August 2022.ExposuresMississippi House bill 996, the Naloxone Standing Order Act, signed into law in 2017, allowing pharmacists to dispense naloxone under a physician state standing order at a patient’s request.Main Outcomes and MeasuresThe main outcomes were naloxone availability under Mississippi’s state standing order and the out-of-pocket cost of available formulations.ResultsThere were 591 open-door community pharmacies surveyed for this study, with a 100% response rate. The most common pharmacy type was independent (328 [55.50%]), followed by chain (147 [24.87%]) and grocery store (116 [19.63%]). When asked, “Do you have naloxone that I can pick up today?” 216 Mississippi pharmacies (36.55%) had naloxone available for purchase under the state standing order. Of the 591 pharmacies, 242 (40.95%) were unwilling to dispense naloxone under the state standing order. Among the 216 pharmacies with naloxone available, the median out-of-pocket cost for naloxone nasal spray (n = 202) across Mississippi was $100.00 (range, $38.11-$229.39; mean [SD], $105.58 [$35.42]) and the median out-of-pocket cost of naloxone injection (n = 14) was $37.70 (range, $17.00-$208.96; mean [SD], $66.62 [$69.27]).Conclusions and RelevanceIn this survey study of open-door Mississippi community pharmacies, availability of naloxone was limited despite standing order implementation. This finding has important implications for the effectiveness of the legislation in preventing opioid overdose deaths in this region. Further studies are needed to understand pharmacists’ unwillingness to dispense naloxone and the implications of lack of availability and unwillingness for further naloxone access interventions.

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Section: Discussioncontrasting

confidence: 82%

Naloxone Accessibility Under the State Standing Order Across Mississippi

et al. 2023

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“…7,[10][11][12][13]16,19,20,23,24,26 Many of these measured outcomes related to potential access barriers, such as whether the medication is in stock or accessible without a prescription, price of the drug, pharmacists' willingness to dispense naloxone without a prescription or bill a patient's insurance plan when picking it up without a prescription, or whether they would dispense to an adolescent or third-party patient. 12 Others have utilized secret shopper methodology to assess whether pharmacists offered to counsel the patient and characterized the counseling provided (e.g., length, accuracy, and content) or to assess for evidence of stigma or bias during patient interactions. 17,23 Furthermore, some assessed changes in a study measure after an educational intervention or potentially practice-changing event (e.g., change in legislation and new guideline publication).…”

Section: Audit Settings and Outcomesmentioning

confidence: 99%

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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“…7 Furthermore, many community pharmacies, mainly independent, maintain a low level of naloxone in stock. [8][9][10] Reasons for pharmacists not dispensing naloxone at higher rates have been explored in the literature and highlight two key areas: a lack of training on the product, and a lack of confidence in communicating to patients about it. 11,12 One method to address these concerns would be via academic detailing.…”

Section: Introductionmentioning

confidence: 99%

“…While many pharmacists have utilized their state‐specific method to increase naloxone distribution, the amount of naloxone dispensed from pharmacies remains low 7 . Furthermore, many community pharmacies, mainly independent, maintain a low level of naloxone in stock 8–10 . Reasons for pharmacists not dispensing naloxone at higher rates have been explored in the literature and highlight two key areas: a lack of training on the product, and a lack of confidence in communicating to patients about it 11,12 .…”

Section: Introductionmentioning

confidence: 99%

Assessment of student pharmacist‐led academic detailing on independent community pharmacy naloxone orders

Franko,

Yencha,

Sayre

2023

J Am Coll Clin Pharm

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IntroductionAcademic detailing has been used as a preferential method to increase pharmacists’ awareness of naloxone, however, its impact on actual dispensing rates is not well established.ObjectiveThe aim of this pilot study is to determine if a student‐led academic detailing on naloxone use and communication increased the amount of naloxone ordered from independent pharmacies in various geographic settings throughout Northeast Pennsylvania.Methods39 independent pharmacies which utilized a single wholesaler were randomized to receive an in‐person, student‐led training about naloxone use and communication. Students attended a train‐the‐trainer presentation to ensure a universal training was provided to all pharmacies. Students were provided with intranasal naloxone demonstration devices, handouts on effective communication, and talking points for each pharmacy visit. All academic detailing sessions were held live at each pharmacy during that pharmacy's regular business hours. Topics covered included appropriate naloxone use, what to expect after giving naloxone, and evidence‐based communication methods for engaging with patients about purchasing naloxone. Devices and handouts were left behind for pharmacists to use in daily practice. Naloxone and opioid shipping data for three months prior to and three months post‐intervention were compared.ResultsNaloxone ordered in the pre‐intervention period was 21 vs. 26 (intervention vs. control) (p = 0.59) and 31 vs. 29 post‐intervention (p = 0.25). There was no statistically significant difference in the number of pharmacies which ordered more naloxone pre vs. post‐intervention or in the total amount of opioids ordered pre vs. post‐intervention.ConclusionWhile pharmacies which received academic detailing did order more naloxone that pharmacies which did not, the difference did not rise to a level of statistical significance. As the population of this pilot study was small, expanding this approach to academic detailing to a larger population is warranted to possibly see more robust results.This article is protected by copyright. All rights reserved.

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Naloxone accessibility without an outside prescription from U.S. community pharmacies: A systematic review

Cited by 13 publications

References 64 publications

Naloxone Accessibility Under the State Standing Order Across Mississippi

Naloxone Accessibility Under the State Standing Order Across Mississippi

Research and scholarly methods: Audit studies

Assessment of student pharmacist‐led academic detailing on independent community pharmacy naloxone orders

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