Pharmacist counseling when dispensing naloxone by standing order: A secret shopper study of 4 chain pharmacies

Contreras, Jillian; Baus, Courtney; Brandt, Claire; Witry, Matthew J.; Peters, Joanne; Evoy, Kirk E.

doi:10.1016/j.japh.2020.10.010

Cited by 19 publications

(16 citation statements)

References 31 publications

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“…Trained researchers, including the authors and student researchers, used novel “secret shopper” methodology to call all independent pharmacies in Georgia posing as unidentified customers inquiring about the availability of naloxone at that pharmacy. This approach has been previously used in other studies accessing the availability of naloxone at pharmacies [ 31 , 38 ]. One form of naloxone, a nasal spray, is FDA-approved and can be easily administered.…”

Section: Methodsmentioning

confidence: 99%

Naloxone availability in independent community pharmacies in Georgia, 2019

Gilbert

Elliott

Beasley

et al. 2021

Subst Abuse Treat Prev Policy

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Background Increasing the availability of naloxone among people who use opioids, and friends and family of past and present people who use opioids is a vitally important mission to reduce the occurrence of opioid-related overdose deaths. The purpose of this study was to determine the availability of naloxone in independent community pharmacies in Georgia. Secondary objectives include determining pharmacists’ knowledge regarding the standing order and ability to counsel regarding naloxone. Methods A cross-sectional study using a secret shopper approach with phone contact was conducted over a period of 10 months. The study was population based and was conducted at all independent pharmacies in the state of Georgia. All independent community pharmacies in the state of Georgia were contacted and asked the naloxone questions with a 96% response rate (n = 520). Results Five hundred fifty-eight independent community pharmacies were called, with a 96% response rate (n = 520 pharmacies). Two hundred-twenty pharmacies reported having naloxone in stock. Of the 335 pharmacists asked, 174 (51.9%) incorrectly said that a prescription was required. The mean (SD) cash price was $148.02 (27.40), with a range of $0 to $300. Of 237 pharmacists asked who had naloxone in stock or who stated they could get naloxone in stock, 212 stated that they could demonstrate how to use it, 8 stated they could not, and 17 said that they possibly could or were unsure how to use it. Conclusions This study provided insight into the limited availability of naloxone at independent community pharmacies in Georgia after the standing order was issued. The majority of pharmacists at independent pharmacies in Georgia were not using the publicly available state naloxone standing order. Additionally, the low availability of naloxone and its high cost for uninsured individuals are significant structural barriers for reducing opioid-related mortality.

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Section: Methodsmentioning

confidence: 99%

Naloxone availability in independent community pharmacies in Georgia, 2019

Gilbert

Elliott

Beasley

et al. 2021

Subst Abuse Treat Prev Policy

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“…Unfortunately, the preponderance of evidence regarding pharmacists’ current practices related to naloxone dispensing indicates this level of clinical service is increasingly rare in US pharmacies, and that in some cases, a pharmacist may be more likely to hinder naloxone access than to facilitate it. 41 , 56 Furthermore, the concern raised by SPPCP could be similarly applied to nearly any OTC medication, including many which possess risks for harm from improper use that exceed that of naloxone. In fact, over a million doses of naloxone are distributed annually from non-pharmacy OEND programs, with no evidence of harmful effects.…”

Section: Potential Benefits and Risks Of Otc Transitionmentioning

confidence: 99%

“… 59 , 78 However, studies continue to document gaps in both pharmacist-reported knowledge regarding naloxone and its actual practice behaviors related to its dispensing, indicating that these educational efforts must remain a high priority. 51 , 56 , 59 , 78 , 79 It is possible that converting naloxone to OTC status could remove a powerful incentive for pharmacists to seek, and colleges of pharmacy to provide, opioid-related education. However, this need not and should not be the case, especially since we envision that some formulations would likely remain prescription-only even if more user-friendly versions are moved OTC.…”

Section: Potential Benefits and Risks Of Otc Transitionmentioning

confidence: 99%

Considering the Potential Benefits of Over-the-Counter Naloxone

Evoy¹,

Hill²,

Davis³

2021

IPRP

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Since 1999, annual opioid-related overdose (ORO) mortality has increased more than six-fold. In response to this crisis, the US Department of Health and Human Services outlined a 5-point strategy to reduce ORO mortality which included the widespread distribution of naloxone, an opioid antagonist that can rapidly reverse an opioid overdose. Increased distribution has been facilitated by the implementation of naloxone access laws in each US state aimed at increasing community access to naloxone. While these laws differ from state-to-state, most contain mechanisms to enable pharmacists to dispense naloxone without a patient-specific prescription. These laws have enhanced community naloxone distribution, both from pharmacies and overdose education and naloxone distribution programs, and produced positive effects on ORO mortality. However, a growing body of evidence has revealed that significant barriers to naloxone access from pharmacies remain, and annual ORO deaths have continued to climb. Given these concerns, there has been a push among some clinicians and policymakers for the US Food and Drug Administration to re-classify naloxone as an over-the-counter (OTC) medication as a means to further increase its accessibility. If an OTC transition occurs, educational outreach and funding for clinical innovations will continue to be crucial given the important role of health professionals in recommending naloxone to people at risk for experiencing or witnessing an ORO. Recognizing the severity of the ORO public health crisis, we believe transitioning formulations of naloxone approved for layperson use to OTC status would result in a net benefit through increased access. However, such a change should be combined with measures to ensure affordability.

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“… 4–6 Furthermore, pharmacists rarely assess the need for, or counsel on the benefits of, OUD treatment when dispensing naloxone, and often report feeling unprepared to do so. 7 , 8 …”

Section: Dear Editormentioning

confidence: 99%

“…4-6 Furthermore, pharmacists rarely assess the need for, or counsel on the benefits of, OUD treatment when dispensing naloxone, and often report feeling unprepared to do so. 7,8 Despite continuing legal and regulatory barriers associated with naloxone's status as a prescription-only medication, many people currently obtain naloxone without ever meeting a medical provider. In fact, harm reduction organizations were for many years the dominant source of take-home naloxone.…”

mentioning

confidence: 99%