Pharmacy Students’ Perceptions and Stigma Surrounding Naloxone Use in Patients with Opioid Use Disorder: A Mixed Methods Evaluation

Abstract

Pharmacists represent a key group of healthcare professionals that can increase awareness and destigmatize naloxone use. The objective of this study was to investigate pharmacy student perceptions of the use, dispensing, and stigma surrounding naloxone. An electronic survey was administered to pharmacy students that included questions about demographics, work history, naloxone use, and naloxone stigma. Separate qualitative interviews were performed to identify themes surrounding naloxone use. Two-hundred sixty-two participants completed the survey. The majority of participants were “highly willing” (74%) to fill a naloxone prescription for a patient and “somewhat comfortable” (38%) in counseling on naloxone; most were “somewhat comfortable” (38%) administering naloxone. Naloxone is “very rarely” (87%) recommended in community workplace settings, and the majority (64%) reported that patients never request information about naloxone availability. Seventy-six percent of respondents reported that naloxone-associated interactions have an influence on the way they communicate with patients in community pharmacy settings. Thematic analyses found that pharmacy students identify the importance of naloxone as a life-saving medication and the need for naloxone training, but patient-perceived stigma and limited access to naloxone remain prevalent. Pharmacy students are generally well-versed and inclined toward distributing, counseling on, and administering naloxone. Naloxone is rarely dispensed and patient conversations involving naloxone are infrequent in community settings. Future efforts focused on approaches toward difficult patient conversations and normalization of naloxone are needed to destigmatize and facilitate use.

Effect of a simulated overdose response on student ability to counsel on naloxone use

“…Furthermore, recent recommendations from the American Association of Colleges of Pharmacy indicate that naloxone counseling and overdose management should be core components of the Doctor of Pharmacy curriculum 15 . The current literature highlights several innovative naloxone training programs; however, the majority focus on student's perceived self‐efficacy in counseling as the primary outcome 8‐11 …”

“…In response to the passage of naloxone specific state legislation, several Doctor of Pharmacy programs began incorporating naloxone training as part of the required curriculum 7 . Much of the literature focuses on training student pharmacists through a combination of traditional lecture and active learning in a lab environment or experiential setting, followed by an assessment of perceived confidence in the ability to counsel on naloxone use 8‐11 . While self‐confidence in one's ability to counsel is important, there is little evidence highlighting the impact of a specific training format on the ability to effectively counsel a patient on naloxone use.…”

Stigma by Association: To what Extent is the Attitude Toward Naloxone Affected by the Stigma of Opioid Use Disorder?

“…Naloxone stigma is still undefined, despite its use in academic literature. 38-40 To define naloxone stigma within a scope applicable to patients, pharmacists, and prescribers, based on relevant studies, 17,20-23 the pertinent individual stigma variants, including perceived stigma (awareness) and personal stigma (agreement) are considered (Table 1). Self-stigma (concurrence) is only applicable to patients since they are “the stigmatized.” 34,36 Even then, this may be debatable because, unlike mental illness and OUD, 32,34,36,41 patients can choose to distance themselves from naloxone.…”

“Don’t Label Them as Addicts!” Student Pharmacists’ Views on the Stigma Associated with Opioid use Disorder

“…For example, a recent study investigating stigma-related barriers to naloxone recommendations by student pharmacists found that although stigma was seen among students, it was also perceived to be present amongst patients as well -limiting the patients' willingness to receive a naloxone recommendation. 10 Although work has been done to reduce OUD stigma, research suggests that educators may still have an incomplete picture of health professional students and stigma, and therefore strategies by which to overcome it. For example, one U.S. college of nursing implemented an interactive presentation on OUD.…”

“…For example, a recent study investigating stigma-related barriers to naloxone recommendations by student pharmacists found that although stigma was seen among students, it was also perceived to be present amongst patients as well – limiting the patients’ willingness to receive a naloxone recommendation. 10 …”