Public Perceptions of Community Pharmacy-Based Naloxone Services: A National Cross-Sectional Survey

Abstract

Little is known about the general public’s perceptions regarding community pharmacist-delivered naloxone services at the national level. Accordingly, the purpose of this study was to describe the US general public’s awareness, knowledge, beliefs, comfort, perceived barriers, abilities, and communication preferences related to community pharmacy-based naloxone services. A national, online cross-sectional survey was conducted in September 2021 among US adults ≥18 years recruited via Amazon Mechanical Turk (MTurk). Primary outcome measures were assessed via 5-point Likert-type scales, including: (1) naloxone awareness and knowledge; (2) naloxone beliefs; (3) comfort with pharmacist-provided naloxone; (4) perceived barriers to pharmacy-based naloxone; (5) opioid overdose competencies, concerns, and readiness; and (6) preferred pharmacist-patient naloxone communication strategy. Analyses included descriptive statistics and logistic regression models to assess predictors of preferred communication strategies. Of 301 respondents, 82.1% were White, 48.8% female, and mean 43 years. Eighty-five percent were unaware of pharmacy-provided naloxone and mean [SD] knowledge score was low (29.3% [16.8]). Mean [SD] beliefs (3.78 [0.61]) and comfort (3.70 [0.54]) were positive, while perceived barriers were low/neutral (2.93 [0.78]). For communication, 54% preferred general advertisement, 32.9% universal offer, and 13.3% targeted offer. The odds of preferring a general advertisement or universal offer over a targeted offer increased with greater awareness (AOR:4.52; p = 0.003) and comfort (AOR:3.79; p = 0.003), and decreased with greater competence (AOR:0.35; p = 0.001). Although awareness and knowledge regarding community pharmacy-based naloxone services was low, beliefs and comfort were positive and perceived barriers were low/neutral. General or universal offers of naloxone were preferred over targeted approaches. Future studies should test the impact of communication strategies on naloxone uptake.

Organizational Readiness to Implement Community Pharmacy-Based Opioid Counseling and Naloxone Services: A Scoping Review of Current Practice Models and Opportunities

“…Furthermore, pharmacies encountering patient resistance to OCN services may consider using a universal rather than a targeted approach to patient identification. Although few studies in the current review reported using a universal approach to patient identification and communication, this approach has been shown to reduce perceptions of stigma and targeting experienced by patients [ 59 , 60 ]. The use of technology in patient intake/screening (e.g., tablets, QR codes) [ 29 , 31 ] and identification (e.g., clinical flags in the dispensing software) [ 14 , 32 ] has likewise been reported in few articles and represents an area for future research in the OCN services realm, as the integration of health information technology has proven successful in other services such as MTM [ 61 ].…”

Factors Associated with Gaps in Naloxone Knowledge: Evidence from a 2022 Great Plains Survey

“…First, our measurements of naloxone knowledge are self-reported in a yes/no format rather than asking skill questions (e.g., identifying correct ways to administer naloxone or a location they could obtain naloxone). If respondents exaggerated their knowledge of naloxone, our estimates of overall naloxone knowledge in Nebraska would be biased upwards compared to a skill-focused measure of knowledge used in prior studies (Hohmann, 2022). Using binary variables to measure naloxone knowledge does not capture nuance such as how many sources of naloxone a respondent could identify or how quickly they could administer naloxone in an emergency.…”

“…Despite the increased nationwide distribution of naloxone, there are currently significant gaps in the naloxone treatment cascade. Studies find that although most surveyed adult Americans are familiar with naloxone, only a small proportion are aware that naloxone can be obtained in pharmacies ( Hohmann et al, 2022 ; Schneider, 2021 ; Tobin, 2018 ). Gaps in naloxone coverage also exist among people who use drugs (PWUD): a 2021 meta-analysis of studies in areas across North America and Europe found that although 57% of PWUD owned naloxone, only 20–28% carried it on a regular basis ( Burton et al, 2021 ).…”

“…Research on familiarity with naloxone among people who do not regularly use drugs is limited and fails to directly measure a key drop off in the naloxone treatment cascade: knowledge of where to access naloxone. Two studies, an online panel survey and a survey distributed in the Richmond, VA area, measured naloxone familiarity and knowledge that naloxone is sold at pharmacies, but not if participants knew a source for naloxone ( Haggerty et al, 2018 ; Hohmann, 2022 ). This distinction is especially important because knowledge that pharmacies sell naloxone does not necessarily lead to an individual being able to find naloxone.…”

Factors associated with gaps in naloxone knowledge: evidence from a 2022 great plains survey

“…Despite consistent annual nationwide increases in distribution of naloxone, there are currently significant gaps in the naloxone treatment cascade [7]. Studies find that although most surveyed adult Americans are familiar with naloxone, only a small proportion are aware that naloxone can be obtained in pharmacies [8,21,24]. Serious gaps in naloxone coverage also exist among PWUD: A 2021 meta-analysis of studies in areas across North America and Europe found that although 57% of PWUD owned naloxone, only 20-28% carried it on a regular basis [4].…”