Revisiting pharmacy-based naloxone with pharmacists and naloxone consumers in 2 states: 2017 perspectives and evolving approaches

Green, Traci C.; Donovan, Elizabeth; Klug, Brittany; Case, Patricia; Baird, Janette; Burstein, Dina; Tapper, Abigail; Walley, Alexander Y.; Bratberg, Jeffrey

doi:10.1016/j.japh.2020.03.005

Cited by 18 publications

(19 citation statements)

References 20 publications

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“…Although less frequently mentioned, there were a variety of facilitators identified in the studies ( Table 3 ). These included education and training for both pharmacists and patients, standardization of training, comfort in discussing naloxone, and interprofessional collaboration [ 25 , 36 , 37 , 48 , 54 , 56 , 57 , 58 , 59 ]. Pharmacists noted how practice and experience in dispensing naloxone with the opt-out model made it easier to perform [ 25 ].…”

Section: Resultsmentioning

confidence: 99%

“… - Participants also noted a lack of staff training, including confusion about dispensing and billing procedures. Green [ 58 ] 2020 USA Patients taking opioids for chronic pain, people with opioid use disorders, caregivers, and pharmacists Focus groups, semi-structured interviews - Experiences obtaining naloxone at the pharmacy - Reactions to pharmacy tools and patient outreach materials Barriers : Fear of future consequences when requesting naloxone, stigma, discomfort in asking pharmacy staff for naloxone Facilitators : practice made pharmacists more comfortable in dispensing, creating privacy for patients, interprofessional collaboration - Participants were accepting of a program that included display pads which patients could present to the pharmacist to reduce the stigma of verbally asking for a naloxone kit. - Pharmacists expressed a desire for further education because they still felt uncomfortable engaging naloxone discussions even with previous experience/training.…”

Section: Embase Search Strategy (Performed 1 June 2020)mentioning

confidence: 99%

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What Is Known about Community Pharmacy-Based Take-Home Naloxone Programs and Program Interventions? A Scoping Review

2021

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A variety of new sources describing community pharmacy-based take-home naloxone (THN) programs have emerged recently in the literature. There is a need to define the types of take-home naloxone programs being offered to support future research designs in implementing and evaluating standardized programs that fill pharmacist and patient knowledge gaps and lift current barriers for optimal community pharmacy naloxone provision. The objective of this paper is to summarize the literature on community pharmacy-based THN programs, including specific program interventions used to increase naloxone dispensing, naloxone availability and dispensing patterns, facilitators and barriers for the THN programs, and knowledge gaps. Online databases such as PubMed, EMBASE, Scopus, and International Pharmaceutical Abstracts (IPA) and a search of the grey literature were used to identify eligible sources. Sources were screened by two reviewers for eligibility in COVIDENCE software. Both reviewers compared screening results and resolved conflicts through discussion. A data extraction form for all identified full texts was completed by both reviewers and results were compiled through reviewer discussion. Fifty-two sources met the eligibility criteria. The top three barriers identified were: cost/coverage of naloxone, stigma, and education/training for pharmacists. THN program interventions included screening tools, checklists, pocket cards, patient brochures, and utilizing the pharmacy management system to flag eligible patients. Patient knowledge gaps included naloxone misinformation and lack of awareness, while pharmacists demonstrated administrative, clinical, and counselling knowledge gaps. Naloxone availability was found to be highly variable, where independent and rural pharmacies were less likely to stock or dispense naloxone. Further, pharmacies located in districts with higher rates of opioid overdose deaths and lower household income were also less likely to have naloxone available. This review identified multiple new programs, showcasing that the implementation and evaluation of THN programs are an expanding area of research. Future research should focus on implementing and evaluating a THN program through a randomized controlled trial design that incorporates solutions for the barriers and knowledge gaps identified in this study.

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Section: Resultsmentioning

confidence: 99%

Section: Embase Search Strategy (Performed 1 June 2020)mentioning

confidence: 99%

What Is Known about Community Pharmacy-Based Take-Home Naloxone Programs and Program Interventions? A Scoping Review

2021

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“…Other individuals may be concerned with judgement in inquiring about naloxone products in community pharmacies, or such that they would be labeled as addicts by law enforcement if found carrying it. One study found law enforcement to be the least likely to exhibit stigma on social media out of a group of potential naloxone providers [ 29 , 30 ]. A 2019 study on public perceptions of naloxone use found that 61% of survey respondents had never heard of naloxone or were unaware that a medication existed to treat opioid overdose.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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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.

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“… 63 Increased pharmacist experience in dispensing naloxone may also improve pharmacists’ understanding of the importance of efforts to improve anonymity and reduce stigma, as well as their comfort level in carrying out such interactions. 64 However, such interventions will require significant time and resources and are unlikely to be carried out uniformly across the country, perpetuating disparities in naloxone access. Given the continued rise in ORO mortality and persistent gaps in access to naloxone under the current NAL approach, a transition to OTC status warrants serious consideration.…”

Section: Successes and Shortcomings Of Current Nals And Non-otc Appromentioning

confidence: 99%

“…Educational interventions directed towards pharmacists and healthcare providers, as well as patients, are likely to help mitigate this stigma to some extent. 64 , 73 It appears that efforts as simple as placing patient-facing signage around the pharmacy or on dispensed medications recommending the use of naloxone may help reduce stigma and facilitate productive conversations between pharmacists and at-risk patients. 64 …”

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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Revisiting pharmacy-based naloxone with pharmacists and naloxone consumers in 2 states: 2017 perspectives and evolving approaches

Cited by 18 publications

References 20 publications

What Is Known about Community Pharmacy-Based Take-Home Naloxone Programs and Program Interventions? A Scoping Review

What Is Known about Community Pharmacy-Based Take-Home Naloxone Programs and Program Interventions? A Scoping Review

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

Considering the Potential Benefits of Over-the-Counter Naloxone

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