Using the behaviour change wheel to understand and address barriers to pharmacy naloxone supply in Australia

Nielsen, Suzanne; Olsen, Anna

doi:10.1016/j.drugpo.2020.103061

Cited by 18 publications

(15 citation statements)

References 21 publications

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“…72 In turn, this means that it has not been available for others at risk populations including people prescribed opioids for pain. 73 Stigma may also undermine public support for naloxone: where naloxone recipients are perceived as dangerous, there may be less support for programs. 74 Stigma also has considerable influence on community support of other harm reduction efforts, including safe consumption facilities.…”

Section: Dovepressmentioning

confidence: 99%

The Impact of Stigma on People with Opioid Use Disorder, Opioid Treatment, and Policy

Cheetham¹,

Picco²,

Barnett³

et al. 2022

SAR

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Illicit drug use disorders are the most stigmatised health conditions worldwide, and stigma acts as a meaningful barrier to treatment entry and treatment provision. In the context of dramatically rising opioid-related harms, it is critical that we understand the drivers of stigma and how it affects opioid use disorder treatment and policy. The aim of this narrative review is to discuss how opioid-related stigma impacts treatment provision and harm reduction, and provide potential strategies to reduce stigma at a social and structural level. We used the Framework for Integrating Normative Influences on Stigma (FINIS) to identify sources of opioid-related stigma at the macro (structural stigma), meso (public stigma) and micro (internalised stigma) levels. Reducing stigma requires strategies that target multiple levels, however addressing inequity in the laws, regulations, and rules that segregate people with opioid and other substance use disorders from mainstream society is essential.

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Section: Dovepressmentioning

confidence: 99%

The Impact of Stigma on People with Opioid Use Disorder, Opioid Treatment, and Policy

Cheetham¹,

Picco²,

Barnett³

et al. 2022

SAR

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“…Previous Australian studies found that despite high levels of support for the role of pharmacists in overdose prevention, pharmacist knowldege and confidence around naloxone supply was low [37]. In addition to individual level barriers such as knowldege and training, system‐level barriers also need to be addressed, including the stigmatisation associated with substance use, as pharmacists strongly link naloxone supply to illicit substance use [38,39]. Further, limited awareness among pharmacists about the role of naloxone for people who are prescribed opioids, limited awareness of opioid toxicity signs and overdose risk among people who are prescribed opioids speak to the need for more general awareness‐raising campaigns to clarify the role of naloxone among those who may supply and receive it [38].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The cost and impact of distributing naloxone to people who are prescribed opioids to prevent opioid‐related deaths: findings from a modelling study

et al. 2021

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Background and aims Although most opioid‐related mortality in Australia involves prescription opioids, most research to understand the impact of naloxone supply on opioid‐related mortality has focused upon people who inject heroin. We aimed to examine the cost and probable impact of up‐scaling naloxone supply to people who are prescribed opioids. Design Decision‐tree model. Four scenarios were compared with a baseline scenario (the current status quo): naloxone scale‐up between 2020 and 2030 to reach 30 or 90% coverage by 2030, among the subgroups of people prescribed either ≥ 50 or ≥ 100 mg of oral morphine equivalents (OME). Setting Australia. Participants People who are prescribed opioids. Measurements Possible deaths averted, costs (ambulance and naloxone distribution) and cost per life saved for different scenarios of naloxone scale‐up. Findings Maintaining the status quo, there would be an estimated 7478 [uncertainty interval (UI) = 6868–8275] prescription opioid overdose deaths between 2020 and 2030, resulting in Australian dollars (A$)51.9 million (49.4, 56.0) in ambulance costs. If naloxone were scaled‐up to 90% of people prescribed > 50 mg OME, an estimated 657 (UI = 245, 1489) deaths could be averted between 2020 and 2030 (a 20% reduction in the final year of the model compared with the no naloxone scenario), with a cost of A$43 600 (20 800–110 500) per life saved. If naloxone were scaled‐up to 30% of people prescribed > 50 mg OME an estimated 219 (82–496) deaths could be averted with the same cost per live saved. If naloxone were restricted to those prescribed > 100 mg OME, an estimated 130 (UI = 44–289) deaths would be averted if scaled‐up to 30% or 390 (UI = 131–866) deaths averted if scaled‐up to 90%, with the cost per life saved for both scenarios A$38 200 (UI = 12 400–97 400). Conclusion In Australia, scaling‐up take‐home naloxone by 2030 to reach 90% of people prescribed daily doses of ≥ 50 mg of oral morphine equivalents would be cost‐effective and save more than 650 lives.

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“…Pharmacists may label those asking for naloxone as "drug seeking", further creating an unwelcome environment (Green et al, 2017). Experience from Australia suggests that only pharmacists already providing harm reduction services (e.g., syringes) are receptive to offering take-home naloxone (Nielsen and Olsen, 2021). Co-prescribing of naloxone with prescription opioids also faces low uptake (Haffajee et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Naloxone Buyers Club: Overlooked Critical Public Health Infrastructure for Preventing Overdose Deaths

Doe-Simkins¹,

Wheeler²,

Figgatt

et al. 2021

Preprint

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BackgroundCommunity-based naloxone distribution is an evidence-based pillar of overdose prevention. Since 2012, the naloxone Buyers Club facilitated purchase of low-cost naloxone by harm reduction and syringe service programs, the primary conduits for reaching people who use drugs. This innovative purchasing and mutual aid network has not been previously described.MethodsWe analyzed transactional records of naloxone orders (2017-2020, n=965), a survey of current Buyers Club members (2020, n=104), and mutual aid requests (2021, n=86).ResultsBetween 2017 and 2020, annual orders for naloxone increased 2.6-fold. 114 unique harm reduction programs from 40 states placed orders for 3,714,110 vials of 0.4 mg/mL generic naloxone through the Buyers Club. States with most orders were: Arizona (600,000 vials), Illinois (576,800), Minnesota (347,450), California (317,200), North Carolina (315,040). Among programs that ordered naloxone in 2020, 52% (n=32) received no federal funding and ordered half as much as funded programs. During the 2021 shortage, mutual aid redistribution was common, with 80% participating as either a donor or recipient. Among 59 mutual aid requestors, 59% (n=35) were willing to accept expired naloxone; the clear preference was for generic injectable naloxone, 95% (n=56).ConclusionsThe naloxone Buyers Club is a critical element of overdose prevention infrastructure. Yet, barriers from corporate compliance officers and federal prescription-only status impede access. These barriers can be reduced by FDA removing the prescription requirement for naloxone and government funding for harm reduction programs.

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Using the behaviour change wheel to understand and address barriers to pharmacy naloxone supply in Australia

Cited by 18 publications

References 21 publications

The Impact of Stigma on People with Opioid Use Disorder, Opioid Treatment, and Policy

The Impact of Stigma on People with Opioid Use Disorder, Opioid Treatment, and Policy

The cost and impact of distributing naloxone to people who are prescribed opioids to prevent opioid‐related deaths: findings from a modelling study

Naloxone Buyers Club: Overlooked Critical Public Health Infrastructure for Preventing Overdose Deaths

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