Pharmacists’ attitudes toward dispensing naloxone and medications for opioid use disorder: A scoping review of the literature

Abstract

Background: Pharmacists are on the frontline caring for patients at risk of an opioid overdose and for patients with an opioid use disorder (OUD). Dispensing naloxone and medications for OUD and counseling patients about these medications are ways pharmacists can provide care. Key to pharmacists’ involvement is their willingness to take on these practice responsibilities. Methods: The purpose of this scoping review is to identify, evaluate, and summarize published literature describing pharmacists’ attitudes toward naloxone and medications for OUD, i.e., methadone, buprenorphine, and naltrexone. All searches were performed on December 7, 2018, in 5 databases: Embase.com, PubMed.gov, Cumulative Index to Nursing and Allied Health Literature (CINAHL) via EBSCOhost, Cochrane Central Register of Controlled Trials via Wiley, and Clarivate Web of Science. Articles included original research conducted in the United States, described attitude-related language toward naloxone and medications for OUD, and pharmacists. Results: A total of 1323 articles were retrieved, 7 were included. Five studies reported on pharmacists’ attitudes toward naloxone dispensing, 1 study reported on attitudes toward naloxone, buprenorphine, and buprenorphine/naloxone, and 1 reported on attitudes toward buprenorphine/naloxone. Respondents were diverse, including pharmacists from different practice specialties. Studies found that pharmacists agreed with a naloxone standing order, believed that naloxone should be dispensed to individuals at risk of an opioid overdose, and were supportive of dispensing buprenorphine. A minority of pharmacists expressed negative attitudes. Barriers cited to implementation included education and training, workflow, and management support. Conclusions: Pharmacists were positive in their attitudes toward increased practice responsibilities for patients at risk of an opioid overdose or with an OUD. Pharmacists must receive education and training to be current in their understanding of OUD medications, and they must be supported in order to provide effective care to this patient population.

Keywords:

• Attitudes
• buprenorphine
• naloxone
• opioid
• pharmacists
• substance use

Disclosures

Dr. Li-Tzy Wu has received research funding from Alkermes Inc. Dr. Muzyk has served on advisory boards for Alkermes Inc.

Author contributions

Drs. Muzyk and Wu developed the scoping review question and design. Mr. MacEachern performed the literature searches and Mr. Smothers and Ms. Collins reviewed the articles and extracted the data from them. Dr. Muzyk wrote the first draft of the manuscript, and all authors provided critical revisions. All authors contributed to and approved the final manuscript.

Additional information

Funding

This work was made possible by research support from the National Institute on Drug Abuse of the National Institutes of Health (UG1DA040317, Principal Investigator: Li-Tzy Wu). The sponsoring agency had no further role in the study design and analysis, the writing of the report, or the decision to submit the paper for publication. The opinions expressed in this paper are solely those of the authors. Dr. Li-Tzy Wu also has received research funding from the National Institutes of Health (R01MD007658, K12-HL138030), Patient-Centered Outcomes Research Institute (PCORI), Duke Endowment, and Centers for Disease Control and Prevention.