Scaling opioid overdose prevention and naloxone dispensation among rural and small metro area pharmacists: findings from a qualitative study

ABSTRACT

Background

Community pharmacies offer a population-wide approach to scale opioid overdose prevention programs (OOPP). This qualitative study identified factors influencing implementation of New York State’s OOPP to inform the uptake of naloxone dispensation in rural and small metro area pharmacies.

Methods

In-person interviews were conducted among licensed retail, independent, or supermarket pharmacists (n = 60) in the mid-Hudson valley area of New York in high- and medium-overdose regions. The semi-structured 29-item survey captured attitudes and experiences related to pharmacy participation in naloxone dispensation.

Results

Data revealed pharmacist support for naloxone dispensation. Barriers to OOPP success included: (1) Insufficient retail pharmacy leadership support for administrative and clinical tasks for OOPP tasks; (2) excessive opioid analgesic prescribing by physicians; (3) limited uptake of naloxone by prescribers and patients; (4) out-of-pocket costs for patients to obtain naloxone; (5) lack of time, staffing, and space to provide opioid overdose prevention counseling; (6) concern for increased overdose fatalities and injection drug use in the pharmacy premises if pharmacists dispensed sterile syringes, naloxone, and/or Buprenorphine-naloxone; and (7) stigmatizing attitudes toward persons who use opioids.

Conclusion

Multi-level intervention efforts that include pharmacist-prescriber communication and training, and stigma-reducing efforts in rural and small metro area regions are needed.

KEYWORDS:

• Naloxone
• opioid overdose
• rural health
• pharmacists

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The project was sponsored by the Center for Research on Cultural and Structural Equity in Behavioral Health, Research Foundation for Mental Hygiene. BT was supported by the National Institute on Drug Abuse (K23DA042140).