Barriers and facilitators to dispensing of intranasal naloxone by pharmacists

ABSTRACT

Background: Although misuse of prescription opioids has reached epidemic proportions, pharmacy-based preventive services to combat this epidemic are limited. The aims of this study were to identify barriers and facilitators to the dispensing of intranasal naloxone (INN) by pharmacists in New Mexico. Methods: For this mixed-methods study, a qualitative component (focus group) informed the development of a quantitative component (electronic survey) distributed to all pharmacists registered with the New Mexico Board of Pharmacy and practicing in the state. A 46-item survey included questions about pharmacists' concerns regarding dispensing INN, barriers and facilitators to dispensing INN, efforts needed to increase availability and utilization of pharmacist-dispensed INN, and characteristics of respondents and their pharmacies. Results: Pharmacists from all geographical regions and all types of pharmacy settings were represented in the sample (final N = 390, participation rate 23.5%, including a subset of 182 community pharmacists). The main barriers identified were (1) out-of-pocket costs for patients; (2) time constraints for pharmacists; and (3) inadequate reimbursement for pharmacists. The main facilitators were (1) increased awareness among opioid-using patients and family members about the need for INN; (2) additional education to the general public; and (3) additional training for pharmacists on how to initiate discussions about INN with high-risk patients. Some community pharmacists were concerned that INN dispensing would promote opioid abuse (16.5%) and attract undesirable clientele (14.3%). In a multivariable logistic regression analysis of a community pharmacy subset, a higher number of concerns about INN (odds ratio [OR] = 0.87; 95% confidence interval [CI]: 0.82–0.93) and a pharmacy setting in a chain grocery or a “big box” store (OR = 0.38; 95% CI: 0.16–0.92) were associated with decreased odds of dispensing INN. Conclusions: Effective intervention strategies for increasing dispensing of intranasal naloxone by pharmacists should focus on pharmacists' concerns, include education to multiple audiences, and address provider-level, system-level, and society-level barriers.

KEYWORDS:

• Naloxone
• opioids
• pharmacists
• pharmacy-based interventions

Acknowledgments

The authors would like to thank the staff of the New Mexico Pharmacists Association, in particular, Mr. Dale Tinker and Ms. Julie Weston, New Mexico Board of Pharmacy, and University of New Mexico leadership for assistance with the study design and implementation. We also thank Ms. Laura Garrison for her assistance with institutional review board approvals and manuscript preparation.

Funding

Funding was provided by University of New Mexico College of Pharmacy and New Mexico Pharmacists Association. The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Author contributions

All coauthors contributed substantially to the development of the manuscript. Research conception and design was led by L.N.B., T.H.C., and A.M.B.; data collection was performed by S.C., S.S., T.H.C, and A.B., L.B, S.S., and T.H.C. analyzed the data, whereas all coauthors contributed to the interpretation of results, as well as the writing and revising of the manuscript.