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Karthikeyan N, Xia T, Nielsen S, Picco L. Stocking and supplying naloxone: Findings from a representative sample of community pharmacies in Victoria, Australia. Drug Alcohol Rev 2024. [PMID: 38691509 DOI: 10.1111/dar.13855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 04/03/2024] [Accepted: 04/10/2024] [Indexed: 05/03/2024]
Abstract
INTRODUCTION Naloxone is an opioid receptor antagonist, which can rapidly reverse the effects of an opioid overdose. Community pharmacists may experience several barriers to stocking and supplying naloxone including a lack of confidence or knowledge and time constraints. The current study aimed to examine the extent to which Victorian community pharmacies stock and supply naloxone and determine specific characteristics associated with stocking naloxone. METHODS A representative sample of community pharmacists (n = 558) in Victoria, Australia, were contacted between October and November 2020 and invited to participate in an online survey. Data related to pharmacy- and pharmacist-related characteristics, including stocking and frequency of supplying naloxone in the past year. Multivariate logistic regression analysis was performed to examine the effect of various covariates on stocking naloxone. RESULTS The sample comprised 265 pharmacists (response rate 47%). Most pharmacies were located in Melbourne (the capital city of Victoria, 59.6%) and were part of a pharmacy chain (61.5%). In total, 100 (38%) pharmacies stocked naloxone, a third of whom did not supply it in the past year. Pharmacies that provided opioid agonist treatment had 2.4 times higher odds of stocking naloxone (95% confidence interval 1.425-4.136; p = 0.001). DISCUSSION AND CONCLUSION Less than half of Victorian community pharmacies stock naloxone, with even fewer actually supplying it in the past year. Future efforts are needed to increase the number of pharmacies that stock naloxone and the frequency in which it is supplied, while also addressing possible barriers to stocking and supplying naloxone among community pharmacists.
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Affiliation(s)
- Nandini Karthikeyan
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
- School of Medicine, Monash University, Melbourne, Australia
| | - Ting Xia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Louisa Picco
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
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Chavanne D, Ahluwalia JS, Goodyear K. The effects of race and class on community-level stigmatization of opioid use and policy preferences. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 120:104147. [PMID: 37639913 DOI: 10.1016/j.drugpo.2023.104147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND With opioid use and overdose rates continuing to plague minority communities in the U.S., we explored whether a geographic community's racial composition and social class affect how opioid use in the community is stigmatized and what policy preferences arise in response. METHODS We use case vignettes in a randomized, between-subjects study (N = 1478) with a nation-wide survey. The vignettes describe a community where opioids are harmfully used, varying whether the community was (1) wealthy or poor, (2) predominantly Black or White and (3) facing prevalent use of painkillers or heroin. We tested how these variables affect public stigmatization of opioid use (measured with ratings of responsibility, dangerousness, sympathy, concern, anger, and disappointment) preferred levels of social distance from communities with opioid use (measured with responses to questions about living, working, and interacting in the community), and policy preferences for responding to opioid use (measured with levels of support for providing a safe-consumption site in the community, treating drug use in the community punitively, treating drug use in the community as an illness, and funding drug treatment in the community through income redistribution). RESULTS Compared to wealthy communities with opioid use, poor communities with opioid use were less stigmatized in terms of responsibility, sympathy, concern, anger, and disappointment; they were also met with less support for punitiveness, more support for treating drug use as an illness, and preferences for greater social distance. Compared to White communities with opioid use, Black communities with opioid use were less stigmatized in terms of responsibility, and they were met with stronger preferences to not live and work there and with reduced support for using income redistribution to provide drug treatment for people in the community. Poor-Black communities with opioid use were also perceived to be more dangerous than both poor-White and wealthy-Black communities with opioid use. CONCLUSION These results point to class- and race-based territorial stigma affecting how communities with opioid use are judged and whether policies for providing communities with treatment are supported.
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Affiliation(s)
- David Chavanne
- Department of Economics, Connecticut College, New London, CT, USA.
| | - Jasjit S Ahluwalia
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
| | - Kimberly Goodyear
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA; Center for Alcohol and Addiction Studies, Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
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Mill D, Johnson JL, Percival M, Lee K, Salter SM, D'Lima D, Seubert L, Clifford R, Page AT. Pharmacists' use of guidelines for the supply of non-prescription medicines: a cross-sectional survey. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2023; 31:478-488. [PMID: 37440321 DOI: 10.1093/ijpp/riad044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES Guidelines support best practice for healthcare practice. In Australia, some non-prescription medicines are only accessible after consultation with a pharmacist and are known as Pharmacist Only medicines. Guidelines for providing some Pharmacist Only medicines are available, however, it is currently unknown if and how these guidelines are used in practice.The objective was to characterise pharmacists', intern pharmacists and pharmacy students' use of guidelines for Pharmacist Only medicines. METHODS A cross-sectional electronic survey of Australian registered pharmacists, intern pharmacists and pharmacy students was administered in July 2020. Questions explored the participants' use of Pharmacist Only medicine guidelines (available both in print and online; available online only) in the preceding 12 months. Data were analysed descriptively (i.e. frequencies, percentages). KEY FINDINGS In total, 574 eligible respondents completed the survey. Overall, 396 (69%) reported accessing the online and in-print guidelines in the previous 12 months with 185 (33%) accessing online-only guidelines. The guideline on emergency contraception was used the most out of all guidelines in the past 12 months (278, 48%). Overall, respondents reported accessing guidelines to update knowledge, check their practice reflected best practice and content familiarisation. Respondents' reasons for not accessing guidelines were due to respondents stating they did not need the information or that they had previously accessed the guidelines more than 12 months ago. These reasons varied between respondent groups. CONCLUSIONS Access and use of the Pharmacist Only medicines guidelines varied between pharmacists, interns and students. Further understanding of the influences of the use of these guidelines will help inform professional bodies on how best to develop guidelines to increase consistent use in practice and implement interventions to increase use.
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Affiliation(s)
- Deanna Mill
- School of Allied Health, University of Western Australia, Perth, Western Australia, Australia
| | - Jacinta L Johnson
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
- SA Pharmacy, SA Health, Adelaide, South Australia, Australia
| | - Mia Percival
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Victoria, Australia
| | - Kenneth Lee
- School of Allied Health, University of Western Australia, Perth, Western Australia, Australia
| | - Sandra M Salter
- School of Allied Health, University of Western Australia, Perth, Western Australia, Australia
| | - Danielle D'Lima
- Department of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, London, UK
| | - Liza Seubert
- School of Allied Health, University of Western Australia, Perth, Western Australia, Australia
| | - Rhonda Clifford
- School of Allied Health, University of Western Australia, Perth, Western Australia, Australia
| | - Amy Theresa Page
- School of Allied Health, University of Western Australia, Perth, Western Australia, Australia
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Picco L, Sanfilippo P, Xia T, Lam T, Nielsen S. How do patient, pharmacist and medication characteristics and prescription drug monitoring program alerts influence pharmacists' decisions to dispense opioids? A randomised controlled factorial experiment. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 109:103856. [PMID: 36150356 DOI: 10.1016/j.drugpo.2022.103856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/22/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Prescription drug monitoring programs (PDMP) are electronic databases that track the prescribing and dispensing of high-risk medicines such as opioids. They have the ability to provide clinicians with alerts, which identify medication-related risks, and are used to help inform decisions to supply. This study aimed to determine to what extent patient, pharmacist, and medication related characteristics and PDMP alerts influence decisions to dispense opioids and take other action, using a randomised controlled factorial design. METHODS Pharmacists completed an online factorial experiment, comprising six randomly generated vignettes, describing a hypothetical pharmacy patient. Pharmacists ranked the likelihood of dispensing an opioid prescription and indicated other actions, if any, they would make. Mixed-effects linear and logistical models were used to examine the association between the vignette (patient, medication and alerts), and pharmacist characteristics and the likelihood to dispense and take other actions. RESULTS 241 pharmacists were included in the analysis (n = 1353 vignettes). The PDMP alert for high dose and multiple prescriber episodes were significant predicators of reduced likelihood to dispense, with a respective 2.73- and 4.1-unit decrease in likelihood to dispense (p < 0.001). Alerts had the strongest association with other actions such as contacting the prescriber, talking to the patient and recommending naloxone, though patient and medication characteristics including age, opioid dose, benzodiazepine use and co-morbidity were also associated with increased odds of engaging in some actions. CONCLUSION PDMP alerts were the most significant predictor of reduced likelihood to dispense and were associated with the greatest odds of taking other actions. Well-established risk factors such as high dose and high-risk drug combinations, in the absence of PDMP alerts, were associated with some actions, though to a lesser degree than PDMP alerts. These findings have significant policy implications and suggest PDMP alerts are a greater driver of decisions to dispense opioids and take other actions, compared with other known clinical risk factors.
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Affiliation(s)
- Louisa Picco
- Monash Addiction Research Centre, Eastern Health, Clinical School, Monash University, 47-49 Moorooduc Hwy Frankston, Melbourne, Victoria 3199, Australia.
| | - Paul Sanfilippo
- Monash Addiction Research Centre, Eastern Health, Clinical School, Monash University, 47-49 Moorooduc Hwy Frankston, Melbourne, Victoria 3199, Australia
| | - Ting Xia
- Monash Addiction Research Centre, Eastern Health, Clinical School, Monash University, 47-49 Moorooduc Hwy Frankston, Melbourne, Victoria 3199, Australia
| | - Tina Lam
- Monash Addiction Research Centre, Eastern Health, Clinical School, Monash University, 47-49 Moorooduc Hwy Frankston, Melbourne, Victoria 3199, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health, Clinical School, Monash University, 47-49 Moorooduc Hwy Frankston, Melbourne, Victoria 3199, Australia
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Slocum S, Ozga JE, Joyce R, Walley AY, Pollini RA. If we build it, will they come? Perspectives on pharmacy-based naloxone among family and friends of people who use opioids: a mixed methods study. BMC Public Health 2022; 22:735. [PMID: 35418048 PMCID: PMC9006069 DOI: 10.1186/s12889-022-13078-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Expanding access to the opioid antagonist naloxone to reduce overdose mortality is a public health priority in the United States. Naloxone standing orders (NSOs) have been established in many states to increase naloxone dispensing at pharmacies, but increased pharmacy access does not ensure optimal uptake among those likely to witness an overdose. In a prior statewide purchase trial, we documented high levels of naloxone access at Massachusetts pharmacies under a statewide NSO. In this study, we characterize barriers to pharmacy-based naloxone uptake among potential opioid overdose "bystanders" (friends or family of people who use opioids) that may be amenable to intervention. METHODS Eligible bystanders were Massachusetts residents ≥ 18 years of age, did not use illicit opioids in the past 30 days, and knew someone who currently uses illicit opioids. We used a sequential mixed methods approach, in which a series of semi-structured qualitative interviews (N = 22) were conducted April-July 2018, to inform the development of a subsequent quantitative survey (N = 260), conducted February-July 2020. RESULTS Most survey participants (77%) reported ever obtaining naloxone but few (21%) attempted to purchase it at a pharmacy. Qualitative participants revealed that barriers to utilizing the NSO included low perceived risk of overdose, which was rooted in misconceptions regarding the risks of prescription opioid misuse, denial about their loved one's drug use, and drug use stereotypes; inaccurate beliefs about the impact of naloxone on riskier opioid use; and concerns regarding anticipated stigma and confidentiality. Many participants had engaged in mutual support groups, which served as a source of free naloxone for half (50%) of those who had ever obtained naloxone. CONCLUSIONS Despite high levels of pharmacy naloxone access in Massachusetts, few bystanders in our study had attempted to obtain naloxone under the NSO. Low perceived risk of overdose, misinformation, stigma, and confidentiality were important barriers to pharmacy naloxone uptake, all of which are amenable to intervention. Support groups provided a setting for addressing stigma and misinformation and provided a discreet and comfortable setting for naloxone access. Where these groups do not exist and for bystanders who do not participate in such groups, pharmacies are well-positioned to fill gaps in naloxone availability.
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Affiliation(s)
- Susannah Slocum
- Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Jenny E Ozga
- Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Rebecca Joyce
- Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Alexander Y Walley
- Department of Community Health Sciences, School of Public Health, Boston University, Boston, MA, USA.,Grayken Center for Addiction, Clinical Addiction Research Education Unit, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Robin A Pollini
- Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, USA. .,Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, USA.
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Potaka KL, Freeman R, Soo D, Nguyen NA, Sim TF, Moullin JC. Retrospective analysis of patterns of opioid overdose and interventions delivered at a tertiary hospital emergency department: impact of COVID-19. BMC Emerg Med 2022; 22:62. [PMID: 35397487 PMCID: PMC8994187 DOI: 10.1186/s12873-022-00604-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/07/2022] [Indexed: 11/29/2022] Open
Abstract
Background Opioid-related overdoses cause substantial numbers of preventable deaths. Naloxone is an opioid antagonist available in take-home naloxone (THN) kits as a lifesaving measure for opioid overdose. As the emergency department (ED) is a primary point of contact for patients with high-risk opioid use, evidence-based recommendations from the Society of Hospital Pharmacists of Australia THN practice guidelines include the provision of THN, accompanied by psychosocial interventions. However, implementation of these guidelines in practice is unknown. This study investigated ED opioid-related overdose presentations, concordance of post-overdose interventions with the THN practice guidelines, and the impact, if any, of the SARS-CoV-2 (COVID-19) pandemic on case presentations. Methods A single-centre retrospective audit was conducted at a major tertiary hospital of patients presenting with overdoses involving opioids and non-opioids between March to August 2019 and March to August 2020. Patient presentations and interventions delivered by the paramedics, ED and upon discharge from the ED were collated from medical records and analysed using descriptive statistics, chi square and independent T-tests. Results The majority (66.2%) of patients presented to hospital with mixed drug overdoses involving opioids and non-opioids. Pharmaceutical opioids were implicated in a greater proportion (72.1%) of overdoses than illicit opioids. Fewer patients presented in March to August 2020 as compared with 2019 (26 vs. 42), and mixed drug overdoses were more frequent in 2020 than 2019 (80.8% vs. 57.1%). Referral to outpatient psychology (22.0%) and drug and alcohol services (20.3%) were amongst the most common post-discharge interventions. Naloxone was provided to 28 patients (41.2%) by the paramedics and/or ED. No patients received THN upon discharge. Conclusions This study highlights opportunities to improve ED provision of THN and other interventions post-opioid overdose. Large-scale multi-centre studies are required to ascertain the capacity of EDs to provide THN and the impact of COVID-19 on opioid overdose presentations. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-022-00604-w.
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Martignetti L, Sun W. Perspectives of Stakeholders of Equitable Access to Community Naloxone Programs: A Literature Review. Cureus 2022; 14:e21461. [PMID: 35223245 PMCID: PMC8858082 DOI: 10.7759/cureus.21461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 12/02/2022] Open
Abstract
The purpose of this review is to examine the existing literature about facilitators and barriers influencing equitable access to naloxone programs by individuals who use opioids. A total of 49 published articles were examined, which generated four overarching themes:(1) Stigma as a barrier to access; (2) Lack of a wide range of stakeholder perspectives; (3) Need for a comprehensive understanding of factors affecting equitable access to naloxone programs; (4) Facilitators to increase the access of community naloxone programs. Our review highlighted the importance of advocacy in practice, education, administration, and policy to address the health inequities that exist in naloxone distribution programs. Advocacy activities involve the need for health care professionals to engage in social justice practice through evidence-based informed research about the facts of opioid use; challenging the stigma toward victim-blaming against naloxone users; as well as promoting program development and health policy to bring about equitable access to naloxone programs by marginalized and socially disadvantaged populations.
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Cheetham A, Picco L, Barnett A, Lubman DI, Nielsen S. The Impact of Stigma on People with Opioid Use Disorder, Opioid Treatment, and Policy. Subst Abuse Rehabil 2022; 13:1-12. [PMID: 35115860 PMCID: PMC8800858 DOI: 10.2147/sar.s304566] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 01/11/2022] [Indexed: 12/25/2022] Open
Abstract
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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Affiliation(s)
- Ali Cheetham
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, 3199, Australia
- Turning Point, Eastern Health, Richmond, Victoria, 3121, Australia
| | - Louisa Picco
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, 3199, Australia
| | - Anthony Barnett
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, 3199, Australia
- Turning Point, Eastern Health, Richmond, Victoria, 3121, Australia
| | - Dan I Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, 3199, Australia
- Turning Point, Eastern Health, Richmond, Victoria, 3121, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, 3199, Australia
- Turning Point, Eastern Health, Richmond, Victoria, 3121, Australia
- Correspondence: Suzanne Nielsen, Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, 47-49 Moorooduc Hwy, Frankston, Victoria, 3199, Australia, Tel +61 3 9904 4641, Email
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Smart R, Grant S. Effectiveness and implementability of state-level naloxone access policies: Expert consensus from an online modified-Delphi process. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 98:103383. [PMID: 34340167 PMCID: PMC8671224 DOI: 10.1016/j.drugpo.2021.103383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/23/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Naloxone distribution, a key global strategy to prevent fatal opioid overdose, has been a recent target of legislation in the U.S., but there is insufficient empirical evidence from causal inference methods to identify which components of these policies successfully reduce opioid-related harms. This study aimed to examine expert consensus on the effectiveness and implementability of various state-level naloxone policies. METHODS We used the online ExpertLens platform to conduct a three-round modified-Delphi process with a purposive sample of 46 key stakeholders (advocates, healthcare providers, human/social service practitioners, policymakers, and researchers) with naloxone policy expertise. The Effectiveness Panel (n = 24) rated average effects of 15 types of policies on naloxone pharmacy distribution, opioid use disorder (OUD) prevalence, nonfatal opioid-related overdoses, and opioid-related overdose mortality. The Implementation Panel (n = 22) rated the same policies on acceptability, feasibility, affordability, and equitability. We compared ratings across policies using medians and inter-percentile ranges, with consensus measured using the RAND/UCLA Appropriateness Method Inter-Percentile Range Adjusted for Symmetry technique. RESULTS Experts reached consensus on all items. Except for liability protections and required provision of education or training, experts perceived all policies to generate moderate-to-large increases in naloxone pharmacy distribution. However, only three policies were expected to yield substantive decreases on fatal overdose: statewide standing/protocol order, over-the-counter supply, and statewide "free naloxone." Of these, experts rated only statewide standing/protocol orders as highly affordable and equitable, and unlikely to generate meaningful population-level effects on OUD or nonfatal opioid-related overdose. Across all policies, experts rated naloxone prescribing mandates relatively lower in acceptability, feasibility, affordability, and equitability. CONCLUSION Experts believe statewide standing/protocol orders are an effective, implementable, and equitable policy for addressing opioid-related overdose mortality. While experts believe many other broad policies are effective in reducing opioid-related harms, they also believe these policies face implementation challenges related to cost and reaching vulnerable populations.
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Affiliation(s)
- Rosanna Smart
- Economics, Sociology, and Statistics Department, RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, USA.
| | - Sean Grant
- Department of Social & Behavioral Sciences, Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, RG 6046, Indianapolis, IN 46202, USA
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Tse WC, Djordjevic F, Borja V, Picco L, Lam T, Olsen A, Larney S, Dietze P, Nielsen S. Does naloxone provision lead to increased substance use? A systematic review to assess if there is evidence of a 'moral hazard' associated with naloxone supply. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 100:103513. [PMID: 34798434 DOI: 10.1016/j.drugpo.2021.103513] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/15/2021] [Accepted: 10/16/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Take home naloxone (THN) programs have been rapidly upscaled in response to increasing opioid-related mortality. One often cited concern is that naloxone provision could be associated with increased opioid use, due to the availability of naloxone to reverse opioid overdose. We conducted a systematic review to determine whether THN provision is associated with changes in substance use by participants enrolled in THN programs. METHODS We conducted a systematic review of the literature to assess changes in heroin or other substance use by people who use opioids following THN provision. RESULTS Seven studies with 2578 participants were included. Of the seven studies, there were two quasi-experimental studies and five cohort studies. Based on the Joanna Briggs Institute quality assessment, four studies were of moderate quality and three studies were of high quality. Of the five studies that reported on the primary outcome of heroin use, no study found evidence of increased heroin use across the study population. Five studies reported on other substance use (benzodiazepines, alcohol, cocaine, amphetamine, cannabis, prescription opioids), none of which found evidence of an increase in other substance use associated with THN provision. Four studies reported on changes in overdose frequency following THN provision: three studies reporting no change, and one study of people prescribed opioids finding a reduction in opioid-related emergency department attendances for participants who received naloxone. CONCLUSION We found no evidence that THN provision was associated with increased opioid use or overdose. Concerns that THN supply may lead to increased substance use were not supported by data from reviewed studies.
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Affiliation(s)
- Wai Chung Tse
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, VIC 3199, Australia; Monash University School of Medicine, Clayton Campus, Clayton, VIC 3800, Australia
| | - Filip Djordjevic
- Burnet Institute Centre for Epidemiology and Population Health Research, Melbourne, VIC 3004, Australia
| | - Viandro Borja
- Alfred Mental and Addiction Health program, Alfred Health, Melbourne, VIC 3181, Australia
| | - Louisa Picco
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, VIC 3199, Australia
| | - Tina Lam
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, VIC 3199, Australia
| | - Anna Olsen
- Australian National University College of Health & Medicine, Australia
| | - Sarah Larney
- Université de Montréal and Centre de Recherche du CHUM, 2900 Edouard Montpetit Blvd, Montreal, Quebec H3T 1J4, Canada
| | - Paul Dietze
- Burnet Institute Centre for Epidemiology and Population Health Research, Melbourne, VIC 3004, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, VIC 3199, Australia.
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Cid A, Patten A, Grindrod K, Beazely MA. Frequently asked questions about naloxone: Part 1. Can Pharm J (Ott) 2021; 154:301-304. [PMID: 34484479 DOI: 10.1177/17151635211034528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 06/28/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Ashley Cid
- School of Pharmacy, University of Waterloo, Kitchener, Ontario
| | - Alec Patten
- School of Pharmacy, University of Waterloo, Kitchener, Ontario
| | - Kelly Grindrod
- School of Pharmacy, University of Waterloo, Kitchener, Ontario
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McMillan SS, Chan H, Hattingh LH. Australian Community Pharmacy Harm-Minimisation Services: Scope for Service Expansion to Improve Healthcare Access. PHARMACY 2021; 9:pharmacy9020095. [PMID: 33926030 PMCID: PMC8167599 DOI: 10.3390/pharmacy9020095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/23/2021] [Accepted: 04/24/2021] [Indexed: 11/16/2022] Open
Abstract
Community pharmacies are well positioned to participate in harm-minimisation services to reduce harms caused by both licit and illicit substances. Considering developments in pharmacist practices and the introduction of new professional pharmacy services, we identified a need to explore the contemporary role of community pharmacy in harm minimisation. Semi-structured interviews were undertaken to explore the opinions of stakeholders, pharmacy staff, and clients about the role of community pharmacy in harm minimisation, including provision of current services, experiences, and expectations. Participants (n = 28) included 5 stakeholders, 9 consumers, and 14 staff members from seven community pharmacies. Three over-arching themes were identified across the three participants groups: (i) scope and provision, (ii) complexity, and (iii) importance of person-centred advice and support in relation to community pharmacy harm minimisation services. Community pharmacies are valuable healthcare destinations for delivery of harm minimisation services, with scope for service expansion. Further education, support, and remuneration are needed, as well as linkage to other sector providers, in order to ensure that pharmacists and pharmacy staff are well equipped to provide a range of harm minimisation services.
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Affiliation(s)
- Sara S. McMillan
- Gold Coast Campus, School of Pharmacy and Pharmacology, Griffith University, Southport 4215, Australia;
| | - Hidy Chan
- The Pharmacy Guild of Australia, Queensland Branch, Brisbane 4000, Australia;
| | - Laetitia H. Hattingh
- Gold Coast Campus, School of Pharmacy and Pharmacology, Griffith University, Southport 4215, Australia;
- Gold Coast Hospital and Health Service, Southport 4215, Australia
- Correspondence:
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Macleod ER, Tajbakhsh I, Hamilton-Wright S, Laliberte N, Wiese JL, Matheson FI. "They're not doing enough.": women's experiences with opioids and naloxone in Toronto. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2021; 16:26. [PMID: 33743756 PMCID: PMC7980746 DOI: 10.1186/s13011-021-00360-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 03/04/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Amid increasing opioid overdose deaths in Canada since 2010 and a changing naloxone access landscape, there is a need for up-to-date research on Canadian women's experiences with opioids. Studies on Canadian take-home naloxone programs are promising, but research beyond these programs is limited. Our study is the first to focus on women's experiences and perspectives on the opioid crisis in Ontario, Canada's most populous province, since the opioid crisis began in 2010. OBJECTIVE Our objective was to address research knowledge gaps involving Canadian women with criminal justice involvement who use opioids, and identify flaws in current policies, responses, and practices. While the opioid overdose crisis persists, this lack of research inhibits our ability to determine whether overdose prevention efforts, especially involving naloxone, are meeting their needs. METHODS We conducted semi-structured, qualitative interviews from January to April 2018 with 10 women with experience of opioid use. They were recruited through the study's community partner in Toronto. Participants provided demographic information, experiences with opioids and naloxone, and their perceptions of the Canadian government's responses to the opioid crisis. Interviews were transcribed verbatim and inductive thematic analysis was conducted to determine major themes within the data. RESULTS Thematic analysis identified seven major concerns despite significant differences in participant life and opioid use experiences. Participants who had used illicit opioids since naloxone became available over-the-counter in 2016 were much more knowledgeable about naloxone than participants who had only used opioids prior to 2016. The portability, dosage form, and effects of naloxone are important considerations for women who use opioids. Social alienation, violence, and isolation affect the wellbeing of women who use opioids. The Canadian government's response to the opioid crisis was perceived as inadequate. Participants demonstrated differing needs and views on ideal harm reduction approaches, despite facing similar structural issues surrounding stigma, addiction management, and housing. CONCLUSIONS Participants experienced with naloxone use found it to be useful in preventing fatal overdose, however many of their needs with regards to physical, mental, and social health, housing, harm reduction, and access to opioid treatment remained unmet.
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Affiliation(s)
- Emilie R Macleod
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B1W8, Canada
| | - Iren Tajbakhsh
- Elizabeth Fry Society Toronto, 215 Wellesley Street East, Toronto, ON, M4X 1G1, Canada
| | - Sarah Hamilton-Wright
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B1W8, Canada
| | - Nancy Laliberte
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Jessica L Wiese
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B1W8, Canada
| | - Flora I Matheson
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B1W8, Canada. .,Dalla Lana School of Public Health, University of Toronto, 55 College St Room 500, Toronto, ON, M5T 3M7, Canada.
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Antoniou T, Pritlove C, Shearer D, Martins D, Tadrous M, Munro C, Gomes T. A qualitative study of a publicly funded pharmacy-dispensed naloxone program. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 92:103146. [PMID: 33568317 DOI: 10.1016/j.drugpo.2021.103146] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 12/28/2022]
Abstract
AIMS To characterize the experiences of individuals accessing pharmacy-based naloxone and relate these experiences to the risk environments and discourses in which they are embedded. METHODS We conducted a qualitative study using in-depth interviews of 37 adults aged 18 years and over who had accessed pharmacy-dispensed naloxone. Participants were recruited from across Ontario, Canada, and comprised individuals taking opioids for chronic pain, those taking opioids for reasons other than chronic pain, and individuals acquiring naloxone to act as bystanders in an opioid overdose setting. We drew upon risk environment theory to interpret participants' accounts. RESULTS Following analysis and interpretation, we generated five theoretically-informed themes characterizing the experiences of individuals accessing pharmacy-dispensed naloxone: 'intersection of naloxone narrative with pharmacy environment', 'individual risk environment and pharmacy-dispensed naloxone uptake', 'safe spaces: creating an enabling environment for pharmacy-dispensed naloxone', 'individuation: becoming a first responder' and 'beyond naloxone: the macro risk environment'. Specifically, participants described how judgement and stereotyping associated with the broader naloxone narrative can be amplified in the space of the pharmacy, leading to fears of reprisals and strategies to mitigate social risk. In addition, the social construction of naloxone as a drug for 'problematic' opioid use and a lack of pharmacist awareness regarding the risk environments in which opioid use occurs was perceived to limit opportunities for optimizing naloxone distribution and training. Finally, participants described approaches that could create enabling environments in the space of the pharmacy while remaining cognizant of the structural changes required in the macro risk environments of people who take opioids. CONCLUSIONS Despite increasing the availability of naloxone, participants characterized several social and environmental factors that could limit the accessibility of the drug from pharmacies. Strategies to address these factors could create enabling environments within pharmacies that optimize the reach and impact of pharmacy-dispensed naloxone.
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Affiliation(s)
- Tony Antoniou
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada; Department of Family and Community Medicine, Unity Health, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Ontario Drug Policy Research Network, Toronto, Ontario, Canada
| | - Cheryl Pritlove
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada; School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Dana Shearer
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada; Ontario Drug Policy Research Network, Toronto, Ontario, Canada
| | - Diana Martins
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada; Ontario Drug Policy Research Network, Toronto, Ontario, Canada
| | - Mina Tadrous
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada; Ontario Drug Policy Research Network, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Toronto, Ontario, Canada
| | - Charlotte Munro
- Ontario Drug Policy Research Network, Toronto, Ontario, Canada
| | - Tara Gomes
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada; Ontario Drug Policy Research Network, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
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What Is Known about Community Pharmacy-Based Take-Home Naloxone Programs and Program Interventions? A Scoping Review. PHARMACY 2021; 9:pharmacy9010030. [PMID: 33540676 PMCID: PMC7931101 DOI: 10.3390/pharmacy9010030] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/29/2021] [Accepted: 01/29/2021] [Indexed: 12/13/2022] Open
Abstract
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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Gadd S, Cox N, Samuelson J, Kenney A, Turner K, Cochran G. Abuse-Deterrent Opioid Formulations and the Opioid Crisis: A Pharmacist's Perspective. Ther Drug Monit 2021; 43:35-41. [PMID: 33278243 DOI: 10.1097/ftd.0000000000000844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/04/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND For over 20 years, the United States has suffered the detrimental effects of an opioid epidemic. Extended-release opioid products are particularly prone to abuse due to the high amount of opioid present. By bypassing the controlled-release mechanisms and nonoral administration, individuals experience intense and dangerous "highs." Abuse-deterrent opioid formulations have been recommended as a potential solution to the crisis, but widespread utilization has been stunted and their role in therapy remains unclear owing to limited real-world efficacy data and affordability issues. This review discusses abuse-deterrent opioid formulations, the mechanisms and data underlying available products, and a pharmacist's perspective of their role in the opioid crisis. METHODS The authors reviewed PubMed, MEDLINE, and Google Scholar electronic databases for premarketing and postmarketing studies on OxyContin, Xtampza ER, and Hysingla ER. RESULTS Studies showed lower rates of abuse (19% reduction), opioid use disorder (27%), overdose (34%), and fatalities (85%) with the reformulated OxyContin when compared with the original product and comparator opioids. However, these studies revealed the potential for bypassing abuse-deterrent mechanisms and diverting abuse to other drugs. Postmarketing studies are unavailable for Xtampza ER or Hysingla ER, although premarketing studies suggested that some controlled-release properties persist when the product is manipulated, indicating that abuse may be more difficult and less rewarding. CONCLUSIONS Abuse-deterrent opioid products may lead to reductions in abuse, overdose, and overdose fatalities. However, cost, loopholes in deterrence mechanism, and possible diversion to other substances hinder their role in the opioid crisis. Multiple approaches must be used to improve opioid safety, and further postmarketing and real-world analyses should be performed on available opioid formulations to assess their impact on abuse-related adverse events.
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Affiliation(s)
- Shannon Gadd
- Department of Pharmacotherapy, College of Pharmacy, University of Utah
| | - Nicholas Cox
- Department of Pharmacotherapy, College of Pharmacy, University of Utah
- Department of Pharmacy, University of Utah Health
| | - James Samuelson
- Division of Epidemiology, Department of Internal Medicine, Program for Addiction Research, Clinical Care, Knowledge, and Advocacy, School of Medicine, University of Utah; and
| | - Amy Kenney
- Division of Epidemiology, School of Medicine, University of Utah, Salt Lake City, UT
| | - Kyle Turner
- Department of Pharmacotherapy, College of Pharmacy, University of Utah
- Department of Pharmacy, University of Utah Health
| | - Gerald Cochran
- Division of Epidemiology, Department of Internal Medicine, Program for Addiction Research, Clinical Care, Knowledge, and Advocacy, School of Medicine, University of Utah; and
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Nielsen S, Olsen A. Using the behaviour change wheel to understand and address barriers to pharmacy naloxone supply in Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 90:103061. [PMID: 33321285 DOI: 10.1016/j.drugpo.2020.103061] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND There has been low community pharmacy-based naloxone supply in Australia despite its over-the-counter status. The Behaviour Change Wheel (BCW) is a method used to understand individual and system-level barriers and facilitators to a particular behaviour to inform program implementation. The BCW is focused on three essential conditions of behaviour change (capability, opportunity, and motivation (termed the COM-B)) which we use to assess pharmacists perceptions and experiences of naloxone provision with the aim of using informing targets for interventions to improve naloxone distribution. METHOD Qualitative interviews with community pharmacists (n = 37) from four Australian jurisdictions explored naloxone knowledge, expectations and experiences dispensing the medicine. Audio-recorded interviews were transcribed verbatim and coded against the a priori domains in the COM-B (capability, opportunity, and motivation). Results were analysed to identify key barriers and facilitators to naloxone provision within each domain. Finally, we mapped our analysis against the intervention functions and policy-level strategies provided in the BCW to identify example intervention strategies. RESULTS Underlying all pharmacists' descriptions of naloxone were structural impediments to dispensing including poor communication regarding pharmacists' role and disrupted supply chains. Mapped across the three COM-B domains, we find two divergent groups of pharmacists. Pharmacists' capability and motivation to supply naloxone was higher amongst those who did not problematize people who inject drugs and who worked in pharmacies already supplying harm reduction services. Pharmacists were less likely to discuss capabilities and opportunities for naloxone dispensing when harm reduction was not normalised in their workplace and/or they described people who inject drugs using negative and stigmatising language. CONCLUSIONS Analysis using the COM-B framework reveals key areas where implementation and policy strategies are needed to increase naloxone supply. Individual- and structural-level supports are needed to improve pharmacists' knowledge of naloxone and address other logistical and cultural barriers that limit naloxone provision in pharmacy settings.
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Affiliation(s)
- Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, 47-49 Moorooduc Hwy, Frankston 3199, VIC, Australia; National Drug and Alcohol Research Centre, UNSW Sydney, 22-32 King St, Randwick 2031 New South Wales, Australia.
| | - Anna Olsen
- Medical School, The Australian National University, Florey Building 54 Mills Road, Acton 2601, Canberra, Australia
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Varisco TJ, Downs CG, Rathburn KR, Fleming ML, Thornton JD. Applying the capability, opportunity, motivation, and behavior model to identify opportunities to increase pharmacist comfort dispensing naloxone in Texas: A structural equation modeling approach. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 83:102827. [DOI: 10.1016/j.drugpo.2020.102827] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 05/14/2020] [Accepted: 06/07/2020] [Indexed: 11/25/2022]
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Fomiatti R, Farrugia A, Fraser S, Dwyer R, Neale J, Strang J. Addiction stigma and the production of impediments to take-home naloxone uptake. Health (London) 2020; 26:139-161. [PMID: 32529843 DOI: 10.1177/1363459320925863] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Opioid overdose deaths are a major health issue in Australia and around the world. Programmes to provide opioid consumers with 'take-home' naloxone to reverse overdose exist internationally, but uptake by mainstream health services and consumers remains inconsistent. Researchers have identified a range of important educational, training and logistical impediments to take-home naloxone uptake and distribution, yet they have focused less on the social dynamics that can enhance or limit access, such as stigma. In this article, we also explore impediments to uptake, drawing on qualitative interview data gathered for an Australian research project on take-home naloxone. Mobilising a performative approach to stigma, we argue that overdose and prevention are shaped by the social dynamics of stigma and, as such, responsibility for dealing with overdose, as with take-home naloxone, should also be considered social (i.e. shared among peers, the public, communities and governments). Our interview data illuminate the various ways in which addiction stigma limits the possibilities and capacities of take-home naloxone and overdose prevention. First, we focus on how stigma may impede professional information provision about take-home naloxone by limiting the extent to which it is presented as a matter of interest for all opioid consumers, not just those who consume opioids illicitly. Second, we explore how stigma may limit the scale-up and expansion of programmes and access points. From here, we focus on how stigma co-constitutes the politics of overdose and prevention, rendering take-home naloxone ill-suited to many social settings of overdose. In closing, we point out that stigma is not just a post hoc impediment to access to and use of take-home naloxone but is central to opioid overdose production itself, and to effective prevention. While take-home naloxone is an excellent life-saving initiative, uncritically valorising it may divert attention from broader goals, such as the de-stigmatisation of drug consumption through decriminalisation, and other ambitious attempts to reduce overdose.
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Affiliation(s)
- Renae Fomiatti
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia
| | - Adrian Farrugia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia; National Drug Research Institute, Curtin University, Australia
| | - Suzanne Fraser
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia; Centre for Social Research in Health, Faculty of Arts and Social Sciences, University of New South Wales, Australia
| | - Robyn Dwyer
- Centre for Alcohol Policy Research, La Trobe University, Australia; National Drug Research Institute, Curtin University, Australia
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Madras BK, Ahmad NJ, Wen J, Sharfstein JS. Improving Access to Evidence-Based Medical Treatment for Opioid Use Disorder: Strategies to Address Key Barriers within the Treatment System. NAM Perspect 2020; 2020:202004b. [PMID: 35291732 PMCID: PMC8916813 DOI: 10.31478/202004b] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Even though evidence-based treatment for opioid use disorders (OUD) is effective, almost four in five Americans with OUD do not receive any form of treatment. The gap in access to evidence-based care, including treatment with medications for OUD, stems in part from barriers to change within the health care system. This paper includes nine key barriers that prevent access to evidence-based care, including stigma; inadequate clinical training; a dearth of addiction specialists; lack of integration of MOUD provision in practice; regulatory, statutory, and data sharing restrictions; and financial barriers. Action from a number of actors is urgently needed to address this crisis.
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Affiliation(s)
| | - N Jia Ahmad
- Johns Hopkins Bloomberg School of Public Health
| | - Jenny Wen
- Johns Hopkins University School of Medicine
| | - Joshua Sharfstein Sharfstein
- Johns Hopkins Bloomberg School of Public Health; and the Prevention, Treatment, and Recovery Working Group of the Action Collaborative on Countering the U.S. Opioid Epidemic
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Tse WC, Sanfilippo P, Lam T, Dietze P, Nielsen S. Community pharmacy naloxone supply, before and after rescheduling as an over‐the‐counter drug: sales and prescriptions data, 2014–2018. Med J Aust 2020; 212:314-320. [DOI: 10.5694/mja2.50524] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/26/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Wai Chung Tse
- Monash Addiction Research CentreMonash University Melbourne VIC
- Monash University Melbourne VIC
| | - Paul Sanfilippo
- Monash Addiction Research CentreMonash University Melbourne VIC
| | - Tina Lam
- Monash Addiction Research CentreMonash University Melbourne VIC
| | - Paul Dietze
- Monash Addiction Research CentreMonash University Melbourne VIC
- Centre for Epidemiology and Population Health ResearchBurnet Institute Melbourne VIC
| | - Suzanne Nielsen
- Monash Addiction Research CentreMonash University Melbourne VIC
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