Changing the Conversation: Flip the Script on Naloxone

Providing education and naloxone to those at risk of witnessing or experiencing an overdose is associated with a 30%-45% decrease in overdose death rates, opioid consumption, and emergency visits.

Pharmacies are uniquely positioned to educate on and distribute naloxone. However, little is known about attitudes and perceptions of the newest pharmacy-based harm reduction initiative.

A new study published in the Journal of the American Pharmacists Association examines how to best implement naloxone dispensing and explore the attitudes of various stakeholders toward dispensing in community pharmacies. The research focused on pharmacies in Massachusetts and Rhode Island.

The researchers presented scenarios based on offering naloxone to 8 focus groups that represented:

• People using illicit drugs or in recovery,
• Chronic opioid patients,
• Caregivers and family members,
• Pharmacists.

All cohorts identified stigmas. Patients, illicit drug users, and family members all reported feeling uncomfortable requesting naloxone for fear of being labeled or treated differently in the future.

In the pharmacist groups, many practical issues surfaced. These included a lack of clarity on logistics, insufficient training and demonstration materials, and time and space constraints during patient education.

Pharmacists also worried that by offering naloxone, they might offend their chronic opioid patients, or undermine a patient’s care plan. Once patients requested naloxone, billing was often confusing and difficult. Many pharmacists were unaware of naloxone’s status as a rescue medication, which allows it to be dispensed and billed to someone other than the end user. These concerns highlight the need for comprehensive pharmacist training programs.

All cohorts agreed that offering naloxone to all patients according to clear evidence-based criteria would be the most comfortable for pharmacists and least stigmatizing for patients. This is in stark contrast to the “opt-in” method currently employed, where patients must initiate requests for naloxone.

By adopting an opt-out method, pharmacists can reduce the stigma and increase access to naloxone.

The next challenge will be to create clear criteria focused on risk factors that do not stigmatize patients, the researchers concluded.

Reference

Green TC, Case P, Fiske H, et al. Perpetuating stigma or reducing risk? Perspectives from naloxone consumers and pharmacists on pharmacy-based naloxone in 2 states. J Am Pharm Assoc (2003). 2017 Feb 14. pii: S1544-3191(17)30013-4. doi: 10.1016/j.japh.2017.01.013. [Epub ahead of print]