Anna Olsen1, Belinda Lawton2, Robyn Dwyer3, Meng-Wong Taing4, Ka Lai Joyce Chun5, Samantha Hollingworth5, Suzanne Nielsen6. 1. National Centre for Epidemiology and Population Health, Australian National University, Acton ACT, 0200, Australia. Electronic address: anna.olsen@anu.edu.au. 2. Crawford School of Public Policy, Australian National University, Acton ACT, 0200, Australia. 3. Centre for Alcohol Policy Research, LaTrobe University, Bundoora Vic, 3086, Australia. 4. School of Pharmacy, University of Queensland, Brisbane St Lucia, Queensland, 4072, Australia; Centre for Optimising Pharmacy Practice-based Excellence in Research, The University of Queensland, Brisbane, Queensland, Australia. 5. School of Pharmacy, University of Queensland, Brisbane St Lucia, Queensland, 4072, Australia. 6. National Drug and Alcohol Research Centre, University of New South Wales, Randwick New South Wales, 2031, Australia; Monash Addiction Research Centre, Monash University, Frankston, Victoria, 31699, Australia.
Abstract
BACKGROUND: Opioid overdose is a significant public health issue among people who use pharmaceutical opioids and/or heroin. One response to reducing overdose deaths is to expand public access to naloxone. The Australian Therapeutic Goods Administration down-scheduled naloxone from prescription only (S4) to pharmacist only over-the-counter (OTC, schedule 3) in February 2016. There is little research examining pharmacists' perspectives or experiences of this change. METHODS: Thirty-seven semi-structured interviews with Australian community pharmacists were conducted in 2016-2017 to investigate pharmacists' attitudes to and experiences of OTC naloxone. Transcripts were thematically analysed, guided by a broad interest in facilitators and barriers to OTC supply. RESULTS: Around half of the pharmacists were aware of the down-scheduling and only two had provided OTC naloxone. Core barriers to pharmacist provision of OTC naloxone included limited understanding of opioid overdose, confusion about the role and responsibilities of pharmacists in providing OTC naloxone, concerns about business, stigma related to people who inject drugs (PWID) and system-level challenges. CONCLUSION: Pharmacy provision of OTC naloxone offers an important opportunity to reduce overdose mortality. Our study suggests this opportunity is yet to be realised and highlights several individual- and structural-level impediments hindering the expansion of public access to naloxone via community pharmacies. There is a need to develop strategies to improve pharmacists' knowledge of OTC naloxone and opioid overdose as well as to address other logistical and cultural barriers that limit naloxone provision in pharmacy settings. These need to be addressed at the individual level (training) as well as the system level (information, regulation and supply).
BACKGROUND:Opioid overdose is a significant public health issue among people who use pharmaceutical opioids and/or heroin. One response to reducing overdose deaths is to expand public access to naloxone. The Australian Therapeutic Goods Administration down-scheduled naloxone from prescription only (S4) to pharmacist only over-the-counter (OTC, schedule 3) in February 2016. There is little research examining pharmacists' perspectives or experiences of this change. METHODS: Thirty-seven semi-structured interviews with Australian community pharmacists were conducted in 2016-2017 to investigate pharmacists' attitudes to and experiences of OTC naloxone. Transcripts were thematically analysed, guided by a broad interest in facilitators and barriers to OTC supply. RESULTS: Around half of the pharmacists were aware of the down-scheduling and only two had provided OTC naloxone. Core barriers to pharmacist provision of OTC naloxone included limited understanding of opioid overdose, confusion about the role and responsibilities of pharmacists in providing OTC naloxone, concerns about business, stigma related to people who inject drugs (PWID) and system-level challenges. CONCLUSION: Pharmacy provision of OTC naloxone offers an important opportunity to reduce overdose mortality. Our study suggests this opportunity is yet to be realised and highlights several individual- and structural-level impediments hindering the expansion of public access to naloxone via community pharmacies. There is a need to develop strategies to improve pharmacists' knowledge of OTC naloxone and opioid overdose as well as to address other logistical and cultural barriers that limit naloxone provision in pharmacy settings. These need to be addressed at the individual level (training) as well as the system level (information, regulation and supply).
Authors: Susannah Slocum; Jenny E Ozga; Rebecca Joyce; Alexander Y Walley; Robin A Pollini Journal: BMC Public Health Date: 2022-04-13 Impact factor: 3.295