Robin A Pollini1, Jenny E Ozga2, Rebecca Joyce2, Ziming Xuan3, Alexander Y Walley4. 1. Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, 3602 Collins Ferry Road, Morgantown, WV 26505, United States; Department of Epidemiology, School of Public Health, West Virginia University, 3602 Collins Ferry Road, Morgantown, WV 26505, United States. Electronic address: Robin.Pollini@hsc.wvu.edu. 2. Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, 3602 Collins Ferry Road, Morgantown, WV 26505, United States. 3. Department of Community Health Sciences, School of Public Health, Boston University, Crosstown Building - CT 454, 801 Massachusetts Ave, 4th Floor, Boston, MA 02118, United States. 4. Boston Medical Center and Boston University School of Medicine, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA 02118, United States.
Abstract
BACKGROUND: West Virginia (WV) has the highest overdose mortality rate in the United States and expanding naloxone access is crucial for reducing opioid overdose deaths. We conducted a purchase trial to establish an objective measure of naloxone access under WV's naloxone standing order (NSO) program. METHODS: A stratified random sample of 200 chain and independent retail pharmacies across WV were included. Each pharmacy underwent two purchase attempts-one by a person who used illicit opioids (PWUIO) and one by a potential bystander who did not use illicit opioids but had a relationship with a PWUIO. We used matched-pairs analysis to identify differences in outcomes by purchaser type (PWUIO vs bystander). Chi-square and independent-samples t-tests were used to compare outcomes by pharmacy type (chain vs independent). RESULTS: Overall, 29% of purchase attempts were successful, with no significant difference between PWUIO and bystanders (p = 0.798). Fewer than half (44%) of successful purchases included verbal counseling, and bystanders were more likely to receive counseling than PWUIO (33% vs 4%, p = 0.018). Common reasons for failed purchases were naloxone not being in stock (41%), requiring a naloxone prescription (35%), and/or requiring formal identification (23%). Chain pharmacies were more likely to sell naloxone than independents (35% vs 19%, p = 0.001). CONCLUSIONS: We documented limited naloxone access under the WV NSO. These findings indicate that simply establishing an NSO program is insufficient to expand access. Implementation efforts should ensure adequate naloxone stocks, pro-active delivery of NSO-related information and pharmacist training, and avoidance of recordkeeping requirements that may impede access.
BACKGROUND: West Virginia (WV) has the highest overdose mortality rate in the United States and expanding naloxone access is crucial for reducing opioid overdose deaths. We conducted a purchase trial to establish an objective measure of naloxone access under WV's naloxone standing order (NSO) program. METHODS: A stratified random sample of 200 chain and independent retail pharmacies across WV were included. Each pharmacy underwent two purchase attempts-one by a person who used illicit opioids (PWUIO) and one by a potential bystander who did not use illicit opioids but had a relationship with a PWUIO. We used matched-pairs analysis to identify differences in outcomes by purchaser type (PWUIO vs bystander). Chi-square and independent-samples t-tests were used to compare outcomes by pharmacy type (chain vs independent). RESULTS: Overall, 29% of purchase attempts were successful, with no significant difference between PWUIO and bystanders (p = 0.798). Fewer than half (44%) of successful purchases included verbal counseling, and bystanders were more likely to receive counseling than PWUIO (33% vs 4%, p = 0.018). Common reasons for failed purchases were naloxone not being in stock (41%), requiring a naloxone prescription (35%), and/or requiring formal identification (23%). Chain pharmacies were more likely to sell naloxone than independents (35% vs 19%, p = 0.001). CONCLUSIONS: We documented limited naloxone access under the WV NSO. These findings indicate that simply establishing an NSO program is insufficient to expand access. Implementation efforts should ensure adequate naloxone stocks, pro-active delivery of NSO-related information and pharmacist training, and avoidance of recordkeeping requirements that may impede access.
Authors: Elizabeth Donovan; Jeffrey Bratberg; Janette Baird; Dina Burstein; Patricia Case; Alexander Y Walley; Traci C Green Journal: Res Social Adm Pharm Date: 2020-01-18
Authors: Lucas G Hill; Lindsey J Loera; Kirk E Evoy; Mandy L Renfro; Sorina B Torrez; Claire M Zagorski; Joshua C Perez; Shaun M Jones; Kelly R Reveles Journal: Addiction Date: 2020-11-22 Impact factor: 6.526
Authors: Alexander Y Walley; Ziming Xuan; H Holly Hackman; Emily Quinn; Maya Doe-Simkins; Amy Sorensen-Alawad; Sarah Ruiz; Al Ozonoff Journal: BMJ Date: 2013-01-30