Advertisement

Journal of Urban Health

, Volume 96, Issue 3, pp 367–378 | Cite as

Beliefs Associated with Pharmacy-Based Naloxone: a Qualitative Study of Pharmacy-Based Naloxone Purchasers and People at Risk for Opioid Overdose

  • Elizabeth DonovanEmail author
  • Patricia Case
  • Jeffrey P. Bratberg
  • Janette Baird
  • Dina Burstein
  • Alexander Y. Walley
  • Traci C. Green
Article

Abstract

Drug overdose is the leading cause of unintentional death in the USA and the majority of deaths involve an opioid. Pharmacies are playing an increasingly important role in getting naloxone—the antidote to an opioid overdose—into the community. The aim of the current study was to understand, from the perspective of those who had obtained naloxone at the pharmacy, whose drug using status and pain patient status was not known until the interviews were conducted, as well as those who had not obtained naloxone at the pharmacy but were at risk for overdose, factors that impact the likelihood of obtaining pharmacy-based naloxone (PBN). Fifty-two participants from two New England states were interviewed between August 2016 and April 2017. We used a phenomenological approach to investigate participants’ beliefs about pharmacy-based naloxone. The social contextual model was chosen to structure the collection and analysis of the qualitative data as it takes into account individual, interpersonal, organizational (pharmacy), community, and societal influences on a specific health behavior. Of the 52 people interviewed, 24 participants had obtained naloxone from the pharmacy in the past year, of which 4% (n = 1) self-disclosed during the interview current illicit drug use and 29% (n = 7) mentioned using prescribed opioid pain medication. Of the 28 people who had not obtained naloxone from the pharmacy, 46% (n = 13) had obtained an over the counter syringe from a pharmacy in the past month and had used an opioid in the past month, and 54% (n = 15) had used a prescribed opioid pain medication in the past month but did not report a syringe purchase. Several main themes emerged from the interview data. Individual-level themes were as follows: helplessness and fear, naloxone as empowerment to help, and past experiences at the pharmacy. Interpersonal-level themes were as follows: concern for family and friends, and sources of harm reduction information. Themes associated with pharmacy-level influence were as follows: perceived stigma from pharmacists, confusion at the pharmacy counter, and receptivity to pharmacists’ offer of naloxone; community-level themes were as follows: community caretaking and need for education and training. Finally, themes at the societal-level of influence were as follows: generational crisis, and frustration at lack of response to opioid crisis. Overall our findings reveal factors at multiple levels which may play a role in likelihood of obtaining naloxone at the pharmacy. These factors can be used to inform interventions seeking to increase provision of pharmacy-based naloxone.

Keywords

Opioid Overdose Naloxone Pharmacy Qualitative Interviews USA 

Notes

Acknowledgements

We wish to acknowledge Abigail Tapper for her support in compiling this manuscript. This research is funded by the Agency for Healthcare Research and Quality (1R18HS024021-01).

References

  1. 1.
    Understanding the epidemic | Drug overdose | CDC Injury Center. https://www.cdc.gov/drugoverdose/epidemic/index.html. Accessed 17 May 2018.
  2. 2.
    Opioid overdose reversal with naloxone (Narcan, Evzio) | National Institute on Drug Abuse (NIDA). https://www.drugabuse.gov/related-topics/opioid-overdose-reversal-naloxone-narcan-evzio. Accessed 17 May 2018.
  3. 3.
    Walley AY, Xuan Z, Hackman HH, Quinn E, Doe-Simkins M, Sorensen-Alawad A, et al. Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis. BMJ. 2013;346:f174.  https://doi.org/10.1136/bmj.f174.CrossRefGoogle Scholar
  4. 4.
    Ama A. Help save lives: co-prescribe naloxone to patients at risk of overdose. https://www.end-opioid-epidemic.org/wp-content/uploads/2017/08/AMA-Opioid-Task-Force-naloxone-one-pager-updated-August-2017-FINAL-1.pdf. Accessed 17 May 2018.
  5. 5.
    General S. Surgeon General’s advisory on naloxone and opioid overdose. https://www.surgeongeneral.gov/priorities/opioid-overdose-prevention/naloxone-advisory.html. Accessed 27 May 2018.
  6. 6.
    HHS, Samhsa, Capt. SAMHSA’S CENTER FOR THE APPLICATION OF PREVENTION TECHNOLOGIES Preventing the Consequences of Opioid Overdose: Understanding Naloxone Access Laws https://www.samhsa.gov/capt/. Accessed 21 May 2018.
  7. 7.
    Meyerson BE, Agley JD, Davis A, Jayawardene W, Hoss A, Shannon DJ, et al. Predicting pharmacy naloxone stocking and dispensing following a statewide standing order, Indiana 2016. Drug Alcohol Depend. 2018;188:187–92.  https://doi.org/10.1016/j.drugalcdep.2018.03.032.CrossRefGoogle Scholar
  8. 8.
    Puzantian T, Gasper JJ. Provision of naloxone without a prescription by California pharmacists 2 years after legislation implementation. JAMA. 2018;320(18):1933–4.  https://doi.org/10.1001/jama.2018.12291.CrossRefGoogle Scholar
  9. 9.
    Stopka TJ, Donahue A, Hutcheson M, Green TC. Nonprescription naloxone and syringe sales in the midst of opioid overdose and hepatitis C virus epidemics: Massachusetts, 2015. J Am Pharm Assoc (2003). 2017;57(2S):S34–44.  https://doi.org/10.1016/j.japh.2016.12.077.CrossRefGoogle Scholar
  10. 10.
    Khatiwoda P, Proeschold-Bell RJ, Meade CS, Park LP, Proescholdbell S. Facilitators and barriers to naloxone kit use among opioid-dependent patients enrolled in medication assisted therapy clinics in North Carolina. N C Med J. 2018;79(3):149–55.  https://doi.org/10.18043/ncm.79.3.149.Google Scholar
  11. 11.
    Green TC, Case P, Fiske H, Baird J, Cabral S, Burstein D, et al. Perpetuating stigma or reducing risk? Perspectives from naloxone consumers and pharmacists on pharmacy-based naloxone in 2 states. J Am Pharm Assoc. 2017;57(2):S19–S27.e4.  https://doi.org/10.1016/j.japh.2017.01.013.CrossRefGoogle Scholar
  12. 12.
    Starks H, Brown Trinidad S. Choose your method: a comparison of phenomenology, discourse analysis, and grounded theory. Qual Health Res. 2007;17(10):1372–80.  https://doi.org/10.1177/1049732307307031.CrossRefGoogle Scholar
  13. 13.
    Kuzel A. Sampling in qualitative inquiry. In: Crabtree M, Miler BF, editors. Doing Qualitative Research. 2nd ed. Thousand Oaks: Sage Publications; 1999. p. 33–46.Google Scholar
  14. 14.
    Sorensen G, Emmons K, Hunt MK, Barbeau E, Goldman R, Peterson K, et al. Model for incorporating social context in health behavior interventions: applications for cancer prevention for working-class, multiethnic populations. Prev Med (Baltim). 2003;37(3):188–97. http://www.ncbi.nlm.nih.gov/pubmed/12914824. Accessed 27 May 2018.CrossRefGoogle Scholar
  15. 15.
    Morse JM. The significance of saturation. Qual Health Res. 1995;5(2):147–9.  https://doi.org/10.1177/104973239500500201.CrossRefGoogle Scholar
  16. 16.
    Lim JK, Bratberg JP, Davis CS, Green TC, Walley AY. Prescribe to prevent: overdose prevention and naloxone rescue kits for prescribers and pharmacists. J Addict Med. June;10:300–8.  https://doi.org/10.1097/ADM.0000000000000223.
  17. 17.
    Green TC, Dauria EF, Bratberg J, Davis CS, Walley AY. Orienting patients to greater opioid safety: models of community pharmacy-based naloxone. Harm Reduct J. 2015;12:25.  https://doi.org/10.1186/s12954-015-0058-x.CrossRefGoogle Scholar
  18. 18.
    NVivo qualitative data analysis software; QSR International Pty Ltd. Version 10. No title. 2012.Google Scholar
  19. 19.
    Prevent & protect—Save a life, get naloxone—Opioid safety and overdose prevention information. http://prevent-protect.org/. Accessed 20 Sept 2018.
  20. 20.
    Wakeman SE. Medications for addiction treatment. J Addict Med. 2017;11(1):1–2.  https://doi.org/10.1097/ADM.0000000000000275.CrossRefGoogle Scholar

Copyright information

© The New York Academy of Medicine 2019

Authors and Affiliations

  • Elizabeth Donovan
    • 1
    Email author
  • Patricia Case
    • 2
  • Jeffrey P. Bratberg
    • 3
  • Janette Baird
    • 4
  • Dina Burstein
    • 4
  • Alexander Y. Walley
    • 5
  • Traci C. Green
    • 6
    • 7
  1. 1.Department of PsychologySimmons UniversityBostonUSA
  2. 2.Institute on Urban Health Research and PracticeNortheastern UniversityBostonUSA
  3. 3.Department of Pharmacy Pratice, College of PharmacyUniversity of Rhode IslandKingstonUSA
  4. 4.Department of Emergency MedicineAlpert Medical School of Brown UniversityProvidenceUSA
  5. 5.Clinical Addiction Research Education Unit, Section of General Internal Medicine, Department of MedicineBoston University School of MedicineBostonUSA
  6. 6.Departments of Emergency Medicine and EpidemiologyAlpert Medical School of Brown UniversityProvidenceUSA
  7. 7.Boston Medical Center Injury Prevention Center, Department of Emergency MedicineBoston University School of MedicineBostonUSA

Personalised recommendations