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


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.


Opioid Overdose Naloxone Pharmacy Qualitative Interviews USA 



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).


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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

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