Search

Objectives In a prior statewide naloxone purchase trial conducted in Massachusetts, we documented a high rate of naloxone dispensing under the state's standing order program. The purpose of this study was to understand the factors that facilitate naloxone access under the Massachusetts naloxone standing order (NSO) program and identify any remaining barriers amenable to intervention. Design Mixed methods design involving a pharmacist survey and 3 pharmacist focus groups. Setting and participants Focus groups were conducted at 3 separate professional conferences for pharmacists (n = 27). The survey was conducted among Massachusetts pharmacists (n = 339) working at a stratified random sample chain and independent retail pharmacies across Massachusetts. All data were collected between September 2018 and November 2019. Outcome measures Facilitators and barriers to NSO implementation and naloxone dispensing and pharmacists' attitudes and beliefs regarding naloxone and opioid use. Results Most pharmacists described NSO implementation as being straightforward, although differences were reported by pharmacy type in both the survey and focus groups. Facilitators included centralized implementation at chain pharmacies, access to Web-based resources, regularly stocking naloxone, and use of naloxone-specific intake forms. Barriers included patient confidentiality concerns and payment/cost issues. Only 31% of surveyed pharmacists reported always providing naloxone counseling; the most commonly cited barriers were perceived patient discomfort (21%) and time limitations (14%). Confidential space was also more of a concern for independent (vs. chain) pharmacists (18% vs. 6%, P = 0.008). A majority of pharmacists held supportive attitudes toward naloxone, although some reported having moral/ethical concerns about naloxone provision. Conclusion We documented several facilitators to NSO implementation and naloxone dispensing. Areas for improvement include addressing stigma and misconceptions around opioids and naloxone use. These remain important targets for improving pharmacy-based naloxone dispensing, although our overall positive results suggest Massachusetts' experience with NSO implementation can inform other states' efforts to expand pharmacy-based naloxone access.

OBJECTIVES: Massachusetts was among the first states to allow standing orders to facilitate pharmacy-based naloxone purchase and reduce opioid overdose deaths. We conducted a unique purchase trial to establish a valid measure of standing order naloxone in Massachusetts, using purchasers from two high priority populations to determine whether naloxone is less accessible to those who use illicit opioids than other potential purchasers. METHODS: A random sample of 200 retail pharmacies was selected from a statewide list. 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 someone at risk of opioid overdose. Purchases were conducted in accordance with a detailed purchase protocol between May 2018 and April 2019. Matched pairs analysis was used to identify statistically significant differences in purchase outcomes and experiences by purchaser type. RESULTS: Overall, 322 of 397 purchase attempts (81%) were successful, with no significant difference between PWUIO and bystanders (p=.221). Most purchases (93%) resulted in acquisition of single-step nasal naloxone (NARCAN; median cost $133.38). Forty percent of purchases included state-mandated verbal counseling, and PWUIO were significantly less likely to receive counseling than bystanders (30% vs. 51%, p$150 (25%), and requiring a prescription (15%). Chain pharmacies were significantly more likely to sell naloxone than independent pharmacies (86% vs. 53%, p