Mandatory Pharmacist Consultation for Opioid Prescriptions May Help Naloxone Access

Mandatory pharmacist consultation for patients prescribed opioids and more training for front-line pharmacy technicians may improve naloxone codispensing in Massachusetts, according to authors of a study published in the Journal of the American Pharmacists Association.

“In a prior statewide naloxone purchase trial conducted in Massachusetts, we documented high levels of naloxone accessibility, upon patient request, under the state’s naloxone standing order (NSO) program,” wrote Robin A Pollini, PhD, MPH, of West Virginia University, and coauthors. “Equally important for reducing overdose mortality rates is expanding naloxone access via co-dispensing alongside opioid prescription and syringe purchases at pharmacies.”

To better understand how pharmacists perceive naloxone codispensing under the Massachusetts NSO program, researchers conducted focus group discussions with more than 2 dozen Massachusetts pharmacists at professional conferences. Additionally, they surveyed 339 pharmacists from across the state.

Overall, 69% of pharmacists said they or their pharmacy actively promote naloxone codispensing with opioid prescriptions. Most (80%) do so for patients prescribed high dosages, the study found, but just 20% promote naloxone codispensing for patients also prescribed benzodiazepines.

Existing relationships between pharmacists and prescribers, mandatory patient/pharmacist consultation, and universal naloxone promotion to all patients meeting certain criteria are factors that facilitate naloxone codispensing, according to study authors. Barriers to more widespread co-dispensing include pharmacist concern that patients would take offense if naloxone were brought up, insufficient technician training, workflow and resource constraints, and misconceptions surrounding naloxone.

“More training for pharmacists around how to initiate and frame conversations about naloxone is clearly needed, particularly in the context of illicit drug use,” wrote researchers. “Increasing physician coprescribing for patients at high risk of opioid overdose would also help alleviate pressure on pharmacists to initiate these conversations and provide a complement to codispensing that could substantially increase naloxone uptake for high-risk groups.”

Reference:
Pollini RA, Slocum S, Ozga JE, et al. Pharmacy naloxone co-dispensing: a mixed methods study of practices and perspectives under a statewide standing order program. J Am Pharm Assoc. Published online March 19, 2022. doi:10.1016/j.japh.2022.03.015