Pharmacist-Based Naloxone Services Should Extend Beyond Community Pharmacy, Study Suggests

A recent systematic review aimed to synthesize evidence from studies that explored pharmacists' provision of naloxone services in settings other than community pharmacies. The review had two main objectives: to identify the services provided by pharmacists regarding naloxone and their outcomes, and to examine the knowledge, attitudes, and barriers related to naloxone service provision in non-community pharmacy settings.

To conduct the review, the researchers searched several databases including PubMed, Web of Science, and CINAHL for eligible studies. The inclusion criteria required the studies to be peer-reviewed empirical research conducted in the United States between January 2010 and February 2022, published in English, and focused on pharmacists' naloxone services or the knowledge, attitudes, and barriers associated with naloxone implementation. The study followed PRISMA guidelines for reporting.

A total of 76 studies met the inclusion criteria. Most of these studies were non-randomized and observational, with only two employing a randomized controlled trial (RCT) design. The majority of studies were conducted in veterans affairs settings (30%) and academic medical centers (21%). Sample sizes varied widely, ranging from as low as 10 to as high as 217,469, with the majority reporting sample sizes of less than 100.

The naloxone services provided by pharmacists in these settings encompassed various activities. These included clinical staff education, the use of screening tools to identify at-risk patients, naloxone prescribing and overdose education, as well as naloxone dispensing (also known as OEND, or overdose education and naloxone distribution). The implementation of these services yielded positive outcomes, including improved naloxone knowledge, positive attitudes towards naloxone, increased rates of OEND, and documented cases of overdose reversals.

Despite the overall positive findings, the review identified several barriers that hindered the implementation of naloxone services by pharmacists. These barriers included inadequate training, time constraints, reimbursement issues, and the persistence of stigma associated with substance use disorders and naloxone distribution.

Based on the findings of this review, it is recommended that future programs targeting pharmacist-based naloxone services in non-community pharmacy settings employ targeted approaches to address the identified barriers and enhance service provision. Additionally, further research is needed in this area, employing more rigorous methodologies such as larger sample sizes and randomized controlled designs, to provide a stronger evidence base for pharmacist naloxone services beyond community pharmacies.

Reference: 

Rawal S, Osae SP, Cobran EK, Albert A, Young HN. Pharmacists' naloxone services beyond community pharmacy settings: A systematic review. Res Social Adm Pharm. 2023;19(2):243-265. doi:10.1016/j.sapharm.2022.09.002