Challenges and Facilitators of Implementing a Physician-approved Naloxone Protocol: A Mixed-methods Study

Area of Science:

• Public Health
• Pharmacology
• Health Policy

Background:

• In 2015, Ohio enacted legislation permitting pharmacists to dispense naloxone (an opioid overdose reversal medication) under a physician-approved protocol.
• This policy change aimed to expand access to naloxone by allowing its furnishing without requiring patients to see a prescriber directly.

Purpose of the Study:

• To evaluate the implementation of Ohio's legislation enabling physician-approved protocols for naloxone dispensing.
• To compare the barriers and facilitators encountered by sites that implemented the protocol versus those that did not.

Main Methods:

• A convergent parallel mixed-method design was employed.
• Quantitative data were gathered through surveys (n=168) of pharmacies and community naloxone distribution sites.
• Qualitative data were collected via semi-structured interviews (n=17).

Main Results:

• Most respondents indicated the policy successfully expanded naloxone access.
• Facilitators included leadership and organizational support for protocol implementation.
• Barriers identified were cost, stigma, and insufficient demand for naloxone.

Conclusions:

• The study identified key facilitators and barriers to implementing naloxone dispensing protocols in Ohio.
• While most sites could implement protocols, challenges related to cost, public awareness, and stigma persist.
• Addressing these barriers is crucial for maximizing the impact of naloxone accessibility initiatives.