Pharmacists' experiences with a statewide naloxone standing order program in Massachusetts: a mixed methods study

Area of Science:

• Public Health
• Pharmacy Practice
• Opioid Overdose Prevention

Background:

• A prior trial in Massachusetts showed high naloxone dispensing rates under a standing order program.
• Understanding facilitators and barriers to naloxone access is crucial for expanding its availability.

Purpose of the Study:

• To identify factors facilitating naloxone access through the Massachusetts naloxone standing order (NSO) program.
• To pinpoint remaining barriers to naloxone dispensing that can be addressed through interventions.

Main Methods:

• A mixed-methods approach was employed, including a survey of 339 Massachusetts pharmacists and 3 focus groups with 27 pharmacists.
• Data collection occurred between September 2018 and November 2019, covering chain and independent retail pharmacies.

Main Results:

• Most pharmacists found NSO implementation straightforward; facilitators included centralized systems, web resources, stocking, and intake forms.
• Barriers included patient confidentiality and cost issues. Counseling rates were low (31%), hindered by perceived patient discomfort and time limits.
• Independent pharmacists expressed greater concerns about confidential space compared to chain pharmacists.

Conclusions:

• The Massachusetts NSO program demonstrates successful facilitators for naloxone dispensing.
• Addressing stigma, misconceptions, and practical issues like confidentiality and cost can further improve pharmacy-based naloxone access.
• Massachusetts' experience offers a model for other states aiming to enhance naloxone availability through pharmacies.