Lethal means management innovations in community pharmacies: A preimplementation study in 6 states

Suicide is a leading cause of death in the United States, and a common means is intentional overdose. Community pharmacists have endorsed using pharmacy technologies and services for lethal means management. However, little is known about the barriers and facilitators to implementation.

To identify implementation facilitators and barriers to novel lethal means management (LMM) innovations.

The Consolidated Framework for Implementation Research was used to develop semi-structured interviews with rural community pharmacists in 6 states to explore innovative LMM strategies, including Medication Therapy Management for Suicidal Behavior Disorder (MTM-SBD), compliance packaging, monitoring of patients taking medications labeled for suicide risk, training pharmacy staff as suicide prevention gatekeepers, pharmacy staff referrals of patients to #988 or local services, limiting nonprescription medication package sizes and/or placing large quantity nonsteroidal anti-inflammatories behind the counter, naloxone distribution either with every opioid or to only high-risk patients, and distributing gun locks.

Pharmacists described in detail the site and community context relative to potential implementation of previously identified LMM strategies. Pharmacists from 19 stores in 6 states identified compliance packaging and MTM-SBD as most promising due to established and adaptable workflows and informatics systems, trained staff, reimbursement models, availability and low cost of supplies, trained pharmacy staff and potential patient demand. Barriers included lack of an MTM protocol, payment codes and insurance coverage for the indication of SBD or more generally, suicidal risk.

The majority of rural community pharmacists endorsed more facilitators than barriers to MTM and compliance packaging for management of suicide risk. Barriers are limited to expansion of current payment models to include the indication.