Identifying barriers and facilitators to providing enhanced naloxone education services in community pharmacies

Opioid misuse remains a critical public health issue in the United States, with approximately 80,000 opioid-related deaths reported in 2023. Community pharmacists are well-positioned to improve access to and education about naloxone. Despite the availability of naloxone through standing orders and over-the-counter options, barriers such as stigma, cost, and workflow limitations persist.

This study aimed to identify barriers and facilitators to implementing and billing for reimbursable naloxone education services via a payer contract in community pharmacies.

This implementation science study utilized a qualitative approach. Pennsylvania Pharmacists Care Network eCare plan submissions were analyzed using descriptive statistics. Pharmacies were included in a semi-structured interview if they submitted an eCare plan for the naloxone education service since January 2023. An interview guide was developed based on the RE-AIM framework, which evaluates service implementation across five domains: Reach, Effectiveness, Adoption, Implementation, and Maintenance. Interviews were recorded and transcribed via Zoom, then independently coded by 3 investigators in NVivo. A mixed deductive-inductive thematic analysis was conducted to identify barriers, facilitators, and sustainability themes related to program implementation.

Forty pharmacies submitted 653 eCare plans for the naloxone and education dispensing payer program for reimbursement. Twelve participated in semi-structured interviews, which represented 232 of the submitted eCare plans. Six themes emerged from the interviews, including building relationships with community members; expanding staff roles and empowering team collaboration in patient care to support and initiate patient services; consistent processes for identifying, educating, and billing; reducing stigma and increasing naloxone distribution through open communication and community engagement; common barriers to implementing naloxone education services; and the need for enhanced education and training resources to improve service efficiency.

Naloxone education by community pharmacists is important in preventing opioid-related adverse events. Providing pharmacists with educational resources and training may enhance their ability to effectively educate patients about naloxone.