Evaluation of pharmacists' opioid dispensing practices: a cross-sectional study from Pakistan

Worldwide, the opioid crisis is escalating, and pharmacists are well-positioned to address opioid abuse. The objective of the study was to assess pharmacists' knowledge, dispensing behaviours, concerns about physicians prescribing, provision of interventions to patients, and obstacles associated with opioid stewardship interventions.

We employed a cross-sectional study design utilising a convenience sampling strategy to collect data from pharmacists employed in community and hospital pharmacies. A self-administered questionnaire of 58 items was utilised to gather data about pharmacists' knowledge of opioids, dispensing procedures, and issues related to physicians' prescribing behaviour from five cities of Punjab, Pakistan. Descriptive statistics were used for nominal and continuous variables. The Spearman Rho correlation was used to evaluate the correlation between knowledge, practice, and concern scores, while ANOVA was implemented to analyse the association between scores and demographics.

A total of 496 pharmacists responded, with a response rate of 72%. About 25% pharmacists were aware of using naloxone in opioid poisoning, 88.9% were aware of the potential risks and adverse effects of opioid therapy, and 87.5% explained these risks to patients. Almost half (48.4%) were concerned about physicians prescribing opioids to patients who were suspected of opioid misuse, and 64.5% were concerned that physicians prescribed opioids to patients who did not need them. The highest intervention provided by pharmacists was educating patients on safe and efficacious use of opioids (90.3% provided), and the least was recommendation of Naloxone in case of overdose (29% never provided). Almost 3/5th (58.0%) said lack of access to education or training resources was a high-impact barrier in opioid stewardship intervention provision.

Pharmacists are concerned about physicians prescribing and mostly provide opioid-related training and interventions, but they also mentioned barriers to the provision of interventions. System-wide strategies are needed to improve opioid prescribing and physician-pharmacist communication.