A qualitative study of a publicly funded pharmacy-dispensed naloxone program
A qualitative study of a publicly funded pharmacy-dispensed naloxone program
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DOI：
10.1016/j.drugpo.2021.103146
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发表时间：
2021-06-16
影响因子：
4.4
通讯作者：
Gomes, Tara
中科院分区：
文献类型：
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作者：
Antoniou, Tony;Pritlove, Cheryl;Gomes, Tara
目标：描述个人访问基于药房的纳洛酮的经验，并将这些经验的风险环境和话语，他们embedded.Methods：我们进行了一项定性研究，使用37名成年人，年龄在18岁及以上谁访问了药房配发纳洛酮的深入访谈。参与者来自加拿大安大略，包括因慢性疼痛服用阿片类药物的个人，因慢性疼痛以外的原因服用阿片类药物的个人，以及在阿片类药物过量情况下获得纳洛酮作为旁观者的个人。我们利用风险环境理论来解释参与者的accounts.Results：经过分析和解释，我们产生了五个理论上知情的主题，这些主题描述了个人访问药房分配的纳洛酮的经历：“纳洛酮叙述与药房环境的交叉点”，“个人风险环境和药房分配的纳洛酮摄取”，“安全空间：为药房配发的纳洛酮创造有利环境“、”个性化：成为第一反应者“和”超越纳洛酮：宏观风险环境“。具体而言，参与者描述了与更广泛的纳洛酮叙事相关的判断和刻板印象如何在药房空间中被放大，导致对报复的恐惧和减轻社会风险的策略。此外，纳洛酮作为“有问题”阿片类药物使用的药物的社会结构以及药剂师对阿片类药物使用的风险环境缺乏认识，被认为限制了优化纳洛酮分配和培训的机会。最后，与会者描述的方法，可以创造有利的环境中的药房的空间，同时保持认识的人谁采取opioids.Conclusions的宏观风险环境中所需的结构变化：尽管增加了纳洛酮的可用性，与会者的特点是一些社会和环境因素，可以限制从药店的药物的可及性。解决这些因素的策略可以在药房内创造有利的环境，优化药房分配纳洛酮的范围和影响。
Aims: To characterize the experiences of individuals accessing pharmacy-based naloxone and relate these experiences to the risk environments and discourses in which they are embedded.Methods: We conducted a qualitative study using in-depth interviews of 37 adults aged 18 years and over who had accessed pharmacy-dispensed naloxone. Participants were recruited from across Ontario, Canada, and comprised individuals taking opioids for chronic pain, those taking opioids for reasons other than chronic pain, and individuals acquiring naloxone to act as bystanders in an opioid overdose setting. We drew upon risk environment theory to interpret participants' accounts.Results: Following analysis and interpretation, we generated five theoretically-informed themes characterizing the experiences of individuals accessing pharmacy-dispensed naloxone: 'intersection of naloxone narrative with pharmacy environment', 'individual risk environment and pharmacy-dispensed naloxone uptake', 'safe spaces: creating an enabling environment for pharmacy-dispensed naloxone', 'individuation: becoming a first responder' and 'beyond naloxone: the macro risk environment'. Specifically, participants described how judgement and stereotyping associated with the broader naloxone narrative can be amplified in the space of the pharmacy, leading to fears of reprisals and strategies to mitigate social risk. In addition, the social construction of naloxone as a drug for 'problematic' opioid use and a lack of pharmacist awareness regarding the risk environments in which opioid use occurs was perceived to limit opportunities for optimizing naloxone distribution and training. Finally, participants described approaches that could create enabling environments in the space of the pharmacy while remaining cognizant of the structural changes required in the macro risk environments of people who take opioids.Conclusions: Despite increasing the availability of naloxone, participants characterized several social and environmental factors that could limit the accessibility of the drug from pharmacies. Strategies to address these factors could create enabling environments within pharmacies that optimize the reach and impact of pharmacy-dispensed naloxone.