Feasibility of a pharmacy-based overdose prevention program in rural/suburban NY

本混合方法探索性研究的目的是（1）研究纳洛酮的支持和扩散 利用长期订单的药房服务;（2）评估扩大公共卫生作用的可行性， 纳洛酮注册药剂师，以帮助增加在农村/郊区新的药房获得纳洛酮的吸收 约克（纽约州）。美国阿片类药物过量危机导致49个州立法允许纳洛酮（即，阿片 过量逆转药物）通过非患者特定处方或“长期订单”分配。在 在纽约州（NYS），超过2，600家药店注册参与阿片类药物过量预防 允许使用长期订单分配纳洛酮的程序（OSTO）。然而，试点数据以及轶事 有证据表明，在纽约，药物获得性纳洛酮并不常见， 阿片类药物相关过量死亡负担最高的郊区/农村县。最近的报告 确定的药房报销挑战、患者负担能力和患者预期的耻辱 抑制纳洛酮需求作为持续的障碍-即使在广泛的药物靶向过量 开展了预防培训和教育。本研究的目的是探索障碍（如。阿片类药物- 相关污名）和促进者（例如，使用国家资助的共同支付报销计划）的药房纳洛酮 纽约郊区/农村县的服务，这些县的药房分配率低或不存在， 很高。此外，我们将探讨药剂师的兴趣，将纳洛酮服务与其他非污名化 药房服务，以帮助增加吸收和支持药房纳洛酮服务（一个成功的耻辱， 减少我们先前在HIV竞技场工作中的干预）。创新的扩散提供了一个理论上的 框架，以审查通过和拒绝药房纳洛酮服务。具体来说，我们将确定 药剂师/药房特征、经验和实践与：（i）纳洛酮注册状态 (Aim（二）支持纳洛酮药房服务，以及（三）支持纳洛酮与其他非 在1，000名纳洛酮注册和非注册药剂师中污名化药房服务（目标1b）。 我们还将进行深入访谈，以了解个人，药房和政策层面的背景 关键利益相关者中纳洛酮药房服务的障碍/促进因素：（a）药剂师（n=24）;（B）阿片类药物- 相关艾德患者（n=20）;和（c）社区倡导者/卫生官员（n=16）（目标2）。我们将针对8个县 纽约州阿片类药物过量率最高， （也可在线和/或面对面），并将选择其中2个县进行深入访谈 我们的研究能力已经建立。将对调查和定性数据进行分析和三角测量 最终数据解释。建议的意义和创新性很高：（1）阿片类药物危机和类似 美国的纳洛酮药物政策，(2)通过地理和种族上的定位获得的普遍性 不同的非城市地区，（3）基于药物的干预，解决耻辱的潜力。

The purpose of this mixed-methods exploratory study is to (1) investigate the support and diffusion of naloxone pharmacy services that utilize a standing order, and (2) assess feasibility of an expanded public health role for naloxone-registered pharmacists to help increase uptake of pharmacy-acquired naloxone in rural /suburban New York (NY). The U.S. opioid overdose crisis has led to legislation in 49 states allowing naloxone (i.e., opioid overdose reversal medication) to be dispensed through a non-patient specific prescription or “standing order”. In New York State (NYS), over 2,600 pharmacies are registered to participate in the Opioid Overdose Prevention Program (OOPP) which allows use of a standing order to dispense naloxone. Yet, pilot data as well as anecdotal evidence suggests that pharmacy-acquired naloxone is infrequent in NY, and either non-existent or limited in suburban/rural counties where burden of opioid-related overdose deaths is highest. Recent reports have identified pharmacy reimbursement challenges, patient affordability, and patient-anticipated stigma dampening naloxone demand as ongoing barriers – even where extensive pharmacy-targeted overdose prevention training and education have taken place. The goal of this study is to explore barriers (eg. opioid- related stigma) and facilitators (eg. use of a state-funded co-pay reimbursement program) of pharmacy naloxone services in NY suburban/rural counties where pharmacy dispensation is low or non-existent, and overdose rates are high. In addition, we will explore pharmacist interest in coupling naloxone services with other non-stigmatizing pharmacy services to help increase uptake and support of pharmacy naloxone services (a successful stigma- reducing intervention from our prior work in the HIV arena). The diffusion of innovation provides a theoretical framework to examine adoption and rejection of pharmacy naloxone services. Specifically, we will identify pharmacist/pharmacy characteristics, experiences, and practices associated with: (i) naloxone registration status (Aim 1a), (ii) support for pharmacy naloxone services, and (iii) support for coupling naloxone with other non- stigmatizing pharmacy services (Aim 1b) among 1,000 naloxone-registered and non-registered pharmacists. We will also conduct in-depth interviews to contextualize the individual-, pharmacy-, and policy-level barriers/facilitators of pharmacy naloxone services among key stakeholders: (a) pharmacists (n=24); (b) opioid- related ED patients (n=20); and (c) community advocates/health officials (n=16) (Aim 2). We will target 8 counties with the highest opioid overdose rates in NYS to administer a pharmacist computer-assisted phone survey (online, and/or in-person also available), and 2 of those counties will be selected to conduct in-depth interviews where our research capacity has been established. Survey and qualitative data will be analyzed and triangulated for final data interpretation. Proposal significance and innovation is high given: (1) the opioid crisis and similar pharmacy naloxone policy across U.S., (2) the generalizability gained by targeting geographically and racially diverse non-urban areas, and (3) the potential for a pharmacy-based intervention that addresses stigma to follow.