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

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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.