Attitudes and availability: A comparison of naloxone dispensing across chain and independent pharmacies in rural and urban areas in Alabama.
BACKGROUND
Fatal opioid overdoses remain the leading cause of accidental deaths in the United States, which have contributed to implementation of standing order laws that allow pharmacists to dispense naloxone to patients. Although pharmacy distribution of naloxone is a promising approach to increase access to this intervention, understanding barriers preventing greater uptake of this service is needed.


METHODS
Data for the current study were collected via telephone survey assessing the availability of various formulations of naloxone at chain and independent pharmacies in rural and urban areas in Birmingham, Alabama (N = 222). Pharmacists' attitudes toward naloxone and potential barriers of pharmacy naloxone distribution were also assessed. One-way analysis of variance (ANOVA) and logistic regression analyses were utilized to examine differences in stocking of naloxone in chain and independent pharmacies and to determine predictors of the number of kits dispensed by pharmacies.


RESULTS
Independent pharmacies were less likely to have naloxone in stock, especially those in rural areas. Furthermore, rural pharmacies required more time to obtain all four formulations of naloxone, and offered less extensive training on naloxone use. Pharmacists endorsing the belief that naloxone allows avoidance of emergent treatment in an overdose situation was associated with fewer dispensed kits by the pharmacies. Over 80% of pharmacists endorsed at least one negative belief about naloxone (e.g., allowing riskier opioid use). Pharmacists noted cost to patients and the pharmacy as contributing to not dispensing more naloxone kits.


CONCLUSION
The current study demonstrates the lower availability of naloxone stocked at pharmacies in independent versus chain pharmacies, particularly in rural communities. This study also highlights several barriers preventing greater naloxone dispensing including pharmacists' attitudes and costs of naloxone. The potential benefit of standing order laws is not being fully actualized due to the structural and attitudinal barriers identified in this study. Strategies to increase naloxone access through pharmacy dispensing are discussed.
['Sisson|Michelle L|ML|', 'McMahan|Kristina B|KB|', 'Chichester|Keith R|KR|', 'Galbraith|James W|JW|', 'Cropsey|Karen L|KL|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D000407:Alabama D001291:Attitude of Health Personnel D003157:Community Pharmacy Services D062787:Drug Overdose D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D009270:Naloxone D009292:Narcotic Antagonists D009293:Opioid-Related Disorders D010595:Pharmacists D019035:Rural Health Services D011795:Surveys and Questionnaires D019037:Urban Health Services D055815:Young Adult
Attitudes Naloxone Pharmacies Opioids