In 2017, more than 49,000 of the 72,000 estimated drug overdose deaths in the U.S. involved opioid drugs1. Non-metropolitan rural areas are disproportionately affected by overdose deaths, but often lack access to naloxone, an opioid overdose reversal agent2. Access to naloxone in rural areas is often limited due to a lack of community substance use treatment resources and trained health professionals3. Community pharmacists (pharmacists who work in outpatient ambulatory care settings) are the most accessible healthcare professional in rural areas4-6 and, due to statewide standing orders that have granted pharmacists increased prescriptive authority to dispense naloxone to anyone who may benefit from it, are well- positioned to increase access to naloxone in rural areas7. The release of the Surgeon General's (SG) Advisory on Naloxone and Opioid Overdose in April 2018, which specifically encourages individuals to talk with their pharmacists about naloxone10, will likely increase the number of patient and caregiver-initiated requests for naloxone at community pharmacies. Unfortunately, multiple studies11-12, including our own13, have shown that even when pharmacies carry naloxone, many pharmacists choose not to offer or dispense it. Pharmacists' reluctance to offer and dispense naloxone is often associated with discomfort communicating about the sensitive topic of overdose14-17. Our own work has shown that pharmacists' comfort communicating about naloxone is significantly associated with how often they offer naloxone13, and existing online naloxone training resources do not sufficiently address the topic of communication13,18. The objective of our 4-state collaboration is to develop an online module (Nalox-Comm) to increase rural pharmacists' self-efficacy to engage in naloxone discussions and, ultimately, increase how often they dispense naloxone.
For Aim 1, we will gather formative data on barriers to engaging in naloxone conversations and preferences for module content from rural pharmacists, patients, and caregivers (i.e., third parties who obtain naloxone for someone who takes opioids). We will then analyze formative data and engage in an iterative intervention development process with a stakeholder development panel and expert consultants to finalize Nalox-Comm content.
For Aim 2, we will conduct a pilot randomized controlled trial in 30 pharmacies to evaluate whether Nalox-Comm increases the frequency with which pharmacists dispense naloxone (primary outcome). We will also assess whether the module increases pharmacists' willingness and self-efficacy to dispense naloxone and improves the quality of their naloxone communication (secondary outcomes).
Community pharmacists are the most accessible health provider in rural areas and, therefore, have a significant opportunity to prevent opioid-related overdose deaths by dispensing naloxone, an opioid overdose reversal agent. Although all 40 states have granted pharmacists increased prescriptive authority to dispense naloxone to anyone who may benefit from it, many pharmacists' discomfort discussing overdose decreases their willingness to offer and dispense it. Our objective is to develop an online module (Nalox-Comm) to teach effective naloxone communication skills to community pharmacists in order to increase their willingness and confidence to counsel about and dispense naloxone to patients and caregivers.
