Expanding the capacity of community pharmacy to respond to pharmaceutical opioid problems

image - Prescription 280l 0
Tags:
Date Commenced:
07/2015
Expected Date of Completion:
06/2017
Project Supporters:

This work is funded by an untied educational grant from Indivior

Drug Type:
Project Members: 
image - Headshot Nielsen 2017 1cropped 0
Dr Suzanne Nielsen
Senior Research Fellow
image - Sarah Larney
Senior Lecturer
Ph +61 (2) 9385 0333
image - Michael Farrell 0
Director
Ph EA Tori Barnes: 02 9385 0292 / t.barnes@unsw.edu.au
Miss Lexi Myers
Clerk
Project Main Description: 

There has been a dramatic increase in opioid prescribing in Australia. This increase has been associated with increased harms including opioid dependence and overdose. Community pharmacy is at the interface of problematic opioid use, with the majority of opioids in Australia supplied direct to patients through community pharmacy. There is considerable potential in community pharmacy settings to respond to problematic pharmaceutical opioid use, including provision of harm reduction measures such as naloxone, a medication that can reverse the effects of opioids, and is commonly used in the treatment of opioid overdose. Community naloxone supply has been successfully implemented in a range of international settings to address the rising rates of opioid overdose death. International pilot studies indicate an important role for pharmacists in these programs. To date, little work has examined the feasibility and willingness provide these services in Australian community pharmacies. 

Project Collaborators: External: 

Project Expert Group:

Angelo Pricolo
(Pharmacy Guild)

Apo Demirkol
(South Eastern Sydney Local Health District)

Belinda McNair
(Pennington Institute)

Catriona Matheson
(University of Aberdeen)

Denis Leahy
(Pharmacy Guild)

John Strang
(Kings College, London)

Marie Claire Van Hout
(Waterford Institute of Technology)

Michelle Lynch
(Pharmaceutical Society of Australia)

Paul Dietze
(Centre for Research Excellence into Injecting Drug Use, Burnet Institute)

Phillip Coffin
(San Francisco Department of Public Health)

Traci Green
(Brown University)

Aims: 

This study aims to develop an understanding of pharmacists’ attitudes, perceptions and confidence in different areas of harm reduction including naloxone supply.

Design and Method: 

This project includes a scoping review to understand the existing knowledge around community pharmacy supply of naloxone, and an online survey of Australian pharmacists. We are now developing a final stage of the project where we will conduct in-depth interviews with pharmacists to gain a richer understanding of some of the results identified in the online survey, with data collection expected to commence later in 2016.

Findings: 

We contacted a random sample of 1317 community pharmacists across Australia, inviting them to participate in an online survey, which assessed attitudes, experiences and knowledge relating to harm reduction, including naloxone supply.  We had 595 pharmacists returned completed surveys that we included in the analyses. Around half of the participants’ were male, and just over half work in regional or rural settings.

Overall, the pharmacists who completed our survey were positive about the role of community pharmacy in harm reduction and they supported overdose prevention measures, including the supply of naloxone. Males were more positive about harm reduction than females, and pharmacists who had been practicing for longer periods also tended to be more positive. Attitudes towards harm reduction and support for overdose prevention did not differ between states, locations and types of pharmacies. 

The majority of pharmacists were willing to stock and supply naloxone, and those who were more positive towards harm reduction tended to be more willing to do this. However, approximately two thirds of our pharmacists were not confident that they could identify appropriate patients or educate patients on the use of naloxone. Many pharmacists also displayed low levels of knowledge about administering naloxone, and its effects, highlighting the need for specific training in this area before naloxone becomes available over the counter.  The majority of pharmacists identified time, a lack of training and a lack of knowledge about the laws relating to naloxone as potential barriers to implementing a naloxone access program.

These results suggest that many pharmacists are interested in further training about naloxone. Most pharmacists indicated that they would prefer the convenience of online training, supplemented by information leaflets for pharmacy use. Results have been shared with the Pharmaceutical Society of Australia, the Pharmacy Guild and the National Naloxone Reference Group in the development of webinars and other materials focus on educating patients about naloxone use and key information about naloxone works, in addition to providing some specific information about knowledge of legal aspects about take home naloxone relevant to different states.

Output: 

Nielsen, S., Menon, N., Larney, S., Farrell, M., & Degenhardt, L. (2016). Community pharmacist knowledge, attitudes and confidence regarding naloxone for overdose reversal. Addiction

Nielsen, S., & VanHout, M. (2016). What is known about community pharmacy supply of naloxone? A scoping review. International Journal of Drug Policy. 32: pp24–33

Benefits: 

The results are being used to identified needs and inform training materials relating community pharmacy naloxone supply in Australia.

Drug Type: 
Project Status: 
Current