Community pharmacists are the key to large-scale roll out of naloxone

October 2016
Nielsen, S., Menon, N., Larney, S., Farrell, M., & Degenhardt, L. (2016). Community pharmacist knowledge, attitudes and confidence regarding naloxone for overdose reversal. Addiction, Advance online publication, 1-10. doi: 10.1111/add.13517.

On 1 February this year Australia became the second country, after Italy (in 1995), to have naloxone formally available over the counter (OTC).

Given the potential to expand naloxone supply through community pharmacy, the investigators sought to estimate Australian pharmacists’ level of support for overdose prevention, barriers and facilitators for naloxone supply and knowledge about naloxone administration.

A total of 1317 community pharmacists were invited to participate in an online survey and 595 responded (45.1%).

The survey found that community pharmacists in Australia were willing to supply naloxone but were hampered by low levels of knowledge about naloxone pharmacology.

Importantly, many participants identified barriers to naloxone supply, including training and knowledge of laws around naloxone. These barriers are modifiable, and pharmacists indicated willingness to receive training in this area. The barrier of time also points to the importance of time-efficient naloxone education and supply to customers.

Cost is a clear potential barrier to large-scale pharmacy naloxone supply. Those with more positive attitudes towards harm reduction felt less remuneration was required, but thought the cost of the medication alone (approximately AUD$20 per 400 μg dose) may be a barrier.

This is the first study to assess in detail the knowledge and perceptions of community pharmacists regarding naloxone supply. Most pharmacists reported that they were not confident in either identifying potential people to receive naloxone, or in training people to use naloxone. Three in five pharmacists were not comfortable with OTC supply, and most were not able to answer correctly questions on naloxone administration.

In light of these findings, it is essential that pharmacists receive training in how to use naloxone in order to increase their confidence in identifying those who may benefit from naloxone, and enable effective delivery of information to customers about its use.

These findings have international relevance, as many countries are currently exploring pharmacy supply of naloxone, and OTC naloxone is now available in Australian pharmacies.

This places a sharp focus on addressing these knowledge gaps to maximise the potential for naloxone supply in this setting.