P-037 - A Survey of Pharmacists on Naloxone Prescribing: Where to Next?

Abstract Title: A Survey of Pharmacists on Naloxone Prescribing: Where to Next?

Background: In 2021, opioid-involved overdose deaths increased to 80,411 in the United States. Veterans are disproportionately affected by the opioid epidemic. From 2010 to 2019, drug overdose mortality rates increased by 53% among United States Veterans. All Veterans Health Administration (VHA) sites have implemented Opioid Overdose Education and Naloxone Distribution (OEND) programs which aim to reduce opioid-involved overdose deaths, with some VHA sites implementing standing orders or protocols allowing pharmacists to independently prescribe naloxone. Naloxone is FDA approved for rapid reversal of the effects of opioid overdose. Expanding access to naloxone is key to preventing­­­ opioid-involved overdose deaths, and pharmacists are uniquely positioned to prescribe and counsel patients to expand the distribution of this lifesaving medication.

Purpose/Objectives: This study aims to identify the barriers and concerns that pharmacists have with prescribing naloxone to Veterans to create and implement targeted interventions to prevent overdose deaths. This study investigated the comfort of pharmacists prescribing naloxone, identified barriers, and created targeted interventions to prevent overdose deaths. There is a current gap in literature regarding pharmacist barriers to naloxone prescribing.



Methods: A voluntary and anonymous survey of pharmacists practicing at the Veterans Affairs (VA) medical centers and clinics across the Veterans Integrated Service Network 10 was conducted via an internet-based questionnaire. The IRB-approved study was distributed by email to inpatient and outpatient staff pharmacists, acute care and ambulatory care clinical pharmacy specialists, and pharmacy administrators. Participants were included if they were actively licensed pharmacists with functional email addresses at the designated VA medical centers and clinics and had VA internet access.

The primary outcome is overall group attitudes toward independent naloxone prescribing under a standing order/protocol. Secondary outcomes include the difference in the four domains (attitudes/beliefs, comfort, lack of knowledge/training, self-identified barriers) based on the presence of a standing order at the facility, years in practice as a licensed pharmacist, length and type of post-graduate pharmacy training, percentage of time spent in direct patient care, and the self-identified barriers not addressed in the survey. Basic descriptive statistics, including percentages, and standard deviations, were used to characterize the study subjects when appropriate. For the primary and secondary endpoints, analytical statistics were used to conduct cross-sectional analysis based on the baseline characteristics provided by each participant.

Results: A total of 124 surveys were completed and included in data analysis, which was a 17.1% response rate. A survey, using VA REDCap, was used to assess items on a 5-point Likert scale, aggregated according to category, and adjusted for reverse scoring of select questions. Descriptive statistics were scaled from 1.0 to 5.0 representing least-to-most favorable perspectives. Aggregated categorical adjusted means (± standard deviation) for attitudes and beliefs, comfort, knowledge, fear of consequences, and time/resources was 4.08 ± 0.91, 3.77 ± 0.97, 3.64 ± 1.04, 3.69 ± 0.86, and 3.07 ± 1.09 respectively. Pharmacists with prior training on naloxone prescribing or administration had higher self-reported comfort and knowledge.

Conclusions/Implications for future research and/or clinical care: This survey revealed that barriers to pharmacist prescribing of naloxone under a standing order or protocol persist for multiple reasons despite pharmacists having positive attitudes and beliefs. Naloxone-specific training improves pharmacists' comfort, knowledge, and perspectives on time and resources with naloxone prescribing. Time, resources, and stigma were identified barriers to pharmacists prescribing naloxone under a standing order or protocol.

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