Pharmacists who are allowed to dispense naloxone, an opioid reversal agent, without a prescription are often uncomfortable talking to patients about the drug, and the profession’s continuing education programs aren’t helping, according to a new study from the University of North Carolina at Chapel Hill.
Over the past 20 years, opioid-related overdoses have increased fourfold, killing more than 42,000 people in 2016. As of January 2017, pharmacists in 13 states were able to dispense naloxone without a physician prescription. Those states were Alabama, Georgia, Indiana, Iowa, Maryland, Michigan, North Carolina, Pennsylvania, South Carolina, Tennessee, Utah, Virginia and Wisconsin.
Researchers at the UNC Eshelman School of Pharmacy led by Assistant Professor Delesha Carpenter, Ph.D., M.S.P.H., found that training programs spent an average of three minutes or less teaching pharmacists how to communicate about naloxone with patients and caregivers. Additionally, training programs provided conflicting recommendations about whether the word “overdose” should be used in naloxone discussions.
“These findings highlight that we do not really understand the best way to communicate about naloxone in the pharmacy setting,” Carpenter said. “Pharmacists who are less comfortable counseling about naloxone may be less likely to dispense it and miss the chance to prevent an opioid-related death, so understanding pharmacist and patient preferences for naloxone communication is of upmost importance.”
The study reviewed 12 naloxone training programs in those states to determine whether training materials prepare pharmacists to counsel patients and caregivers about naloxone. They published their findings in Research in Social and Administrative Pharmacy.
Most programs covered the majority of relevant topics, the researchers found, with the exceptions of extended treatment for individuals who overdose and naloxone storage and expiration information. While 11 programs addressed pharmacist-patient communication, the information provided was often limited. Only one program included an example of a conversation about naloxone between a pharmacist and a patient, but the conversation was 10 minutes long and took place in a private room.
“The model conversation doesn’t reflect the reality of practice in most community pharmacies where both space and time are at a premium,” Carpenter said. “Training materials that include more in-depth content on communication may increase pharmacists’ confidence to discuss the topics of overdose and naloxone.”
The researchers reviewed naloxone training programs and logged information about 15 topics in four categories: background/importance, naloxone products, business operations and communication. Most of the programs reviewed were either one-hour webinars or about 10 pages of written materials.
For the programs that included communication content, researchers looked at whether the programs suggested specific verbiage for naloxone counseling, recommended evidence-based communication practices and included example naloxone conversations.
Authors and Citation
- Delesha M. Carpenter, Ph.D., an assistant professor at the Eshelman School of Pharmacy at University of North Carolina at Chapel Hill
- Courtney A. Roberts, a clinical research specialist at the UNC Eshelman School of Pharmacy
- Salisa C. Westrick, Ph.D., the Sterling Professor in the Harrison School of Pharmacy at Auburn University
- Stefanie P. Ferreri, Pharm.D., clinical associate professor at the Eshelman School of Pharmacy, University of North Carolina at Chapel Hill
- Korey A. Kennelty, Pharm.D., Ph.D., assistant professor in the College of Pharmacy and Carver College of Medicine at the University of Iowa
- Kevin A. Look, Pharm.D., Ph.D., assistant professor at the University of Wisconsin-Madison School of Pharmacy
- Olufunmilola Abraham, Ph.D., assistant professor at the University of Pittsburgh
- Courtenay Wilson, Pharm.D., assistant professor of clinical education at the Eshelman School of Pharmacy at the University of North Carolina at Chapel Hill and a pharmacist with the Mountain Area Health Education Center, Asheville, North Carolina
Carpenter, D. M., Roberts, C. A., Westrick, S. C., Ferreri, S. P., Kennelty, K. A., Look, K. A., Wilson, C. (2017). A content review of online naloxone Continuing Education courses for pharmacists in states with standing orders. Research in Social and Administrative Pharmacy. doi:10.1016/j.sapharm.2017.11.011