Pushing through the barriers

Obstacles still blocking OTC naloxone supply in Australian community pharmacies 

While over the counter supply of naloxone is currently allowed in Australia, new research suggests the opportunity is yet to be realised in community pharmacies.

A series of in-depth interviews conducted with 37 community pharmacists revealed only around half were aware of the 2016 down-scheduling of naloxone, and only two had ever supplied OTC naloxone.

The interviewees reported a number of barriers, including: 

  • limited knowledge of the purpose of naloxone, and what OTC provision meant for the pharmacist – “are they expecting the pharmacist to do it [administer naloxone] on behalf of the patient, or are they expecting the patient to know how to use it?” one said;
  • system-level training and education barriers;
  • concerns from some about negative impacts on their business – “I feel there are risk factors in attracting these types of people”, one respondent said;
  • Concerns about misuse and overuse by patients;
  • Negative perceptions of the patient group.  

“OTC naloxone provided at pharmacies has the potential to reduce overdose mortality, yet our study suggests this opportunity is yet to be realised,” said the researchers.

“Overall, a considerable amount of advocacy will be needed if pharmacies are to reach their potential as venues for delivering opioid overdose services

“Strategies to improve pharmacists’ knowledge of OTC naloxone (e.g., via training) and to
address other logistical and cultural barriers (such as information, regulation and supply and stigma) are needed to address barriers to naloxone provision in pharmacies”. 

It was also apparent from the data that the public are not requesting naloxone from pharmacies, they said.

“The reasons for this could include a lack of knowledge (i.e the public are unaware that naloxone is
available at pharmacies or unaware of naloxone more generally) as well as issues related to fear of stigma.

In addition to education and training for pharmacists, public education about the drug and its availability would enhance the effectiveness of this public health intervention”.

The interview team, comprising researchers from pharmacy and public health departments around Australia, said the policies and practices that would facilitate the routine dispensing of OTC naloxone do not yet exist.

“Laws and policies are only as good as their implementation and political attention is needed at this
macro-level,” they said.

“One system-level strategy is academic detailing in which the pharmaceutical industry provides non-commercial outreach education for health care professionals based on research evidence.

Academic detailing has been shown to increase naloxone prescribing in the USA. A universal precautions approach, similar to that proposed for prescribing analgesics, is another strategy
that would systematise the identification of overdose risk.”

The study was published in the International Journal of Drug Policy.

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