Pharmacist roles, training, and perceived barriers in naloxone dispensing: A systematic review

Thakur, Tanvee; Frey, Meredith; Chewning, Betty

Objectives: Pharmacists are well positioned to identify patients at risk of overdose, dispense naloxone, and counsel patients on appropriate use. In response to growing numbers of opioid-related deaths, many states have issued standing orders allowing pharmacists to dispense naloxone without a prescription. This systematic review examines the current state of naloxone use and dispensing regarding (1) roles for pharmacists dispensing naloxone, (2) barriers to their dispensing naloxone, and (3) pharmacist training to dispense naloxone. Data sources: PubMed, Cinahl Plus, and Cochrane review databases were searched with the use of the terms "pharmacist OR pharmacy" AND "naloxone." Included for review were peer-reviewed original research studies conducted in the U.S. in the past 5 years. Study selection: The preliminary search generated 155 studies, including 50 duplicate studies which were removed. From the remaining 105 studies, 33 were included that addressed pharmacist naloxone dispensing roles, barriers and facilitators to dispensing, or training for pharmacists. Data extraction: Authors, publication year, study title, study objective, method, outcomes, and conclusions were extracted for all studies. Results: Out of 33 studies, 14 focused on pharmacists´ roles in naloxone dispensing, 9 on barriers, and 10 on training pharmacists for dispensing naloxone. The review found that most states permit major naloxone dispensing roles for pharmacists, but pharmacists are often underutilized without programs to support their roles. A key barrier to pharmacist naloxone dispensing is limited pharmacist training to identify and educate patients at risk of overdose. Conclusion: Although pharmacists have the legal opportunity to educate patients and dispense naloxone, barriers have limited their addressing naloxone with patients. There is a need for more intervention studies and in-depth understanding of pharmacist perspectives on barriers, training, and professional roles to facilitate tailored approaches for increasing pharmacist confidence in naloxone dispensing and consultation. (C) 2020 American Pharmacists Association (R). Published by Elsevier Inc. All rights reserved.