Monday, July 15, 2024

Respond to Prevent Trial Enhances Pharmacy Capacity Amid Opioid Crisis

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In light of the escalating opioid crisis in the United States, innovative approaches to improve access to life-saving medications are critical. The Respond to Prevent trial, encompassing four states and two significant pharmacy chains, aimed to enhance pharmacies’ abilities to dispense naloxone, buprenorphine, and nonprescription syringes (NPS). This multi-faceted, randomized study evaluated how policies and organizational practices impact both community health and pharmacy operations, providing crucial insights for policymakers and healthcare stakeholders.

Methodological Insights

The study employed a comprehensive multi-method approach, which included an environmental scan of literature and online sources from January 2015 to June 2021. Researchers also developed timelines of policy and practice milestones and conducted semi-structured interviews with 36 key informants at state and local levels, ensuring a robust data collection process. This methodology allowed for an in-depth understanding of the factors influencing the availability and use of naloxone, buprenorphine, and NPSs.

Facilitators and Barriers

Key informants highlighted several facilitators that improved market access to these critical interventions. State-level naloxone standing orders, partnerships with harm reduction organizations, and supportive federal and state policies, such as Medicaid coverage and telehealth permissions for buprenorphine, were pivotal. However, barriers such as patient stigma, rural access challenges, and high medication costs were frequently mentioned, indicating areas where policy and practice could be improved.

The trial’s findings suggest that harm reduction policies are essential for embedding these interventions within community pharmacies, thus enhancing their capacity to combat the opioid crisis. Yet, structural obstacles remain, requiring more targeted efforts at state and local levels to ensure equitable access to care.

Key Inferences

• State and federal policies play a crucial role in facilitating market access for life-saving opioid interventions.
• Active community partnerships are vital for the successful implementation of these policies.
• Structural barriers like stigma and high costs must be addressed to improve access, particularly in rural areas.
• Telehealth permissions for buprenorphine have significantly increased its accessibility.

The Respond to Prevent trial underscores the importance of supportive policies and community collaborations in expanding pharmacy services. While progress has been made, ongoing efforts are essential to overcome existing barriers and improve access to opioid-related interventions.

Original Article:

Drug Alcohol Depend Rep. 2024 May 28;11:100243. doi: 10.1016/j.dadr.2024.100243. eCollection 2024 Jun.

ABSTRACT

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BACKGROUND: As the US opioid-involved morbidity and mortality increase, uptake and implementation of evidence-based interventions remain key policy responses. Respond to Prevent was a multi-component, randomized trial implemented in four states and two large pharmacy chains with the aim of improving the pharmacy’s capacity to provide naloxone, dispense buprenorphine, and sell nonprescription syringes (NPS). We sought to provide context and assess how policies and organizational practices affect communities and pharmacies across the study states.

METHODS: Using a multi-method approach we: 1) conducted an environmental scan of published literature and online materials spanning January 2015 to June 2021, 2) created timelines of key events pertaining to those policies and practices and 3) conducted semi-structured interviews with stakeholders (key informants) at the state and local levels (N=36) to provide further context for the policies and practices we discovered.

RESULTS: Key informants discussed state policies, pharmacy policies and local practices that facilitated access to naloxone, buprenorphine and NPSs. Interviewees from all states spoke about the impact of naloxone standing orders, active partnerships with community-based harm reduction organizations, and some federal and state policies like Medicaid coverage for naloxone and buprenorphine, and buprenorphine telehealth permissions as key facilitators. They also discussed patient stigma, access in rural settings, and high cost of medications as barriers.

CONCLUSION: Findings underscore the important role harm reduction-related policies play in boosting and institutionalizing interventions in communities and pharmacies while also identifying structural barriers where more focused state and local attention is needed.

PMID:38948428 | PMC:PMC11214408 | DOI:10.1016/j.dadr.2024.100243

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