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Pharmacists’ naloxone offering and dispensing practices

Tanvee Thakur, PhD, BPharm, Mercedes Kile, PharmD, RPh, Betty Chewning, PhD


Objective: The primary objective of this paper is to understand pharmacists’ naloxone offering and dispensing practices and factors affecting those practices. The secondary objective of this paper is to refine an existing survey instrument and use it to understand pharmacists’ naloxone offering and dispensing behaviors and factors affecting it.

Design, settings, and participants: A statewide mail survey of pharmacists was conducted in Wisconsin using stratified random sampling. Survey data were analyzed using descriptive statistics to understand pharmacists’ naloxone offering and dispensing practices and multiple regression analysis to understand factors affecting these practices.

Main outcomes: (1) Pharmacists’ practices about naloxone offering and dispensing; (2) factors affecting these practices.

Results: Most pharmacies stocked naloxone (92.9 percent) and were under the Wisconsin standing order (80.1 percent). The majority of pharmacists reported that they occasionally (36.6 percent), rarely (29.3 percent), or never (21.5 percent) offer naloxone to patients. The majority reported that they occasionally (29.3 percent), rarely (52.4 percent), or never (15.2 percent) dispense naloxone. While most pharmacists were confident in their ability to initiate conversations about naloxone, they were not confident on how to screen patients at risk for opioid overdose. Pharmacists offered naloxone more when they felt more confident initiating a conversation regarding the need for naloxone with patients (β = 0.50, p <0.05). Pharmacists dispensed naloxone more when they have had more previous training about dispensing naloxone (β = 0.43, p <0.05).

Conclusion: Many pharmacists hardly offer or dispense naloxone under the standing order. Pharmacists may benefit from standardized training and resources about screening patients for risk of overdose and overdose risk communication.


naloxone, pharmacist, offering, dispensing, standing order

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National Institute of Health: Opioid overdose crisis. National Institute of Drug Abuse, 2018. Available at Accessed December 3, 2020.

Center for Disease Control and Prevention: Opioid overdose—Understanding the epidemic, 2018. Available at Accessed December 3, 2020.

Opioid overdose: Centers for Disease Control and Prevention, 2018. Available at Accessed December 3, 2020.

Seth B, Scholl L, Rudd R, et al.: Increases and geographic variations in overdose deaths involving opioids, cocaine, and psychostimulants with abuse potential—United States, 2015-2016. MMWR Morb Mortal Wkly Rep. 2018; 67(12): 349-358.

National Institute of Drug Abuse: Naloxone for opioid overdose-life saving science. 2020. Available at Accessed December 3, 2020.

Wickramatilake S, Zur J, Mulvaney-Day N, et al.: How states are tackling the opioid crisis. Public Health Rep. 2017; 132: 171-179.

Thompson EL, Rao PSS, Hayes C, et al.: Dispensing naloxone without a prescription: Survey evaluation of Ohio pharmacists. J Pharm Pract. 2018: 897190018759225.

Spivey CA, Wilder A, Chisholm-Burns MA, et al.: Evaluation of naloxone access, pricing, and barriers to dispensing in Tennessee retail community pharmacies. J Am Pharm Assoc. 2020; 60(5): 694-701.

Evoy KE, Hill LG, Groff L, et al.: Naloxone accessibility without a prescriber encounter under standing orders at community pharmacy chains in Texas. JAMA. 2018; 320: 1934-1937.

Thakur T, Frey M, Chewning B: Pharmacist roles, training, and perceived barriers in naloxone dispensing: A systematic review. J Am Pharm Assoc. 2019; 60(1): 178-194.

Nielsen S, Menon N, Larney S, et al.: Community pharmacist knowledge, attitudes and confidence regarding naloxone for overdose reversal. Addiction. 2016; 111: 2177-2186.

Nielsen S, Van Hout MC: What is known about community pharmacy supply of naloxone? A scoping review. Int J Drug Policy. 2016; 32: 24-33.

Green TC, Dauria EF, Bratberg J, et al.: Orienting patients to greater opioid safety: Models of community pharmacy-based naloxone. Harm Reduct J. 2015; 12: 25.

Wisconsin Department of Health Services: Opioids. 2019. Available at Accessed December 3, 2020.

Wisconsin Department of Health Services: State-wide naloxone standing order for pharmacists. 2019. Available at Accessed December 3, 2020.

Bakhireva LN, Bautista A, Cano S, et al.: Barriers and facilitators to dispensing of intranasal naloxone by pharmacists. Subst Abus. 2018; 39(3): 331-341.

Carpenter DM, Dhamanaskar AK, Gallegos KL, et al.: Factors associated with how often community pharmacists offer and dispense naloxone. Res Social Adm Pharm. 2019; 15(12): 1415-1418.

Timmins F: Surveys and questionnaires in nursing research. Nurs Stand. 2015; 29: 42-50.

Graesser AC, Wiemer-Hastings K, Kreuz R, et al.: QUAID: A questionnaire evaluation aid for survey methodologists. Behav Res Methods Instrum Comput. 2000; 32: 254-262.

Drennan J: Cognitive interviewing: Verbal data in the design and pretesting of questionnaires. J Adv Nurs. 2003; 42: 57-63.

DiBenedetti DB, Price MA, Andrews EB: Cognitive interviewing in risk minimization survey development: Patient and healthcare professional surveys. Expert Rev Clin Pharmacol. 2013; 6: 369-373.

Krosnick JA: Survey research. Annu Rev Psychol. 1999; 50: 537-567.

Wisconsin Department of Health Services: DHS regions by county. 2018. Accessed at Accessed December 3, 2020.

Dilman DA, Smyth JD, Christian LM: Mail Questionnaires and Implementation: Internet, Phone, Mail and Mixed-Mode Surveys. Hoboken, NJ: Wiley, 2014: 351-396.

Griffin JM, Simon AB, Hulbert E, et al.: A comparison of small monetary incentives to convert survey non-respondents: A randomized control trial. BMC Med Res Methodol. 2011; 11: 81.

Donovan E, Bratberg J, Baird J, et al.: Pharmacy leaders’ beliefs about how pharmacies can support a sustainable approach to providing naloxone to the community. Res Soc Adm Pharm. 2020; 16(10): 1493-1497.

Lai Joyce Chun K, Olsen A, Taing MW, et al.: How prepared are pharmacists to provide over-the-counter naloxone? The role of previous education and new training opportunities. Res Soc Adm Pharm. 2019; 15: 1014-1020.

Thakur T, Chewning B: Using role theory to explore pharmacist role conflict in opioid risks communication. Res Social Adm Pharm. 2019; 16(8): 1121-1126.

Thakur T, Chewning B, Zetes N, et al.: Pharmacy intervention to facilitate transparent opioid-risk and safety communication. J Am Pharm Assoc (2003). 2020; 60: 1015-1020.

Carpenter DM, Roberts CA, Westrick SC, et al.: A content review of online naloxone continuing education courses for pharmacists in states with standing orders. Res Soc Adm Pharm. 2018; 14(10): 968-978.

Bachyrycz A, Takeda MY, Wittstrom K, et al.: Opioid overdose response training in pharmacy education: An analysis of students' perception of naloxone use for opioid overdose prevention. Curr Pharm Teach Learn. 2019; 11: 166-171.

Kwon M, Moody AE, Thigpen J, et al.: Implementation of an opioid overdose and naloxone distribution training in a pharmacist laboratory course. Am J Pharm Educ. 2020; 84: 7179.

Schartel A, Lardieri A, Mattingly A, et al.: Implementation and assessment of a naloxone-training program for first-year student pharmacists. Curr Pharm Teach Learn. 2018; 10: 717-722.

Palmer E, Hart S, Freeman PR: Development and delivery of a pharmacist training program to increase naloxone access in Kentucky. J Am Pharm Assoc (2003). 2017; 57: S118-S122.

Roberts AW, Carpenter DM, Smith A, et al.: Reviewing state-mandated training requirements for naloxone-dispensing pharmacists. Res Soc Adm Pharm. 2019; 15(2): 222-225.



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