What’s the Question?
More than 90% of Americans live within 5 miles of a community pharmacy, making pharmacists a natural source for opioid-related preventive services, like screening patients for problem use, educating patients about safe medication practices, providing naloxone rescue kits, delivering brief interventions, and making referrals to treatment.
However, little is known about pharmacists’ concerns about opioid-related problems, what prevention-related practices they already engage in, and their commitment or willingness to provide services to people with opioid or other drug use problems. The studies that have been done to date have identified training/education as a primary factor influencing pharmacists’ attitudes toward and skills related to providing opioid-related prevention services. But what other factors might be involved?
How Was This Study Conducted?
For this study, part of the NIDA National Drug Abuse Treatment Clinical Trials Network (CTN-0105), researchers surveyed pharmacists to better understand their concerns about opioid-related problems and preventive services; examine whether their demographics, pharmacy characteristics, and opioid-related education/training played any role in those concerns, and explore other barriers to delivering preventive services.
Who Were the Study Participants?
1146 respondents were recruited from 47 states and DC (AK, ME, and RI were not represented). Approximately 54% of respondents were female, 49% were aged 35-54, 96% were not Hispanic/Latino, 75% were white, 13% were Asian, and 5% were Black. In addition, 32% resided in the Midwest region (South, 30%, Northeast, 20%, West, 17%), 38% practiced in an urban setting (suburban 33%, rural 29%), 64% worked at an independent pharmacy (chain 17%, hospital/clinic 9%, supermarket 7%, other 2%), approximately 53% had more than 10 years of pharmacy experience, and 55% were pharmacy managers/owners.
What Did Researchers Find Out?
Overall, 75.48% of respondents reported having concerns about opioid use problems at their pharmacy practice sites, with 62.04% also reporting concerns about non-opioid drug use problems (illicit and non-opioid drugs).
Pharmacists who asked patients about their opioid use were more likely to report concerns about opioid misuse in their community, suggesting that these conversations might be ideal times for screening or brief intervention. Pharmacists in rural areas also indicated relatively high concerns about opioid and illicit drug misuse and were more likely that pharmacists in urban areas to deliver intervention services, which may be related to the severity of the opioid epidemic in rural areas, as well as the shortage of treatment options in those regions. These findings suggest that rural pharmacists may be more willing than those in urban areas to receive training and deliver services.
As with other studies, education played a key role in pharmacists’ preventive practices and their willingness to engage in such practices. Pharmacists who received 3+ hours of education in the past year were also less likely than pharmacists with no education in the past year to perceive concerns about opioid and illicit drug misuse in their practices, possibly because pharmacists with training are more confident talking to patients about opioids and thus have fewer concerns.
The main barrier to delivering preventive services was time constraints due to high workloads, burnout, or staff shortages. Pharmacists also had concerns about awkward or negative experiences when talking to people about their opioid use, suggesting that communication strategies might be a good component of any training, as well as resources for screening tools, opioid use disorder treatment options, and contacts for addiction treatment programs. Arming pharmacists with accurate information and teaching them how to have these conversations could increase their confidence in delivering these services, making it more likely that they will.
What Are the Implications for the Workforce?
Pharmacists are on the frontlines of the opioid epidemic and could play an extremely important role in keeping people safe and connecting them to services. Having received opioid-related training on screening, intervention, and referral to treatment in the past year was one of the key indicators of willingness to deliver preventive services, something that educators/trainers in the addiction workforce might be able to play a role in.
Additionally, pharmacists noted as a barrier their lack of awareness of local drug treatment programs and a desire to have pamphlets on hand to share with their patients, another way addiction workforce members might be able to get involved.
With the passage of the Mainstream Addiction Treatment (MAT) Act in December 2022, removing the federal legal barrier to pharmacist buprenorphine prescribing, over 10 states are now allowing pharmacists to prescribe controlled substances like buprenorphine under collaborative practice agreements with healthcare providers. Working with pharmacists to increase their willingness to provide such a service and arming them with information and other supports could help make a difference in rates of opioid use disorder and other illicit drug use disorders as well.