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Research paper thumbnail of Civil commitment perspectives and experiences among friends and family of people who use illicit opioids in Massachusetts, USA

International Journal of Drug Policy

Research paper thumbnail of Drug Treatment Perspectives and Experiences Among Family and Friends of People Who Use Illicit Opioids: A Mixed Methods Study

Research paper thumbnail of Pharmacy naloxone codispensing: A mixed methods study of practices and perspectives under a statewide standing order program

Journal of the American Pharmacists Association, 2022

BACKGROUND In a previous statewide naloxone purchase trial conducted in Massachusetts, we documen... more BACKGROUND In a previous statewide naloxone purchase trial conducted in Massachusetts, we documented high levels of naloxone accessibility, upon patient request, under the state's naloxone standing order (NSO) program. Equally important for reducing overdose mortality rates is expanding naloxone access via codispensing alongside opioid prescription and syringe purchases at pharmacies. OBJECTIVE To understand naloxone codispensing from the perspective of pharmacists under the Massachusetts NSO program. METHODS The study used a mixed methods design involving 3 focus groups and a quantitative survey. Participants in both the focus groups (N = 27) and survey (N = 339) were licensed Massachusetts pharmacists. Focus groups were conducted at 3 separate professional conferences for pharmacists. The survey was conducted using a stratified random sample of 400 chain and independent retail pharmacies across Massachusetts. All data were collected between September 2018 and November 2019. Quantitative and qualitative analyses examined current policies, practices, and attitudes regarding naloxone codispensing for patients at risk of opioid overdose. RESULTS Most pharmacists (69%) reported that they, their pharmacy, or both promoted codispensing alongside opioid prescriptions. A majority promoting naloxone codispensing did so for patients prescribed high opioid dosages (80%); fewer promoted codispensing for patients also prescribed benzodiazepines (20%). Facilitators to codispensing were pre-existing relationships between pharmacists and prescribers, mandatory pharmacist consultation, and universal naloxone promotion to all patients meeting certain criteria. Barriers to codispensing were pharmacists' concerns about offending patients by initiating a conversation about naloxone, insufficient technician training, workflow and resource constraints, and misconceptions surrounding naloxone. We found no substantive differences in outcomes between chain and independent pharmacies. CONCLUSION We documented several facilitators and barriers to naloxone codispensing in Massachusetts pharmacies. Areas amenable to intervention include increased training for front-line pharmacy technicians, mandatory pharmacist consultation for opioid-prescribed patients, workflow reorganization, and addressing stigma concerns on the pharmacist end.

Research paper thumbnail of If We Build It, Will They Come? Perspectives on Pharmacy-Based Naloxone Among Family and Friends of People who use Opioids: A Mixed Methods Study

Background: Expanding access to the opioid antagonist naloxone to reduce overdose mortality is a ... more Background: Expanding access to the opioid antagonist naloxone to reduce overdose mortality is a public health priority in the United States. Naloxone standing orders (NSOs) have been established in many states to increase naloxone dispensing at pharmacies, but increased pharmacy access does not ensure optimal uptake among those likely to witness an overdose. In a prior statewide purchase trial, we documented high levels of naloxone access at Massachusetts pharmacies under a statewide NSO. In this study, we characterize barriers to pharmacy-based naloxone uptake among potential opioid overdose “bystanders” (friends or family of people who use opioids) that may be amenable to intervention.Methods: Eligible bystanders were Massachusetts residents >18 years of age, did not use illicit opioids in the past 30 days, and knew someone who currently uses illicit opioids. We used a sequential mixed methods approach, in which a series of semi-structured qualitative interviews (N=22) were co...

Research paper thumbnail of Pharmacists’ experiences with a statewide naloxone standing order program in Massachusetts: a mixed methods study

Journal of the American Pharmacists Association, 2021

Objectives: In a prior statewide naloxone purchase trial conducted in Massachusetts, we documente... more Objectives: In a prior statewide naloxone purchase trial conducted in Massachusetts, we documented a high rate of naloxone dispensing under the state's standing order program. The purpose of this study was to understand the factors that facilitate naloxone access under the Massachusetts naloxone standing order (NSO) program and identify any remaining barriers amenable to intervention. Design: Mixed methods design involving a pharmacist survey and three pharmacist focus groups. Setting and participants: Focus groups were conducted at three separate professional conferences for pharmacists (N=27). The survey was conducted among Massachusetts pharmacists (N=339) working at a stratified random sample chain and independent retail pharmacies across Massachusetts. All data were collected between September 2018 and November 2019.

Research paper thumbnail of ‘It's just basically a box full of disease’—navigating sterile syringe scarcity in a rural New England state

Addiction, 2020

BACKGROUND AND AIMS Injection drug use has increased in nonurban communities in the United States... more BACKGROUND AND AIMS Injection drug use has increased in nonurban communities in the United States where sterile syringe access is limited. This study aimed to characterize how people who inject drugs in a predominantly rural state navigate syringe scarcity. DESIGN Qualitative study. SETTING New Hampshire (NH), USA. At the time of our study, syringe services programs were illegal in NH but pharmacies could sell <10 syringes without prescription. PARTICIPANTS/CASES Twenty people >18 years old who injected at least once in the past 30 days were recruited through provider referral, street-based recruitment, and snowball sampling. MEASUREMENTS Semi-structured interview guide. Verbatim transcripts were coded based on interview guide constructs and emergent themes. Analysis focused on pharmacy syringe access, unofficial syringe sources, and related impacts on syringe sharing and reuse FINDINGS: Participants could identify no local pharmacies that sold syringes without prescription. Pharmacy purchase in neighboring counties, or across state lines, required private transportation and this, along with purchaser identification requirements, presented substantial access barriers. Interstate travel also exposed participants to vigilant policing of interstate highways and potential criminal justice involvement. Many participants thus resorted to informal syringe sources closer to home including purchasing syringes on the street, using discarded syringes, breaking into biohazard containers, and constructing improvised syringes out of salvaged syringe parts, metals, and plastics. Repeated reuse of syringes until they were no longer operational was common. Overall, syringe scarcity gave participants few options but to engage in syringe sharing and reuse, putting them at risk of serious injection-related infections. CONCLUSIONS Limited sterile syringe access contributes to an environment in which people who inject drugs report that they are less able to refrain from risky injection practices.

Research paper thumbnail of Civil commitment perspectives and experiences among friends and family of people who use illicit opioids in Massachusetts, USA

International Journal of Drug Policy

Research paper thumbnail of Drug Treatment Perspectives and Experiences Among Family and Friends of People Who Use Illicit Opioids: A Mixed Methods Study

Research paper thumbnail of Pharmacy naloxone codispensing: A mixed methods study of practices and perspectives under a statewide standing order program

Journal of the American Pharmacists Association, 2022

BACKGROUND In a previous statewide naloxone purchase trial conducted in Massachusetts, we documen... more BACKGROUND In a previous statewide naloxone purchase trial conducted in Massachusetts, we documented high levels of naloxone accessibility, upon patient request, under the state's naloxone standing order (NSO) program. Equally important for reducing overdose mortality rates is expanding naloxone access via codispensing alongside opioid prescription and syringe purchases at pharmacies. OBJECTIVE To understand naloxone codispensing from the perspective of pharmacists under the Massachusetts NSO program. METHODS The study used a mixed methods design involving 3 focus groups and a quantitative survey. Participants in both the focus groups (N = 27) and survey (N = 339) were licensed Massachusetts pharmacists. Focus groups were conducted at 3 separate professional conferences for pharmacists. The survey was conducted using a stratified random sample of 400 chain and independent retail pharmacies across Massachusetts. All data were collected between September 2018 and November 2019. Quantitative and qualitative analyses examined current policies, practices, and attitudes regarding naloxone codispensing for patients at risk of opioid overdose. RESULTS Most pharmacists (69%) reported that they, their pharmacy, or both promoted codispensing alongside opioid prescriptions. A majority promoting naloxone codispensing did so for patients prescribed high opioid dosages (80%); fewer promoted codispensing for patients also prescribed benzodiazepines (20%). Facilitators to codispensing were pre-existing relationships between pharmacists and prescribers, mandatory pharmacist consultation, and universal naloxone promotion to all patients meeting certain criteria. Barriers to codispensing were pharmacists' concerns about offending patients by initiating a conversation about naloxone, insufficient technician training, workflow and resource constraints, and misconceptions surrounding naloxone. We found no substantive differences in outcomes between chain and independent pharmacies. CONCLUSION We documented several facilitators and barriers to naloxone codispensing in Massachusetts pharmacies. Areas amenable to intervention include increased training for front-line pharmacy technicians, mandatory pharmacist consultation for opioid-prescribed patients, workflow reorganization, and addressing stigma concerns on the pharmacist end.

Research paper thumbnail of If We Build It, Will They Come? Perspectives on Pharmacy-Based Naloxone Among Family and Friends of People who use Opioids: A Mixed Methods Study

Background: Expanding access to the opioid antagonist naloxone to reduce overdose mortality is a ... more Background: Expanding access to the opioid antagonist naloxone to reduce overdose mortality is a public health priority in the United States. Naloxone standing orders (NSOs) have been established in many states to increase naloxone dispensing at pharmacies, but increased pharmacy access does not ensure optimal uptake among those likely to witness an overdose. In a prior statewide purchase trial, we documented high levels of naloxone access at Massachusetts pharmacies under a statewide NSO. In this study, we characterize barriers to pharmacy-based naloxone uptake among potential opioid overdose “bystanders” (friends or family of people who use opioids) that may be amenable to intervention.Methods: Eligible bystanders were Massachusetts residents >18 years of age, did not use illicit opioids in the past 30 days, and knew someone who currently uses illicit opioids. We used a sequential mixed methods approach, in which a series of semi-structured qualitative interviews (N=22) were co...

Research paper thumbnail of Pharmacists’ experiences with a statewide naloxone standing order program in Massachusetts: a mixed methods study

Journal of the American Pharmacists Association, 2021

Objectives: In a prior statewide naloxone purchase trial conducted in Massachusetts, we documente... more Objectives: In a prior statewide naloxone purchase trial conducted in Massachusetts, we documented a high rate of naloxone dispensing under the state's standing order program. The purpose of this study was to understand the factors that facilitate naloxone access under the Massachusetts naloxone standing order (NSO) program and identify any remaining barriers amenable to intervention. Design: Mixed methods design involving a pharmacist survey and three pharmacist focus groups. Setting and participants: Focus groups were conducted at three separate professional conferences for pharmacists (N=27). The survey was conducted among Massachusetts pharmacists (N=339) working at a stratified random sample chain and independent retail pharmacies across Massachusetts. All data were collected between September 2018 and November 2019.

Research paper thumbnail of ‘It's just basically a box full of disease’—navigating sterile syringe scarcity in a rural New England state

Addiction, 2020

BACKGROUND AND AIMS Injection drug use has increased in nonurban communities in the United States... more BACKGROUND AND AIMS Injection drug use has increased in nonurban communities in the United States where sterile syringe access is limited. This study aimed to characterize how people who inject drugs in a predominantly rural state navigate syringe scarcity. DESIGN Qualitative study. SETTING New Hampshire (NH), USA. At the time of our study, syringe services programs were illegal in NH but pharmacies could sell <10 syringes without prescription. PARTICIPANTS/CASES Twenty people >18 years old who injected at least once in the past 30 days were recruited through provider referral, street-based recruitment, and snowball sampling. MEASUREMENTS Semi-structured interview guide. Verbatim transcripts were coded based on interview guide constructs and emergent themes. Analysis focused on pharmacy syringe access, unofficial syringe sources, and related impacts on syringe sharing and reuse FINDINGS: Participants could identify no local pharmacies that sold syringes without prescription. Pharmacy purchase in neighboring counties, or across state lines, required private transportation and this, along with purchaser identification requirements, presented substantial access barriers. Interstate travel also exposed participants to vigilant policing of interstate highways and potential criminal justice involvement. Many participants thus resorted to informal syringe sources closer to home including purchasing syringes on the street, using discarded syringes, breaking into biohazard containers, and constructing improvised syringes out of salvaged syringe parts, metals, and plastics. Repeated reuse of syringes until they were no longer operational was common. Overall, syringe scarcity gave participants few options but to engage in syringe sharing and reuse, putting them at risk of serious injection-related infections. CONCLUSIONS Limited sterile syringe access contributes to an environment in which people who inject drugs report that they are less able to refrain from risky injection practices.