Naloxone availability in independent community pharmacies in Georgia, 2019

Background Increasing the availability of naloxone among people who use opioids, and friends and family of past and present people who use opioids is a vitally important mission to reduce the occurrence of opioid-related overdose deaths. The purpose of this study was to determine the availability of naloxone in independent community pharmacies in Georgia. Secondary objectives include determining pharmacists’ knowledge regarding the standing order and ability to counsel regarding naloxone. Methods A cross-sectional study using a secret shopper approach with phone contact was conducted over a period of 10 months. The study was population based and was conducted at all independent pharmacies in the state of Georgia. All independent community pharmacies in the state of Georgia were contacted and asked the naloxone questions with a 96% response rate (n = 520). Results Five hundred fifty-eight independent community pharmacies were called, with a 96% response rate (n = 520 pharmacies). Two hundred-twenty pharmacies reported having naloxone in stock. Of the 335 pharmacists asked, 174 (51.9%) incorrectly said that a prescription was required. The mean (SD) cash price was $148.02 (27.40), with a range of $0 to $300. Of 237 pharmacists asked who had naloxone in stock or who stated they could get naloxone in stock, 212 stated that they could demonstrate how to use it, 8 stated they could not, and 17 said that they possibly could or were unsure how to use it. Conclusions This study provided insight into the limited availability of naloxone at independent community pharmacies in Georgia after the standing order was issued. The majority of pharmacists at independent pharmacies in Georgia were not using the publicly available state naloxone standing order. Additionally, the low availability of naloxone and its high cost for uninsured individuals are significant structural barriers for reducing opioid-related mortality.

The Knowledge and Perceptions of Florida Pharmacists in Administering Inactivated Influenza Vaccines to Pregnant Women

Background: Influenza vaccine rates in pregnant women remain suboptimal despite the recommendations from healthcare organizations. Though pharmacists can provide immunization services as a result of the standing order, few studies have examined the role of the pharmacist in providing immunization to pregnant women or explored their perspective on their role in providing influenza vaccines among pregnant women. Purpose: This study explored the perceptions and knowledge of Florida pharmacists in administering inactivated influenza vaccines (IIV) to pregnant women. Methods: Semi-structured in-depth interviews guided by the theory of planned behavior were conducted with 18 licensed Florida pharmacists, including clinical and retail pharmacists. A thematic analysis was conducted. Results: The majority of pharmacists (94%) were knowledgeable about the IIV in pregnant women. Participants expressed mixed attitudes, identified barriers and facilitators, and subjective norms influencing vaccine administration in pregnant women. Participants expressed the importance of trust and how that influenced vaccine uptake. Participants also expressed their position not to only provide immunization services but also to counsel and educate patients. Conclusion: There is a need to strengthen immunization services, provided by pharmacists to more individuals, including high-risk groups such as pregnant women.

FEATURES OF THE INTRODUCTION INTO IN VITRO CULTURE AND MICROPROPAGATION OF PAULOWNIA TOMENTOSA

Paulownia sp. are tall and fast-growing perennial plants that grow faster than all woody plants in the world. In many countries, Paulownia sp. are used as a raw material in bioenergy, furniture industry, landscape gardening and technologies for phytoremediation. In this study for the first time in Kazakhstan, conditions of Paulownia tomentosa (P. tomentosa) in vitro cultivation and propagation have been optimized, also the factors influencing the morphogenetic activity of primary explants have been studied. Along with the adaptation potential of Paulownia tomentosa microclones to the ex situ conditions, laboratory standing order for microclonal reproduction have been evaluated. For sterilization of P. tomentosa explants are recommended to use 50% domestos and 0.1% merthiolate. Hormone-free WPM medium was considered as the most optimal for the in vitro propagation. Infrared light is highly recommended for P. tomentosa microclones adaptation, due to its ability to stimulate the formation plants aboveground biomass and root system. For Kazakhstan, the research of this type of tree crops is a relevant, new and promising direction. The development of microclonal propagation of Paulownia tomentosa will accelerate the process of introduction of Paulownia in our Republic.

Naloxone Availability in Community Pharmacies, 2019

Background: Increasing the availability of naloxone among friends and family of past and present opioid users is a vitally important mission to reduce the occurrence of opioid-related overdose deaths. The purpose of this study was to determine the availability of naloxone in independent pharmacies in Georgia. Secondary objectives include determining pharmacists’ knowledge regarding the standing order and ability to counsel regarding naloxone.Methods: A cross-sectional study was conducted over a period of ten months. The study was population based and was conducted at all independent pharmacies in the state of Georgia. All independent pharmacies in the state of Georgia were contacted and asked the below questions with a 96% response rate (n=520). Results: 558 independent, retail pharmacies were called, with a 96% response rate (n=520 pharmacies). Two hundred-twenty pharmacies reported having naloxone in stock. Of the 335 pharmacists asked, 174 (51.9%) incorrectly said that a prescription was required. The mean (SD) cash price was $148.02 (27.40), with a range of $0 to $300. Of 237 pharmacists asked who had naloxone in stock or who stated they could get naloxone in stock, 212 stated that they could, 8 stated they could not, and 17 said that they possibly could or were unsure how to do it. Conclusions: This study provided insight into the limited availability of naloxone at independent retail pharmacies in Georgia after the standing order was issued. The majority of pharmacist’s at independent pharmacies in Georgia were incorrectly under the impression a prescription was needed to obtain naloxone. This is an even greater barrier to access and may also contribute to the infrequency of independent pharmacies stocking naloxone. The low availability of naloxone, its high cost for uninsured individuals, and the lack of pharmacists’ knowledge of the laws surrounding its dispensing are significant structural barriers to access for a drug that can help offset opioid-related mortality.

Preparing pharmacists to increase naloxone dispensing within community pharmacies under the Pennsylvania standing order

Purpose Opioid misuse and overdose deaths remain a public health concern in the United States. Pennsylvania has one of the highest rates of opioid overdose deaths in the country, with Philadelphia County’s being 3 times higher than the national average. Despite several multimodal interventions, including use of SBIRT (screening, brief intervention, and referral to treatment) methods and naloxone distribution, the rate of overdose deaths remains high. Methods To gain insights on strategies for improving access to naloxone and naloxone distribution by pharmacists in Philadelphia County, a study was conducted in 11 community pharmacies (chain and independent) in Philadelphia. Twenty-four pharmacists were recruited and completed SBIRT and naloxone trainings. Each pharmacy elected to have at least 1 pharmacy champion who received additional training on and helped develop pharmacy site–specific naloxone dispensing protocols. Results Pre-post survey results showed a reduction in stigmatizing attitudes regarding naloxone dispensing and an increase in pharmacists’ understanding of the standing order and appropriate naloxone use. There was an increase in pharmacists’ self-reported confidence in their ability to appropriately identify, discuss, and dispense naloxone to patients. All pharmacies increased their average monthly dispensing rate following protocol implementation. Conclusion Pharmacists who received both trainings were more likely to change naloxone dispensing practices, leading to an overall increase in naloxone dispensing by community pharmacists. The study addressed overall gaps in pharmacists’ knowledge, reduced stigma, and prepared pharmacists to address opioid use and overdose prevention with their patients. The described pharmacist-led patient counseling and intervention service for overdose prevention may be explored as a model for other community pharmacies to adopt to improve naloxone dispensing and similar interventions to reduce overdose deaths.