Department of Psychology, Simmons University, 30 Fenway, Boston, MA, 02115, USA.
Institute on Urban Health Research and Practice, Northeastern University, Boston, MA, USA.
J Urban Health. 2019 Jun;96(3):367-378. doi: 10.1007/s11524-019-00349-1.
Drug overdose is the leading cause of unintentional death in the USA and the majority of deaths involve an opioid. Pharmacies are playing an increasingly important role in getting naloxone-the antidote to an opioid overdose-into the community. The aim of the current study was to understand, from the perspective of those who had obtained naloxone at the pharmacy, whose drug using status and pain patient status was not known until the interviews were conducted, as well as those who had not obtained naloxone at the pharmacy but were at risk for overdose, factors that impact the likelihood of obtaining pharmacy-based naloxone (PBN). Fifty-two participants from two New England states were interviewed between August 2016 and April 2017. We used a phenomenological approach to investigate participants' beliefs about pharmacy-based naloxone. The social contextual model was chosen to structure the collection and analysis of the qualitative data as it takes into account individual, interpersonal, organizational (pharmacy), community, and societal influences on a specific health behavior. Of the 52 people interviewed, 24 participants had obtained naloxone from the pharmacy in the past year, of which 4% (n = 1) self-disclosed during the interview current illicit drug use and 29% (n = 7) mentioned using prescribed opioid pain medication. Of the 28 people who had not obtained naloxone from the pharmacy, 46% (n = 13) had obtained an over the counter syringe from a pharmacy in the past month and had used an opioid in the past month, and 54% (n = 15) had used a prescribed opioid pain medication in the past month but did not report a syringe purchase. Several main themes emerged from the interview data. Individual-level themes were as follows: helplessness and fear, naloxone as empowerment to help, and past experiences at the pharmacy. Interpersonal-level themes were as follows: concern for family and friends, and sources of harm reduction information. Themes associated with pharmacy-level influence were as follows: perceived stigma from pharmacists, confusion at the pharmacy counter, and receptivity to pharmacists' offer of naloxone; community-level themes were as follows: community caretaking and need for education and training. Finally, themes at the societal-level of influence were as follows: generational crisis, and frustration at lack of response to opioid crisis. Overall our findings reveal factors at multiple levels which may play a role in likelihood of obtaining naloxone at the pharmacy. These factors can be used to inform interventions seeking to increase provision of pharmacy-based naloxone.
药物过量是美国意外死亡的主要原因，大多数死亡事件涉及阿片类药物。药店在将纳洛酮（阿片类药物过量的解毒剂）引入社区方面发挥着越来越重要的作用。本研究的目的是从那些在药店获得纳洛酮的人的角度出发，了解他们的用药状况和疼痛患者状况，这些信息直到访谈进行时才为人所知，同时也了解那些没有在药店获得纳洛酮但有药物过量风险的人的状况，以了解影响在药店获得纳洛酮（PBN）的可能性的因素。2016 年 8 月至 2017 年 4 月，来自新英格兰两个州的 52 名参与者接受了采访。我们使用现象学方法来研究参与者对基于药店的纳洛酮的看法。选择社会情境模型来组织定性数据的收集和分析，因为它考虑了个体、人际、组织（药店）、社区和社会对特定健康行为的影响。在接受采访的 52 人中，有 24 人在过去一年中从药店获得了纳洛酮，其中 4%（n=1）在访谈中透露了当前的非法药物使用情况，29%（n=7）提到了使用处方类阿片类止痛药。在 28 名没有从药店获得纳洛酮的人中，46%（n=13）在过去一个月从药店获得了非处方注射器，并在过去一个月使用了阿片类药物，54%（n=15）在过去一个月使用了处方类阿片类止痛药，但没有报告注射器购买情况。访谈数据中出现了几个主要主题。个人层面的主题如下：无助和恐惧、纳洛酮赋予的帮助力量以及在药店的过往经历。人际层面的主题如下：对家人和朋友的关心以及减少伤害信息的来源。与药店层面影响相关的主题如下：药剂师的污名化、药店柜台的困惑以及对药剂师提供纳洛酮的接受程度；社区层面的主题如下：社区关怀和教育与培训需求。最后，社会层面影响的主题如下：代际危机以及对阿片类药物危机缺乏应对措施的挫败感。总体而言，我们的研究结果揭示了多个层面的因素，这些因素可能会影响在药店获得纳洛酮的可能性。这些因素可以用于为旨在增加药店提供纳洛酮的干预措施提供信息。
