Prescription overdose prevention intervention (POOR 2)
Research type
Research Study
Full title
Feasibility And Acceptability Of An Overdose Prevention Intervention Delivered By Community Pharmacists For Patients Prescribed Opioids For Chronic Non Cancer Pain.
IRAS ID
288945
Contact name
Rebecca Foster
Contact email
Sponsor organisation
University of Stirling
Clinicaltrials.gov Identifier
Not applicable, Not applicable
Duration of Study in the UK
1 years, 5 months, 1 days
Research summary
Summary of Research
Scotland has one of the highest opioid overdose (OD) mortality rates in Europe. People prescribed opioids for chronic non-cancer pain (CNCP) have increased prescription opioid overdose risk (POOR). Prescribing for CNCP prescriptions has increased over the past decade.\nNaloxone is a drug that can reverse the effects of opioid overdose and save lives, but is currently not routinely distributed among CNCP patients. Naloxone could reduce fatal and non-fatal overdoses among this group.\nThis study will 1) create a novel intranasal/intramuscular Take Home Naloxone (ITHN) intervention overdose prevention package for the POOR population attending community pharmacies in the Grampian region (Work Package 1); 2) explore mechanisms to move elements of the intervention to an online/virtual format to create needed flexibility in respect to Covid-19 restrictions (Work Package 1); 3) determine whether it is feasible to recruit community pharmacies to be involved, and for these community pharmacies to recruit patients (Work Packages 2 and 3); 4) test the ITHN intervention within a sample of community pharmacies in Grampian to access the feasibility and acceptability through qualitative interviews and quantitative questionnaires (Work Packages 2 and 3).\nFour-six community pharmacies (CP) will be invited to take part. Patients will be aged 18+ who are prescribed a strong opioid for CNCP who live with another person, aiming for 20 patients per CP.\nThe lead pharmacist at each CP will identify suitable patients, provide them with verbal and written information on the study and seek consent to pass on their name and phone number to the researchers if they express an interest in taking part. A researcher will contact the patient, discuss the study, and obtain their written consent to participate. Participating patients will receive the intervention from the pharmacy (information on POOR, a supply of naloxone and training on how to use it). \nSummary of Results
The intervention was delivered at a time of increasingly high levels of drug related deaths (DRDs) in Scotland. All patients and pharmacists were aware of the magnitude of fatal overdoses in Scotland and one patient had personal experience of a DRD within their own family. Both patients and pharmacists were supportive of the take home naloxone intervention and viewed naloxone as an important component of a harm reduction strategy. The requirement for harm reduction strategies in response to DRDs was not disputed by any participant in the study. Generally, patient levels of knowledge regarding opioid safety and naloxone were low. Most had been prescribed opioids for a long time and interacted with a range of health professionals including GPs, pain clinics, and pharmacies, however interactions tended to focus on pain management only, not opioid overdose risk. Pharmacists were experienced in the discussion of opioid-related risk, but not commonly with this patient group. This corresponded with patient reports that they had not previously received information from health professionals about opioid-related risk. Pharmacists had experience of dispensing naloxone: one had experience of administering naloxone to an individual who had overdosed outside their pharmacy.In the patient questionnaires, 11 patients reported at least one diagnosed comorbidity, with patients taking an average of four medications. Morphine was the most prescribed opioid, followed by oxycodone, then tramadol. While 25% of patients reported medication-related risk factors for opioid use disorder, only one patient reported two risk factors. In follow up questionnaires, all patients ‘strongly agreed’ that they learned what steps to take if they thought they were having an overdose. No patients felt upset by the naloxone information provided in the intervention. Patients also outlined that the information provided in the intervention was ‘very’ or ‘extremely’ helpful, and ‘very’ or ‘extremely’ easy to understand, and this mirrored findings from patient interviews.
In the interviews, patients described long-term prescription opioid use, but this did not equate to high levels of opioid overdose knowledge. Patients perceived that they were at low risk of opioid overdose, even though all were prescribed high-strength opioids. Patients initially proposed naloxone as being an intervention most suited to people who used non-prescription drugs. However, as the intervention delivered essential opioid risk knowledge, patients developed insight into the value of naloxone for themselves as a member of the chronic non-cancer pain (CNCP) population. Most patients were satisfied with the intervention content and delivery, including the time pharmacists spent with them.
The intervention was delivered during the COVID-19 pandemic when pharmacies were under significant pressure which impacted the ability to either engage or fully engage with the study. Pharmacists identified that the reimbursement for the take home naloxone intervention was reasonable when compared to other services they already provided. Pharmacists reported enjoying delivering the intervention but stated that they would have liked to have been able to dedicate more time to it. Related to limited time was a hesitancy to engage with ‘Near Me’ video consulting software due to limited time to implement the software in the pharmacy or learn how to use this efficiently. Additionally, there were concerns that remote delivery of the intervention would be inferior for patients when compared with face-to-face delivery.
This intervention attended to a critical gap within the knowledge of patients prescribed opioids for CNCP, and patients reported high levels of satisfaction with the intervention content and delivery. Pharmacist perceptions of providing a bespoke take home naloxone intervention for people prescribed opioids for CNCP were also very positive, indicating that the intervention is feasible to deliver if it is streamlined to be as easy to deliver as possible. Many of the barriers perceived related to the research element of the intervention. In terms of next steps, we recommend piloting a slightly revised version of the intervention in sites across Scotland. This should be low barrier to encourage community pharmacies to be involved, enabling reach to be extended. While a larger outcomes focused trial is merited, the research process itself was off-putting to pharmacies given the very challenging external context of COVID-19. The need to undertake further research needs to be considered alongside the potential of the intervention to increase knowledge about opioid risk and overdose in this patient group and potentially prevent overdose and save lives.REC name
North of Scotland Research Ethics Committee 1
REC reference
21/NS/0014
Date of REC Opinion
26 Feb 2021
REC opinion
Favourable Opinion