Table 3:

Addressing Barriers

Addressing Time Barrier
CBHS Pharmacy	Chain Pharmacy
Create pre-filled naloxone prescription Have screening forms in waiting area Cater education based on patient experience Provide educational materials (pamphlet, video) while waiting “I think time is relative. My experience in community pharmacy is that doing an immunization takes much longer than furnishing Naloxone.” “… in the group, try and elicit their experience of rescuing someone, and often in a class, one or two people have actually used naloxone and saved somebody, and so I’ve just learned more through that experience, as well. Like, I’ll ask if anyone’s done a rescue, or done Narcan, and often there will be a person, I’ll ask what happened, what did the person look like that they were rescuing, what was the response.”	Create pre-filled naloxone prescription Create quick bulleted list of naloxone education points Organize naloxone resources into binder “I would consider just consolidating everything into like a binder, we have a special Narcan binder, we have different dividers, everythingyou need. So at any point youjust take a piece ofpaper with all the information from each tab and then you bunch it up and then you have it for the patient.” “Just pre-writing things like we pre-print our Naloxone prescriptions, so it’s super easy, write the patient’s name and then your name and Narcan, all the standard directions are printed there. We also have a short hand sig for Narcan. So the technician just writes Narcan and boom, it has the standard Narcan directions so that makes things really smooth.”
Addressing Cost Barrier
Bill to Medi-Cal for $0 copay IM injectable naloxone is lowest cost naloxone formulation “And then cost, I mean you get reimbursed for it by almost all insurance plans. For us, it’s revenue- generating. I don’t see why cost would be an issue unless you’re giving it outforfree. Then it is very costly” “The IM injectable has been the lowest cost. That’s what’s been the main medication that’s been dispensed through programs such as needle exchange, where it’s worked through physicians’ protocol, partly because the population already knows how to use a needle and syringe. But they do have to issue a needle and syringe and a sharps container with the whole thing, so it’s this whole entire kit.”	Automatically apply manufacturer coupon Bill to Medi-Cal or Medicare Part D if deductible is reached “I would say it works really well when you can identify that it’s no-cost. I think cost is always a barrier because it’s hard enough to get them on board and understand it. But when they have to pay a lot of money for it, they’re like,” Oh I don’t want this.” So I’m catching the patients that it will be free for, so all our Medi-Cal and fee-for-service or all our Medicare patients that have reached the deductible.”
Addressing Unwanted Clientele
Furnishing naloxone attracts diverse patient population Develop policy in response to violence “I try to think of opioids as risky drugs, not the people that we’re giving them to as risky people and really putting the ownership on opioids” “they did have a lot of people who were coming in from the streets into theirpharmacy, and they were aware of it, they were okay with it, so some of it has to be the staff and the leadership at that pharmay. It’s amazing, you think corporate is corporate, but there’s a professional leadership that occurs,”	Naloxone furnishing slows down process time and deters unwanted clientele “So, what I’ve found is that if you are recommending Narcan, especially to that type of clientele, right, quote unquote, I find it actually deters the more −1 don’t want to use the word nefarious, but - you know, maybe not as wanted clienteles. Because when you are slowing down the process in any way, those people normally don’t want to come back, because they want it quick They want to basically bamboozle you into just dispensing their medication quickly or whatever they have written. So if it is the case, the naloxone I think would actually be a little bit more of an advantage of maybe helping to deter that type of clientele”
Addressing Stigma
Provide non-judgmental and encouraging environment for patients Emphasize substance use disorder in pharmacy school education “I think it is consistent with our entire approach here. We want to be respectful, and also honor our clients, and we want to also see that they’re safe. So, we try and make things very available, that’s kind of the main thing.”	Careful usage and phrasing of overdose Promote understanding of benefits and reasoning behind naloxone recommendation “And ultimately the best education and counseling points is not to use the word overdose too literally. But in other words, I’d like to say unintentional overdose and lead to the factors that can lead to unintentional overdose.”