Implementation of Medication Disposal Programs and Availability of Same-Day Naloxone at Community Pharmacies: Protocol for a Secret Shopper Caller Approach (Preprint)
Authors: Egan Kathleen L , Lewis Briana , Fields Kayleigh , McMillian III James , Graves Rachel L , Kline David M , Eldridge Lori Ann 
Published: July 2024

BACKGROUND

Pharmacies have the opportunity to implement multiple strategies to prevent nonmedical prescription opioid use and associated harms, including implementing disposal programs (e.g., disposal boxes, deactivation products, and mail-back envelopes) and offering over-the-counter naloxone.
The quantity of opioid prescriptions dispensed in the United States (US) is so high that every other person could receive one opioid prescription. Many of these opioids go unused and are kept in homes rather than disposed after ceasing use. The primary source of prescription opioids for nonmedical use is relatives or friends, which suggests that the diversion of excess and retained prescription opioids contributes significantly to nonmedical use and associated consequences.
Naloxone is a life-saving medication that works as an opioid antagonist to reverse the effects of mu-agonist opioids and restore normal breathing to a person experiencing an overdose. To increase access to naloxone, all 50 US states have passed laws (e.g., statewide standing orders) that allow pharmacists to distribute naloxone without an individual patient prescription. Additionally, the US Food and Drug Administration (FDA) approved the first over-the-counter naloxone medication in March of 2023.
Socioeconomic disparities are associated with nonmedical opioid use and its related harms. To prevent exacerbating these existing health disparities, it is essential to implement pharmacy-based harm reduction practices equitably.

OBJECTIVE

The overall objective is to assess the extent to which disposal programs and same-day naloxone have been implemented in pharmacies across the US and examine place-based health disparities in implementation. We hypothesize that as neighborhood disadvantage and the proportion of Black/African American residents in a neighborhood increase, the likelihood of a pharmacy having a disposal program or same-day naloxone decreases. We also hypothesize differences in medication disposal programs and same-day naloxone availability by retailer chain and type of pharmacy.

METHODS

A secret shopper caller protocol will be used to identify pharmacies that have implemented a medication disposal program and have naloxone available on the same day without a prescription. We will conduct disproportionate stratified random sampling with the strata being pharmacy chains to maximize the likelihood of sampling diverse corporations and independent pharmacies. The goal is to obtain a final sample of 1,000 pharmacies. Neighborhood sociodemographic characteristics will be appended to the secret shopper data. To explore neighborhood and pharmacy characteristics associated with the availability of medication disposal programs and same-day naloxone, we will use logistic regression.

RESULTS

This protocol represents the entire structure of the secret shopper caller approach. Ethical approval for the study has been obtained and data collection will be completed in 2024.

CONCLUSIONS

This will be the first study to examine national estimates of medication disposal programs and same-day naloxone availability at pharmacies and geographic disparities associated with implementation.

CLINICALTRIAL

N/A