Correlates of stocking naloxone: A cross sectional survey of community pharmacists

Correlates of stocking naloxone: A cross sectional survey of community pharmacists | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Correlates of stocking naloxone: A cross sectional survey of community pharmacists Rose Laing, Ting Xia, Elizabeth Grist, Jana Dostal, Suzanne Nielsen, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4127160/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 23 Jul, 2024 Read the published version in International Journal of Clinical Pharmacy → Version 1 posted 5 You are reading this latest preprint version Abstract Introduction: Provision of take-home naloxone (THN) and overdose education reduces opioid-related mortality. In Australia, from July 2022, all Australian community pharmacies were eligible to supply naloxone for free through the national Take Home Naloxone Program. This study aims to identify naloxone stocking rates and correlates of stocking naloxone across Australian pharmacies. Method: Data was collected from a representative sample of Australian pharmacists in Victoria, New South Wales, Queensland and Western Australia via an online survey. Data collected included pharmacy and pharmacist characteristics and services offered within the pharmacy, including needle and syringe programs, opioid agonist treatment (OAT) and stocking naloxone. Binary probit regression analysis was used to identify correlates of stocking naloxone after controlling for key covariates. Results: Data from 530 pharmacists were analysed. In total, 321 pharmacies (60.6%) reported stocking naloxone. Chain and banner pharmacies and pharmacies that provided OAT had a greater probability of stocking naloxone (B = 0.307, 95%CI: [0.057, 0.556], and B = 0.543, 95%CI: [0.308, 0.777] respectively). Most (61.7%) pharmacists felt comfortable discussing overdose prevention with patients who use prescription opioids, and this comfort was associated with a higher probability of stocking naloxone (B = 0.392, 95%CI: 0.128, 0.655). Comfort discussing overdose prevention with people who use illicit opioids was lower (49.4%) and was not associated with stocking naloxone. Conclusion: There is scope to increase stocking of naloxone and comfort with overdose prevention, particularly through addressing comfort working with higher risk groups such as people who use illicit opioids. Figures Figure 1 IMPACT STATEMENTS Australia is one of the first countries globally to implement nationally funded pharmacist provision of naloxone, and experiences here have a significant impact on global naloxone provision and interventions. Independent pharmacies and pharmacies that do not provide opioid agonist treatment were associated with lower rates of stocking naloxone, suggesting that these are targets to address in increasing naloxone supply. INTRODUCTION Opioid related harm remains a significant public health concern in many high-income countries [ 1 ]. In the USA, opioids were responsible for 80,816 deaths in 2021 [ 2 ] and 3.3% of the US population reported using opioids within the same year [ 3 ]. In Canada, opioid related mortality rates increased by 600% between 2000–2017 [ 4 ]. While most opioid related deaths in the USA, Canada and UK are driven by illicit opioids, the harms caused by prescription opioids are still significant [ 5 , 6 ]. Contrary to other countries, the majority of opioid related deaths in Australia are attributed to prescription opioids [ 7 ]. The number of unintentional opioid related deaths has nearly trebled since 2006, increasing from 338 to 856 in 2020 [ 8 ]. In 2020, 34% of opioid related deaths were attributed to heroin only, with 56% attributed solely to prescription opioids and opioids other than heroin, and the remainder a combination of both prescription opioids and heroin [ 9 ]. Naloxone is an opioid antagonist that can be administered by a layperson to reverse an opioid overdose, preventing mortality [ 10 , 11 ]. Delivered as first aid either as an intramuscular injection or a nasal spray, it can rapidly and temporarily reverse the effects of opioid overdose [ 12 ]. Take-home naloxone (THN) has been widely adopted and has consistently been associated with reduced mortality from unintended opioid overdose in many high-income countries such as the UK, USA and Australia [ 13 – 15 ]. In light of this evidence, in 2014 the World Health Organization (WHO) published guidelines on the use of naloxone to treat opioid overdose, and made strong recommendations that naloxone be available to all individuals who may be at risk of opioid overdose and to those who have a high chance of witnessing an opioid overdose [ 16 ]. Since these recommendations were published, THN programs have expanded globally and are now being trialled in low- and middle-income countries [ 15 ]. Globally, pharmacists have been recognized as potential educators and distributors of naloxone to the community [ 17 ]. In Australia, THN became available over the counter in 2016 [ 18 ], and implementation of the national THN program in 2022 enabled individuals to access naloxone free of charge at any participating community pharmacies [ 19 ]. However, there are still barriers to patients obtaining naloxone including lack of education on availability and usage, fear of stigma associated with opioid use and addiction [ 20 , 21 ], pharmacists’ discomfort in discussing overdose prevention with patients and stigma associated with illicit versus prescription opioid use [ 22 ]. These barriers hinder pharmacists’ ability to deliver optimal pharmacy practice, resulting in evidence-based care not being available to all patients [ 23 ]. There is limited data on rates of stocking naloxone, and correlates of stocking naloxone have yet to be identified in Australia. Global literature suggests that several pharmacist and pharmacy specific characteristics may be associated with whether naloxone is stocked in a pharmacy, such as pharmacy location [ 24 ], whether the pharmacy is part of a chain [ 25 ], and provision of other services within the pharmacy [ 26 ]. Understanding factors that may serve as barriers or facilitators to naloxone supply is crucial to increasing naloxone access. AIM To determine pharmacist and pharmacy-related correlates of stocking naloxone in four Australian states; Victoria, New South Wales (NSW), Queensland and Western Australia (WA). Ethics approval Ethical approval for the study was granted by the Monash University Human Research Ethics Committee (No. 36459). METHOD Design and setting. Data for this analysis was collected via a cross-sectional online survey exploring pharmacist’s roles in opioid use safety [ 27 ], among a representative sample from the four more populous states of Australia (Victoria, NSW, Queensland and WA), representing 88% of the Australian population [ 28 ]. Results were reported according to the STROBE cross sectional reporting guidelines [ 29 ]. Sampling of pharmacies A comprehensive list of community pharmacies in each state was obtained using two publicly available pharmacy marketing lists, Maven Marketing and Australian Marketing List. These lists were combined, and duplicates and non-community pharmacies were removed. This resulted in a total of 1981 pharmacies identified in NSW, 1237 in Queensland, 1469 in Victoria and 633 in WA. Participants and procedures Recruitment occurred throughout August-October 2023. Minimum sample size was calculated using ‘Raosoft” [ 30 ]. The total population of n = 5320 identified community pharmacies was used in the calculation with a confidence level of 99% and a margin of error of 5%, with an estimated response rate of 50%, indicated from a previous study [ 31 ]. Minimum sample size was calculated at n = 359. Approximately 500 pharmacies per state were randomly selected. The total population of pharmacies was divided into subsets by state, and each subset was randomised using the Microsoft Excel formula “= rand() ”. Pharmacies were contacted via telephone, with 1955 pharmacies contacted in total, based on estimated response rate to provide the required sample size (see Fig. 1 ) [ 32 ]. Once contacted, the pharmacist in charge was invited to take part in the survey, with only one pharmacist per pharmacy eligible to participate to remove issues of clustering. At least three attempts were made, on different days and times, to contact the pharmacist in charge at each pharmacy. Upon speaking to the pharmacist in charge, if they agreed to participate, a link to access the survey was sent to the provided email address. The online survey was administered via Monash University Qualtrics platform. From the date of the initial email, reminder emails were sent at the one- and two-week marks to prompt participation. The participating pharmacist was required to read the associated study information sheet and provide online consent before they commenced the survey. Pharmacists who completed the survey could opt in to enter a draw to win one of two iPads, with contact details collected via an unlinked Qualtrics form. Measures The current study examined a range of potential correlates of stocking naloxone related to the five broad factors outlined below, which were selected based on existing literature [ 24 – 26 , 33 , 34 ]. As most covariates were recorded as binary responses, other covariates were recoded and collapsed into binary categories for consistent analysis: 1. Pharmacist characteristics Gender Male or female. Originally recorded as male, female or non-binary. Non-binary was excluded from analysis due to small response rate (n = 3). Years of experience as a pharmacist <15 years or 15 years or more. Originally recorded as a continuous variable where participants entered years of experience manually. These were divided into binary variables using mean number of years’ experience as an indicator of centrality (Mean = 14.88). 2. Pharmacy characteristics Pharmacy state NSW, VIC, QLD or WA. Geographic Location Capital city/urban and rural/remote. Originally recorded as Capital city, urban, rural or remote. Collapsed to represent urban vs rural areas. Pharmacy type Chain/banner or independent/other. Originally recorded as single independent pharmacy, small chain or banner group (2–9 branches), large chain or banner group ( ≥ 10 branches), or other. To make findings comparable to existing literature [ 24 , 35 ], independent pharmacy and other were combined into one variable, while small and large chain or banner pharmacy were combined into a second variable. 3. Frequency of opioid dispensing How often opioid prescriptions were dispensed Less than once a day, or once or more per day. Originally recorded as once per week, multiple times per week, around once per day, several times and day, and more than 10 times a day. These were collapsed into binary variables based on mean and mode response (Mean = 2.79, Mode = 3.00) 4. Provision of pharmacy services: Whether the pharmacy offered or supplied the following services naloxone, needle and syringe program and opioid agonist treatment (OAT) (methadone and buprenorphine for opioid use disorder). All recorded as binary variables (‘yes’ if provided, ‘no’ if not provided) 5. Pharmacists’ comfort Pharmacists comfort in discussing overdose prevention with patients who use prescription or illicit opioids: Comfortable or Not Comfortable. Originally collected on a 4-point Likert scale [ 36 ] with options ‘very comfortable’, ‘comfortable’, ‘uncomfortable’ and very uncomfortable’ collapsed to binary variables. Statistical analysis: Descriptive statistics were used to explore and describe sample characteristics as well as participants’ comfort discussing naloxone. A multivariate probit regression analysis with an adjusted coefficient was used to explore the correlates of stocking naloxone and pharmacist and pharmacy characteristics. The final model included 10 variables that included both pharmacist and pharmacy characteristics. A McNemar test was used to test the difference in pharmacists’ comfort levels discussing overdose prevention with patients who take prescription versus illicit opioids. All statistical tests used a p value of 0.05 to determine significance. All analysis was completed using SPSS V28. RESULTS In total, 1396 pharmacists agreed to participate in the study. Of these, 690 pharmacists commenced the survey, with n = 530 completing the questions relating to naloxone and included in the final analyses. Sample characteristics are reported in Table 1 . A similar proportion of male and female pharmacists were represented (47.8% female), and 40.2% of pharmacists had over 15 years of experience. Most pharmacies were located in capital cities or urban areas (71.5%), were part of a banner or chain (66.8%) and received scripts for opioids more than once per day (91.5%). Naloxone was stocked in 60.6% of pharmacies. Chain or banner group pharmacies had a 30.7% greater probability of stocking naloxone, compared to independent pharmacies (p = 0.016, 95%CI [0.057, 0.556]), while pharmacies that provide OAT had a 54.3% greater probability of stocking naloxone after controlling for other covariates (p < 0.001, 95%CI [0.308, 0.777]) (Table 1 ). Pharmacists who were comfortable discussing overdose prevention with patients who use prescription opioids had a 39.2% greater probability of stocking naloxone, compared with pharmacists who indicated they were uncomfortable (p = 0.004, 95%CI [0.128, 0.655]). In contrast, comfort discussing naloxone with people who use illicit opioids was not associated with stocking naloxone. All other variables were not significantly associated with naloxone supply. Table 1 Pharmacy and pharmacist characteristics by naloxone availability and correlates of stocking naloxone Sample and Pharmacy Characteristics Overall (n b ) n = 530 Stock Naloxone (n, %) n = 321 (60.6%) Don’t Stock Naloxone (Reference) (n, %) n = 209 (39.4%) B P B (95%CI) Pharmacist In Charge Characteristics Gender a Male (52.2%) 275 176 (64.0%) 99 (36.0%) Ref Female (47.8%) 252 144 (57.1%) 108 (42.9%) -0.081 0.487 -0.311, 0.148 Years of Experience as a pharmacist < 15 years (59.8%) 317 199 (62.8%) 118 (37.2%) Ref ≥ 15 years (40.2%) 213 122 (57.3%) 91 (42.7%) -0.079 0.505 -0.312, 0.154 Pharmacy Characteristics State NSW (22.3%) 118 63 (53.4%) 55 (46.6%) Ref VIC (27.7%) 147 92 (62.6%) 55 (37.4%) 0.254 0.135 -0.079, 0.587 QLD (30.2%) 160 103 (64.4%) 57 (35.6%) 0.160 0.329 -0.162, 0.483 WA (19.8%) 105 63 (60.0%) 42 (40.0%) 0.136 0.453 -0.219, 0.490 Pharmacy Location Capital City/ Urban (71.5%) 379 231 (60.9%) 148 (39.1%) Ref Rural/ Remote (28.5%) 151 90 (59.6%) 61 (40.4%) -0.011 0.934 -0.264, 0.242 Pharmacy Type Single/ Independent (33.2%) 176 94 (53.4%) 82 (46.6%) Ref Banner/ chain/ other (66.8%) 354 227 (64.1%) 127 (35.9%) 0.307 0.016 * 0.057, 0.556 Number of Opioid Prescriptions per day in last week once a day (91.5%) 485 297 (61.2%) 188 (38.8%) 0.113 0.589 -0.298, .524 Provides Opioid Agonist Treatment (OAT) No (52.8%) 280 141 (50.4%) 139 (49.6%) Ref Yes (47.2%) 250 180 (72.0%) 70 (28.0%) 0.543 < 0.001 ** 0.308, 0.777 Needle and Syringe Program No (43.6%) 231 127 (55.0%) 104 (45.0%) Ref Yes (56.4%) 299 194 (64.9%) 105 (35.1%) 0.051 0.685 -0.195, 0.296 Pharmacist Comfort Comfort discussing overdose prevention and naloxone with patients who are prescribed opioids Uncomfortable (38.3%) 203 99 (48.8%) 104 (51.2%) Ref Comfortable (61.7%) 327 222 (67.9%) 105 (32.1%) 0.392 0.004 * 0.128, 0.655 Comfort discussing overdose prevention and naloxone with patients who use illicit opioids Uncomfortable (50.6%) 268 140 (52.2%) 128 (47.8%) Ref Comfortable (49.4%) 262 181 (69.1%) 81 (30.9%) 0.206 0.123 -0.056, 0.468 Note: a Participants that identified as ‘other’ too small to enable analysis, total sample size n = 527. b all values represent 100%. *p < 0.05, **p < 0.001. There was a significantly greater proportion (61.7%) of pharmacists who were comfortable discussing overdose prevention with patients who take prescription opioids versus those who take illicit opioids (49.4%) (X 2 (1, N = 530) = 29.468, p < 0.001) ( Table 2 ). Of those pharmacists who felt comfortable discussing overdose prevention with patients who take prescription opioids, 45.3% (n = 102) did not feel comfortable discussing overdose prevention with patients who take illicit opioids. Table 2 Comparison of pharmacist comfort levels discussing overdose prevention with patients who take illicit opioids and those who take prescription opioids. Comfort Discussing Overdose Prevention with Patients Taking Illicit Opioids Total Comfortable Uncomfortable Comfort Discussing Overdose Prevention with Patients Taking Prescription Opioids Comfortable 225 102 327 (61.7%) Uncomfortable 37 166 203 (38.3%) Total 262 (49.4%) 268 (50.6%) 530 (100%) X 2 29.468 P Value P = < 0.001 DISCUSSION Statement of key findings This study, among a representative sample of pharmacies in four Australian states, examined stocking naloxone and its correlates. Most (60.6%) pharmacies stocked naloxone, though as almost 40% of pharmacies did not yet stock it, there appears scope to further increase access to naloxone access through pharmacies. Results revealed that pharmacies within a banner group or chain and those that offer OAT had a greater probability of stocking naloxone. Similarly, pharmacists who were comfortable discussing overdose prevention with patients who use prescription opioids had greater probability of stocking naloxone. Lower levels of comfort were reported with discussing naloxone and overdose education with people who use illicit opioids compared to people who were prescribed opioids. Strengths and Weaknesses This is the first Australian study to explore stocking naloxone in community pharmacies since the introduction of the national THN program. Strengths include the use of a large, randomly selected representative sample of pharmacists from four Australian states with diverse approaches to naloxone provision. Health care professional surveys commonly have low response rates, so several evidence-based strategies were used to maximise responses [ 37 ]. As a result of these strategies, 49.4% of pharmacists started the survey, with 38% completing the section relating to stocking naloxone. Limitations include a lack of information on current naloxone provision, noting that previous research found pharmacies may stock naloxone, however, were not providing or supplying it to patients [ 34 ]. There is the possibility that social desirability bias may have influenced results, as pharmacists may have reported feeling comfortable discussing overdose prevention while they weren’t, however the significantly lower rates of comfort when supplying naloxone to people who use illicit drugs suggest that this was not likely to have overly influenced results. Interpretation In the past, stocking naloxone was not common, with a 2016 Australian study identifying that only 23% of pharmacies stocked naloxone and only 6% had dispensed it to a patient to take home. A more recent study amongst n = 265 pharmacists in Victoria, Australia found that half of pharmacists stocked naloxone, however a third of those did not supply it in the past year [ 31 ]. This study shows that rates of stocking naloxone have increased substantially in recent years, coinciding with the national program that covers the cost of naloxone being provided at no charge to pharmacy patients, alongside a small dispensing fee. Despite this positive change, our findings also indicate that there are still a large number of pharmacies that are not stocking naloxone, and are not comfortable with naloxone supply, with inconsistent naloxone availability having the potential to reduce community access to evidence-based care for overdose prevention. Consistent with earlier research [ 31 ], provision of OAT was significantly associated with stocking naloxone, and pharmacists that provided OAT had a significant greater probability of stocking naloxone. As pharmacists that provide OAT have higher exposure to patients who take both illicit and prescription opioids, it is not surprising that they are more likely to stock naloxone. Use of naloxone is recommended in most Australian state OAT guidelines, including NSW, Victoria and WA [ 38 ], and promotion of naloxone through these guidelines contributes to increased pharmacist knowledge surrounding naloxone usage for prescription opioids and may be a contributing factor to the observed higher odds of stocking naloxone. Pharmacies within a chain or banner group had a greater probability of stocking naloxone than independent pharmacies, which is consistent with findings from the USA [ 39 ]. This pattern is likely related to differences in management structure between chain and independent pharmacies. Banner and chain pharmacies have centralised management structures, and the introduction of new state and national naloxone policies may be rapidly implemented across a large number of pharmacies as a result [ 40 ]. Centralised management structures also contribute to more effective stock control mechanisms for long term storage of naloxone, which protects them against national shortages which have been a problem across Australia [ 41 , 42 ]. Additional benefits of pharmacists working in a chain pharmacy include greater access to educational resources and peer coaching opportunities [ 43 ]. Increased training and internal coordination have been shown to increase levels of stocking and providing naloxone [ 44 ]. Additionally, a 2021 Australian study investigating pharmacists’ comfort in discussing overdose prevention with people who take prescription opioids revealed that pharmacists from chain and banner pharmacies had 1.5 times greater odds to feel comfortable in discussing overdose prevention than pharmacists from independent pharmacies [ 45 ]. This suggests that efforts to support independent pharmacies to provide pharmacist training and education on the benefits of naloxone may be warranted. Pharmacists who were comfortable discussing overdose prevention with patients prescribed opioids had a greater probability of stocking naloxone. Additionally, pharmacists were significantly more comfortable discussing overdose prevention with patients that take prescription opioids versus those that take illicit opioids. This difference may imply the presence of pharmacist stigma surrounding illicit opioid use and naloxone. In a 2019 study, interviews with pharmacists revealed that many pharmacists found it difficult to raise the topic of overdose with patients who take many prescribed opioids as they don’t want to risk offending the patient [ 22 ], suggesting that in recent years progress has been made in pharmacists’ comfort with this population. Naloxone stigma is often a reflection of stigma surrounding opioid use disorder and previous research has found that pharmacists reported a fear that stocking naloxone may attract the ‘wrong clientele’ [ 46 , 47 ]. Education is a proven method of reducing both OUD and naloxone related stigma [ 48 , 49 ]. Although it is promising that pharmacists appear to have greater comfort discussing naloxone with people receiving prescription opioids, there is an urgent need to maximise pharmacist comfort in discussing naloxone with all people at risk of experiencing or witnessing an opioid overdose. As one of the first countries to implement a national program of fully funded pharmacist provision of THN, these findings may inform expansion of pharmacy naloxone supply in other global settings. Findings also highlight the need to address stigma and increase pharmacists’ comfort in discussing naloxone with a wide range of populations, while also demonstrating the importance of funded programs to increase naloxone availability. Further Research While the rate of pharmacies stocking naloxone has increased across Australia, further work to understand naloxone provision and later usage is warranted. Future work could assess if current pharmacist THN training is sufficient to support pharmacists to feel confident supplying THN to different populations and identify how pharmacist’s perceived barriers in providing naloxone can most effectively be addressed [ 46 , 50 ]. CONCLUSION Despite naloxone being free under the national THN program, almost 40% of pharmacies do not stock naloxone. Additional efforts are needed to increase naloxone stocking in independent pharmacies and among those that do not offer OAT, to maximise naloxone access within the community. Pharmacist education to reduce stigma associated with illicit opioid use and increase comfort working with people who use illicit opioids should be included in naloxone promotion strategies. DECLARATIONS Funding This work was supported by a National Health and Medical Research Council (NHMRC) Investigator Grant (#2016909), for which LP is the recipient. SN is the recipient of a National Health and Medical Research Council (NHMRC) Investigator Grant (#2025894). Conflicts of Interest All authors report no conflicts of interest to declare. Author Contributions All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Rose Laing, Elisabeth Grist, Jana Dostal and Louisa Picco. The first draft of the manuscript was written by Rose Laing and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Data Availability The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request with appropriate ethical approval. Consent to participate Informed consent was obtained from all individual participants included in the study. REFERENCES Lam T, Hayman J, Berecki-Gisolf J, et al. 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How do patient, pharmacist and medication characteristics and prescription drug monitoring program alerts influence pharmacists' decisions to dispense opioids? A randomised controlled factorial experiment. The International journal on drug policy. 2022;109:103856. https://doi.org/10.1016/j.drugpo.2022.103856. Freeman PR, Goodin A, Troske S, et al. Pharmacists’ role in opioid overdose: Kentucky pharmacists’ willingness to participate in naloxone dispensing. Journal of the American Pharmacists Association. 2017;57(2, Supplement):S28-S33. https://doi.org/https://doi.org/10.1016/j.japh.2016.12.064. Nielsen S, Menon N, Larney S, et al. Community pharmacist knowledge, attitudes and confidence regarding naloxone for overdose reversal. Addiction. 2016;111(12):2177-86. https://doi.org/10.1111/add.13517. Antoniou T, McCormack D, Campbell T, et al. Geographic variation in the provision of naloxone by pharmacies in Ontario, Canada: A population-based small area variation analysis. Drug and Alcohol Dependence. 2020;216:108238. https://doi.org/https://doi.org/10.1016/j.drugalcdep.2020.108238. Robinson J. Likert Scale. In: Michalos AC, editor. Encyclopedia of Quality of Life and Well-Being Research. Dordrecht: Springer Netherlands; 2014. p. 3620-1. Cho YI, Johnson TP, VanGeest JB. Enhancing Surveys of Health Care Professionals:A Meta-Analysis of Techniques to Improve Response. Evaluation & the Health Professions. 2013;36(3):382-407. https://doi.org/10.1177/0163278713496425. The National Naloxone Reference Group. Summary of Take Home Naloxone in Australia: Information current at 18 November 2021. 2021. https://creidu.edu.au/system/resource/102/file/NNRG_THN.pdf. Accessed 19/01/2024 2024. Stone RH, Hur S, Young HN. Assessment of naloxone availability in Georgia community pharmacies. Journal of the American Pharmacists Association. 2020;60(2):357-61. https://doi.org/https://doi.org/10.1016/j.japh.2019.11.003. Pollini RA, Slocum S, Ozga J, et al. Pharmacists’ experiences with a statewide naloxone standing order program in Massachusetts: a mixed methods study. Journal of the American Pharmacists Association. 2022;62(1):157-66. https://doi.org/https://doi.org/10.1016/j.japh.2021.08.020. Australian Government Department of Health and Aged Care: Therapeutic Goods Administration. Medicine shortage reports database. n.a. https://apps.tga.gov.au/Prod/msi/Search/Details/naloxone%20hydrochloride%20dihydrate?sort=status. Accessed 09/01/2024 2024. Parajuli DR, Khanal S, Wechkunanukul KH, et al. Pharmacy practice in emergency response during the COVID-19 pandemic: Lessons from Australia. Research in Social and Administrative Pharmacy. 2022;18(8):3453-62. https://doi.org/https://doi.org/10.1016/j.sapharm.2021.08.013. Hake KL, Carroll JC, Somma McGivney MA, et al. Pharmacist peer coaching in a traditional community chain pharmacy: Implementation and perceptions. Journal of the American Pharmacists Association. 2021;61(4, Supplement):S85-S90. https://doi.org/https://doi.org/10.1016/j.japh.2021.02.010. Donovan E, Bratberg J, Baird J, et al. Pharmacy leaders’ beliefs about how pharmacies can support a sustainable approach to providing naloxone to the community. Research in Social and Administrative Pharmacy. 2020;16(10):1493-7. https://doi.org/https://doi.org/10.1016/j.sapharm.2020.01.006. Alvin M, Picco L, Wood P, et al. Community pharmacists’ preparedness to intervene with concerns around prescription opioids: findings from a nationally representative survey. International Journal of Clinical Pharmacy. 2021;43(2):411-9. https://doi.org/10.1007/s11096-020-01152-8. Bakhireva LN, Bautista A, Cano S, et al. Barriers and Facilitators to Dispensing of Intranasal Naloxone by Pharmacists. Substance Abuse. 2018;39(3):331-41. https://doi.org/10.1080/08897077.2017.1391924. Adeosun SO. Stigma by Association: To what Extent is the Attitude Toward Naloxone Affected by the Stigma of Opioid Use Disorder? Journal of Pharmacy Practice. 2023;36(4):941-52. https://doi.org/10.1177/08971900221097173. Murphy J, Russell B. Stigma Reduction through Addiction and Naloxone Education. Journal of Criminal Justice Education. 2023;34(2):185-98. https://doi.org/10.1080/10511253.2022.2068632. Bascou NA, Haslund-Gourley B, Amber-Monta K, et al. Reducing the stigma surrounding opioid use disorder: evaluating an opioid overdose prevention training program applied to a diverse population. Harm Reduction Journal. 2022;19(1):5. https://doi.org/10.1186/s12954-022-00589-6. Thakur T, Frey M, Chewning B. Pharmacist roles, training, and perceived barriers in naloxone dispensing: A systematic review. Journal of the American Pharmacists Association. 2020;60(1):178-94. https://doi.org/https://doi.org/10.1016/j.japh.2019.06.016. Cite Share Download PDF Status: Published Journal Publication published 23 Jul, 2024 Read the published version in International Journal of Clinical Pharmacy → Version 1 posted Reviewers agreed at journal 28 Mar, 2024 Reviewers invited by journal 28 Mar, 2024 Editor invited by journal 20 Mar, 2024 Editor assigned by journal 19 Mar, 2024 First submitted to journal 18 Mar, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4127160","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":284983045,"identity":"6a3f0935-6662-4d5a-8389-c3275e8fb453","order_by":0,"name":"Rose Laing","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8UlEQVRIiWNgGAWjYNCCAgYeBgbmA2C2ARBLENZiANLClkCaFiDgMSBOi3l7+8MHDAZ2Mub8a75u+LjDzt6cgfngbR48WmTOnDE2YDBI5rGc8XbbzZlnkhN3NrAlW+PTIiGRwybBYMDMY3Dj7LbbvG3MCQYHeMyk8WtJf/6DwaAeqOXMM6CWenuDA/zfCGhJMAN6+TCPwfkeNqCWw4wbDvCw4dfCc8ZYIsHgONAWNrObM9uOJ244zGZsOQefFvb2hx8+VFTbG5w//OzGxzYg43jzwxtv8GgBgwSw5gQoj5mQcjjgP0C00lEwCkbBKBhhAADQ0kkS0IDS5AAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0009-0001-0094-1332","institution":"Monash University","correspondingAuthor":true,"prefix":"","firstName":"Rose","middleName":"","lastName":"Laing","suffix":""},{"id":284983046,"identity":"754760e1-c4e1-41a4-9fc7-e41dafcd858d","order_by":1,"name":"Ting Xia","email":"","orcid":"","institution":": Monash University Eastern Health Clinical School","correspondingAuthor":false,"prefix":"","firstName":"Ting","middleName":"","lastName":"Xia","suffix":""},{"id":284983047,"identity":"ecf61dba-cd3c-4688-b2db-7b72eb93288c","order_by":2,"name":"Elizabeth Grist","email":"","orcid":"","institution":": Monash University Eastern Health Clinical School","correspondingAuthor":false,"prefix":"","firstName":"Elizabeth","middleName":"","lastName":"Grist","suffix":""},{"id":284983048,"identity":"c074adbf-1108-475c-89cf-697f36b5ad8c","order_by":3,"name":"Jana Dostal","email":"","orcid":"","institution":"Monash University Eastern Health Clinical School","correspondingAuthor":false,"prefix":"","firstName":"Jana","middleName":"","lastName":"Dostal","suffix":""},{"id":284983049,"identity":"689e000d-3361-4abb-8cc7-021d3b3898e4","order_by":4,"name":"Suzanne Nielsen","email":"","orcid":"","institution":": Monash University Eastern Health Clinical School","correspondingAuthor":false,"prefix":"","firstName":"Suzanne","middleName":"","lastName":"Nielsen","suffix":""},{"id":284983050,"identity":"5ace179f-4d4d-49e7-975b-be9e7f14ac01","order_by":5,"name":"Louisa Picco","email":"","orcid":"","institution":": Monash University Eastern Health Clinical School","correspondingAuthor":false,"prefix":"","firstName":"Louisa","middleName":"","lastName":"Picco","suffix":""}],"badges":[],"createdAt":"2024-03-19 04:23:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4127160/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4127160/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s11096-024-01773-3","type":"published","date":"2024-07-23T16:16:02+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":53962550,"identity":"b0817536-852a-4eb2-acaf-c9f8167054a9","added_by":"auto","created_at":"2024-04-02 18:20:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":260245,"visible":true,"origin":"","legend":"\u003cp\u003eFlow diagram of participant recruitment\u003c/p\u003e\n\u003cp\u003e*Pharmacists were required to be using their states real time prescription monitoring system to participate\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4127160/v1/31857afd63134f7468abcee7.png"},{"id":61596335,"identity":"29d47bf3-e67c-40a9-b251-1ecfbb35c1aa","added_by":"auto","created_at":"2024-08-01 17:26:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":974384,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4127160/v1/a03afb2d-0dae-4aa7-a03d-e77c309b7d18.pdf"}],"financialInterests":"","formattedTitle":"Correlates of stocking naloxone: A cross sectional survey of community pharmacists","fulltext":[{"header":"IMPACT STATEMENTS","content":"\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003eAustralia is one of the first countries globally to implement nationally funded pharmacist provision of naloxone, and experiences here have a significant impact on global naloxone provision and interventions.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eIndependent pharmacies and pharmacies that do not provide opioid agonist treatment were associated with lower rates of stocking naloxone, suggesting that these are targets to address in increasing naloxone supply.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"INTRODUCTION","content":"\u003cp\u003eOpioid related harm remains a significant public health concern in many high-income countries [\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e]. In the USA, opioids were responsible for 80,816 deaths in 2021 [\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e] and 3.3% of the US population reported using opioids within the same year [\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e]. In Canada, opioid related mortality rates increased by 600% between 2000\u0026ndash;2017 [\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e]. While most opioid related deaths in the USA, Canada and UK are driven by illicit opioids, the harms caused by prescription opioids are still significant [\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e]. Contrary to other countries, the majority of opioid related deaths in Australia are attributed to prescription opioids [\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e]. The number of unintentional opioid related deaths has nearly trebled since 2006, increasing from 338 to 856 in 2020 [\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e]. In 2020, 34% of opioid related deaths were attributed to heroin only, with 56% attributed solely to prescription opioids and opioids other than heroin, and the remainder a combination of both prescription opioids and heroin [\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eNaloxone is an opioid antagonist that can be administered by a layperson to reverse an opioid overdose, preventing mortality [\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e]. Delivered as first aid either as an intramuscular injection or a nasal spray, it can rapidly and temporarily reverse the effects of opioid overdose [\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e]. Take-home naloxone (THN) has been widely adopted and has consistently been associated with reduced mortality from unintended opioid overdose in many high-income countries such as the UK, USA and Australia [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e]. In light of this evidence, in 2014 the World Health Organization (WHO) published guidelines on the use of naloxone to treat opioid overdose, and made strong recommendations that naloxone be available to all individuals who may be at risk of opioid overdose and to those who have a high chance of witnessing an opioid overdose [\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e]. Since these recommendations were published, THN programs have expanded globally and are now being trialled in low- and middle-income countries [\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eGlobally, pharmacists have been recognized as potential educators and distributors of naloxone to the community [\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e]. In Australia, THN became available over the counter in 2016 [\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e], and implementation of the national THN program in 2022 enabled individuals to access naloxone free of charge at any participating community pharmacies [\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e]. However, there are still barriers to patients obtaining naloxone including lack of education on availability and usage, fear of stigma associated with opioid use and addiction [\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e], pharmacists\u0026rsquo; discomfort in discussing overdose prevention with patients and stigma associated with illicit versus prescription opioid use [\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e]. These barriers hinder pharmacists\u0026rsquo; ability to deliver optimal pharmacy practice, resulting in evidence-based care not being available to all patients [\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eThere is limited data on rates of stocking naloxone, and correlates of stocking naloxone have yet to be identified in Australia. Global literature suggests that several pharmacist and pharmacy specific characteristics may be associated with whether naloxone is stocked in a pharmacy, such as pharmacy location [\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e], whether the pharmacy is part of a chain [\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e], and provision of other services within the pharmacy [\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e]. Understanding factors that may serve as barriers or facilitators to naloxone supply is crucial to increasing naloxone access.\u003c/p\u003e\n\u003ch3\u003eAIM\u003c/h3\u003e\n\u003cp\u003eTo determine pharmacist and pharmacy-related correlates of stocking naloxone in four Australian states; Victoria, New South Wales (NSW), Queensland and Western Australia (WA).\u003c/p\u003e\n\u003ch3\u003eEthics approval\u003c/h3\u003e\n\u003cp\u003eEthical approval\u0026nbsp;for the study was granted by the Monash University Human Research Ethics Committee (No. 36459).\u003c/p\u003e"},{"header":"METHOD","content":"\u003cp\u003e\u003cstrong\u003eDesign and setting.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData for this analysis was collected via a cross-sectional online survey exploring pharmacist\u0026rsquo;s roles in opioid use safety [\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e], among a representative sample from the four more populous states of Australia (Victoria, NSW, Queensland and WA), representing 88% of the Australian population [\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e]. Results were reported according to the STROBE cross sectional reporting guidelines [\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n\u003ch2\u003eSampling of pharmacies\u003c/h2\u003e\n\u003cp\u003eA comprehensive list of community pharmacies in each state was obtained using two publicly available pharmacy marketing lists, Maven Marketing and Australian Marketing List. These lists were combined, and duplicates and non-community pharmacies were removed. This resulted in a total of 1981 pharmacies identified in NSW, 1237 in Queensland, 1469 in Victoria and 633 in WA.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n\u003ch2\u003eParticipants and procedures\u003c/h2\u003e\n\u003cp\u003eRecruitment occurred throughout August-October 2023. Minimum sample size was calculated using \u0026lsquo;Raosoft\u0026rdquo; [\u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e]. The total population of n\u0026thinsp;=\u0026thinsp;5320 identified community pharmacies was used in the calculation with a confidence level of 99% and a margin of error of 5%, with an estimated response rate of 50%, indicated from a previous study [\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e]. Minimum sample size was calculated at n\u0026thinsp;=\u0026thinsp;359. Approximately 500 pharmacies per state were randomly selected. The total population of pharmacies was divided into subsets by state, and each subset was randomised using the Microsoft Excel formula \u0026ldquo;= rand() \u0026rdquo;. Pharmacies were contacted via telephone, with 1955 pharmacies contacted in total, based on estimated response rate to provide the required sample size (see Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e) [\u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e]. Once contacted, the pharmacist in charge was invited to take part in the survey, with only one pharmacist per pharmacy eligible to participate to remove issues of clustering. At least three attempts were made, on different days and times, to contact the pharmacist in charge at each pharmacy. Upon speaking to the pharmacist in charge, if they agreed to participate, a link to access the survey was sent to the provided email address.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n\u003cp\u003eThe online survey was administered via Monash University Qualtrics platform. From the date of the initial email, reminder emails were sent at the one- and two-week marks to prompt participation. The participating pharmacist was required to read the associated study information sheet and provide online consent before they commenced the survey. Pharmacists who completed the survey could opt in to enter a draw to win one of two iPads, with contact details collected via an unlinked Qualtrics form.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch2\u003eMeasures\u003c/h2\u003e\n\u003cp\u003eThe current study examined a range of potential correlates of stocking naloxone related to the five broad factors outlined below, which were selected based on existing literature [\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e]. As most covariates were recorded as binary responses, other covariates were recoded and collapsed into binary categories for consistent analysis:\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n\u003ch2\u003e1. Pharmacist characteristics\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMale or female. Originally recorded as male, female or non-binary. Non-binary was excluded from analysis due to small response rate (n\u0026thinsp;=\u0026thinsp;3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eYears of experience as a pharmacist\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026lt;15 years or 15 years or more. Originally recorded as a continuous variable where participants entered years of experience manually. These were divided into binary variables using mean number of years\u0026rsquo; experience as an indicator of centrality (Mean\u0026thinsp;=\u0026thinsp;14.88).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n\u003ch2\u003e2. Pharmacy characteristics\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003ePharmacy state\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNSW, VIC, QLD or WA.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGeographic Location\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCapital city/urban and rural/remote. Originally recorded as Capital city, urban, rural or remote. Collapsed to represent urban vs rural areas.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePharmacy type\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChain/banner or independent/other. Originally recorded as single independent pharmacy, small chain or banner group (2\u0026ndash;9 branches), large chain or banner group (\u003cspan class=\"Underline\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;10 branches), or other. To make findings comparable to existing literature [\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e], independent pharmacy and other were combined into one variable, while small and large chain or banner pharmacy were combined into a second variable.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n\u003ch2\u003e3. Frequency of opioid dispensing\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eHow often opioid prescriptions were dispensed\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLess than once a day, or once or more per day. Originally recorded as once per week, multiple times per week, around once per day, several times and day, and more than 10 times a day. These were collapsed into binary variables based on mean and mode response (Mean\u0026thinsp;=\u0026thinsp;2.79, Mode\u0026thinsp;=\u0026thinsp;3.00)\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n\u003ch2\u003e4. Provision of pharmacy services:\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eWhether the pharmacy offered or supplied the following services\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003enaloxone, needle and syringe program and opioid agonist treatment (OAT) (methadone and buprenorphine for opioid use disorder). All recorded as binary variables (\u0026lsquo;yes\u0026rsquo; if provided, \u0026lsquo;no\u0026rsquo; if not provided)\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n\u003ch2\u003e5. Pharmacists\u0026rsquo; comfort\u003c/h2\u003e\n\u003cp\u003ePharmacists comfort in discussing overdose prevention with patients who use prescription or illicit opioids: Comfortable or Not Comfortable. Originally collected on a 4-point Likert scale [\u003cspan class=\"CitationRef\"\u003e36\u003c/span\u003e] with options \u0026lsquo;very comfortable\u0026rsquo;, \u0026lsquo;comfortable\u0026rsquo;, \u0026lsquo;uncomfortable\u0026rsquo; and very uncomfortable\u0026rsquo; collapsed to binary variables.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n\u003ch2\u003eStatistical analysis:\u003c/h2\u003e\n\u003cp\u003eDescriptive statistics were used to explore and describe sample characteristics as well as participants\u0026rsquo; comfort discussing naloxone. A multivariate probit regression analysis with an adjusted coefficient was used to explore the correlates of stocking naloxone and pharmacist and pharmacy characteristics. The final model included 10 variables that included both pharmacist and pharmacy characteristics. A McNemar test was used to test the difference in pharmacists\u0026rsquo; comfort levels discussing overdose prevention with patients who take prescription versus illicit opioids. All statistical tests used a p value of 0.05 to determine significance. All analysis was completed using SPSS V28.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eIn total, 1396 pharmacists agreed to participate in the study. Of these, 690 pharmacists commenced the survey, with n\u0026thinsp;=\u0026thinsp;530 completing the questions relating to naloxone and included in the final analyses. Sample characteristics are reported in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. A similar proportion of male and female pharmacists were represented (47.8% female), and 40.2% of pharmacists had over 15 years of experience. Most pharmacies were located in capital cities or urban areas (71.5%), were part of a banner or chain (66.8%) and received scripts for opioids more than once per day (91.5%). Naloxone was stocked in 60.6% of pharmacies.\u003c/p\u003e\n\u003cp\u003eChain or banner group pharmacies had a 30.7% greater probability of stocking naloxone, compared to independent pharmacies (p\u0026thinsp;=\u0026thinsp;0.016, 95%CI [0.057, 0.556]), while pharmacies that provide OAT had a 54.3% greater probability of stocking naloxone after controlling for other covariates (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 95%CI [0.308, 0.777]) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Pharmacists who were comfortable discussing overdose prevention with patients who use prescription opioids had a 39.2% greater probability of stocking naloxone, compared with pharmacists who indicated they were uncomfortable (p\u0026thinsp;=\u0026thinsp;0.004, 95%CI [0.128, 0.655]). In contrast, comfort discussing naloxone with people who use illicit opioids was not associated with stocking naloxone. All other variables were not significantly associated with naloxone supply.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003ePharmacy and pharmacist characteristics by naloxone availability and correlates of stocking naloxone\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eSample and Pharmacy Characteristics\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eOverall\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(n\u003c/em\u003e\u003csup\u003e\u003cem\u003eb\u003c/em\u003e\u003c/sup\u003e\u003cem\u003e)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u0026thinsp;=\u0026thinsp;530\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eStock Naloxone\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(n, %)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u0026thinsp;=\u0026thinsp;321 (60.6%)\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eDon\u0026rsquo;t Stock Naloxone (Reference) (n, %) n\u0026thinsp;=\u0026thinsp;209 (39.4%)\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eB\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eB (95%CI)\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ePharmacist In Charge Characteristics\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"5\" align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eGender\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003cp\u003e(52.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e275\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e176 (64.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e99 (36.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003cp\u003e(47.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e252\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e144 (57.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e108 (42.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.081\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.487\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.311, 0.148\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eYears of Experience as a pharmacist\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;15 years\u003c/p\u003e\n\u003cp\u003e(59.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e317\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e199 (62.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e118 (37.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ge;\u0026thinsp;15 years\u003c/p\u003e\n\u003cp\u003e(40.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e213\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e122 (57.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e91 (42.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.079\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.505\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.312, 0.154\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ePharmacy Characteristics\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"5\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eState\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNSW\u003c/p\u003e\n\u003cp\u003e(22.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e118\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e63 (53.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e55 (46.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVIC\u003c/p\u003e\n\u003cp\u003e(27.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e147\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e92 (62.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e55 (37.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.254\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.135\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.079, 0.587\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eQLD\u003c/p\u003e\n\u003cp\u003e(30.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e160\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e103 (64.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e57 (35.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.160\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.329\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.162, 0.483\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWA\u003c/p\u003e\n\u003cp\u003e(19.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e105\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e63 (60.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e42 (40.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.136\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.453\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.219, 0.490\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003ePharmacy Location\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCapital City/ Urban (71.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e379\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e231 (60.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e148 (39.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRural/ Remote (28.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e151\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e90 (59.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e61 (40.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.011\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.934\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.264, 0.242\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003ePharmacy Type\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSingle/ Independent (33.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e176\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e94 (53.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e82 (46.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBanner/ chain/ other\u003c/p\u003e\n\u003cp\u003e(66.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e354\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e227 (64.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e127 (35.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.307\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.016\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003e*\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.057, 0.556\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eNumber of Opioid Prescriptions per day in last week\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;once a day\u003c/p\u003e\n\u003cp\u003e(8.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24 (53.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e21 (46.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;once a day\u003c/p\u003e\n\u003cp\u003e(91.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e485\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e297 (61.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e188 (38.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.113\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.589\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.298, .524\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eProvides Opioid Agonist Treatment (OAT)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003cp\u003e(52.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e280\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e141 (50.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e139 (49.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003cp\u003e(47.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e250\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e180 (72.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e70 (28.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.543\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003e**\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.308, 0.777\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eNeedle and Syringe Program\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003cp\u003e(43.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e231\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e127 (55.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e104 (45.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003cp\u003e(56.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e299\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e194 (64.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e105 (35.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.051\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.685\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.195, 0.296\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd colspan=\"10\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePharmacist Comfort\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eComfort discussing overdose prevention and naloxone with patients who are prescribed opioids\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUncomfortable (38.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e203\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e99 (48.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e104 (51.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eComfortable (61.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e327\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e222 (67.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e105 (32.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.392\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003e*\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.128, 0.655\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eComfort discussing overdose prevention and naloxone with patients who use illicit opioids\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUncomfortable (50.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e268\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e140 (52.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e128 (47.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eComfortable (49.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e262\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e181 (69.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e81 (30.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.206\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.123\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.056, 0.468\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"11\"\u003eNote: \u003csup\u003ea\u003c/sup\u003eParticipants that identified as \u0026lsquo;other\u0026rsquo; too small to enable analysis, total sample size n\u0026thinsp;=\u0026thinsp;527. \u003csup\u003eb\u003c/sup\u003eall values represent 100%. *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **p\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n\u003cp\u003eThere was a significantly greater proportion (61.7%) of pharmacists who were comfortable discussing overdose prevention with patients who take prescription opioids versus those who take illicit opioids (49.4%) (X\u003csup\u003e2\u003c/sup\u003e (1, N\u0026thinsp;=\u0026thinsp;530)\u0026thinsp;=\u0026thinsp;29.468, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) \u003cem\u003e(\u003c/em\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cem\u003e).\u003c/em\u003e Of those pharmacists who felt comfortable discussing overdose prevention with patients who take prescription opioids, 45.3% (n\u0026thinsp;=\u0026thinsp;102) did not feel comfortable discussing overdose prevention with patients who take illicit opioids.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eComparison of pharmacist comfort levels discussing overdose prevention with patients who take illicit opioids and those who take prescription opioids.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eComfort Discussing Overdose Prevention with Patients Taking Illicit Opioids\u003c/p\u003e\n\u003c/th\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eComfortable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eUncomfortable\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eComfort Discussing Overdose Prevention with Patients Taking Prescription Opioids\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eComfortable\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e225\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e102\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e327 (61.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUncomfortable\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e37\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e166\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e203 (38.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e262 (49.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e268 (50.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e530 (100%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e29.468\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eP Value\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eP\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eStatement of key findings\u003c/h2\u003e \u003cp\u003eThis study, among a representative sample of pharmacies in four Australian states, examined stocking naloxone and its correlates. Most (60.6%) pharmacies stocked naloxone, though as almost 40% of pharmacies did not yet stock it, there appears scope to further increase access to naloxone access through pharmacies. Results revealed that pharmacies within a banner group or chain and those that offer OAT had a greater probability of stocking naloxone. Similarly, pharmacists who were comfortable discussing overdose prevention with patients who use prescription opioids had greater probability of stocking naloxone. Lower levels of comfort were reported with discussing naloxone and overdose education with people who use illicit opioids compared to people who were prescribed opioids.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and Weaknesses\u003c/h2\u003e \u003cp\u003eThis is the first Australian study to explore stocking naloxone in community pharmacies since the introduction of the national THN program. Strengths include the use of a large, randomly selected representative sample of pharmacists from four Australian states with diverse approaches to naloxone provision.\u003c/p\u003e \u003cp\u003eHealth care professional surveys commonly have low response rates, so several evidence-based strategies were used to maximise responses [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. As a result of these strategies, 49.4% of pharmacists started the survey, with 38% completing the section relating to stocking naloxone.\u003c/p\u003e \u003cp\u003eLimitations include a lack of information on current naloxone provision, noting that previous research found pharmacies may stock naloxone, however, were not providing or supplying it to patients [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. There is the possibility that social desirability bias may have influenced results, as pharmacists may have reported feeling comfortable discussing overdose prevention while they weren\u0026rsquo;t, however the significantly lower rates of comfort when supplying naloxone to people who use illicit drugs suggest that this was not likely to have overly influenced results.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eInterpretation\u003c/h2\u003e \u003cp\u003eIn the past, stocking naloxone was not common, with a 2016 Australian study identifying that only 23% of pharmacies stocked naloxone and only 6% had dispensed it to a patient to take home. A more recent study amongst n\u0026thinsp;=\u0026thinsp;265 pharmacists in Victoria, Australia found that half of pharmacists stocked naloxone, however a third of those did not supply it in the past year [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. This study shows that rates of stocking naloxone have increased substantially in recent years, coinciding with the national program that covers the cost of naloxone being provided at no charge to pharmacy patients, alongside a small dispensing fee. Despite this positive change, our findings also indicate that there are still a large number of pharmacies that are not stocking naloxone, and are not comfortable with naloxone supply, with inconsistent naloxone availability having the potential to reduce community access to evidence-based care for overdose prevention.\u003c/p\u003e \u003cp\u003eConsistent with earlier research [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], provision of OAT was significantly associated with stocking naloxone, and pharmacists that provided OAT had a significant greater probability of stocking naloxone. As pharmacists that provide OAT have higher exposure to patients who take both illicit and prescription opioids, it is not surprising that they are more likely to stock naloxone. Use of naloxone is recommended in most Australian state OAT guidelines, including NSW, Victoria and WA [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], and promotion of naloxone through these guidelines contributes to increased pharmacist knowledge surrounding naloxone usage for prescription opioids and may be a contributing factor to the observed higher odds of stocking naloxone.\u003c/p\u003e \u003cp\u003ePharmacies within a chain or banner group had a greater probability of stocking naloxone than independent pharmacies, which is consistent with findings from the USA [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. This pattern is likely related to differences in management structure between chain and independent pharmacies. Banner and chain pharmacies have centralised management structures, and the introduction of new state and national naloxone policies may be rapidly implemented across a large number of pharmacies as a result [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Centralised management structures also contribute to more effective stock control mechanisms for long term storage of naloxone, which protects them against national shortages which have been a problem across Australia [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAdditional benefits of pharmacists working in a chain pharmacy include greater access to educational resources and peer coaching opportunities [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Increased training and internal coordination have been shown to increase levels of stocking and providing naloxone [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Additionally, a 2021 Australian study investigating pharmacists\u0026rsquo; comfort in discussing overdose prevention with people who take prescription opioids revealed that pharmacists from chain and banner pharmacies had 1.5 times greater odds to feel comfortable in discussing overdose prevention than pharmacists from independent pharmacies [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. This suggests that efforts to support independent pharmacies to provide pharmacist training and education on the benefits of naloxone may be warranted.\u003c/p\u003e \u003cp\u003ePharmacists who were comfortable discussing overdose prevention with patients prescribed opioids had a greater probability of stocking naloxone. Additionally, pharmacists were significantly more comfortable discussing overdose prevention with patients that take prescription opioids versus those that take illicit opioids. This difference may imply the presence of pharmacist stigma surrounding illicit opioid use and naloxone. In a 2019 study, interviews with pharmacists revealed that many pharmacists found it difficult to raise the topic of overdose with patients who take many prescribed opioids as they don\u0026rsquo;t want to risk offending the patient [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], suggesting that in recent years progress has been made in pharmacists\u0026rsquo; comfort with this population. Naloxone stigma is often a reflection of stigma surrounding opioid use disorder and previous research has found that pharmacists reported a fear that stocking naloxone may attract the \u0026lsquo;wrong clientele\u0026rsquo; [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. Education is a proven method of reducing both OUD and naloxone related stigma [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Although it is promising that pharmacists appear to have greater comfort discussing naloxone with people receiving prescription opioids, there is an urgent need to maximise pharmacist comfort in discussing naloxone with all people at risk of experiencing or witnessing an opioid overdose.\u003c/p\u003e \u003cp\u003eAs one of the first countries to implement a national program of fully funded pharmacist provision of THN, these findings may inform expansion of pharmacy naloxone supply in other global settings. Findings also highlight the need to address stigma and increase pharmacists\u0026rsquo; comfort in discussing naloxone with a wide range of populations, while also demonstrating the importance of funded programs to increase naloxone availability.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eFurther Research\u003c/h2\u003e \u003cp\u003eWhile the rate of pharmacies stocking naloxone has increased across Australia, further work to understand naloxone provision and later usage is warranted. Future work could assess if current pharmacist THN training is sufficient to support pharmacists to feel confident supplying THN to different populations and identify how pharmacist\u0026rsquo;s perceived barriers in providing naloxone can most effectively be addressed [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eDespite naloxone being free under the national THN program, almost 40% of pharmacies do not stock naloxone. Additional efforts are needed to increase naloxone stocking in independent pharmacies and among those that do not offer OAT, to maximise naloxone access within the community. Pharmacist education to reduce stigma associated with illicit opioid use and increase comfort working with people who use illicit opioids should be included in naloxone promotion strategies.\u003c/p\u003e"},{"header":"DECLARATIONS","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by a National Health and Medical Research Council (NHMRC) Investigator Grant (#2016909), for which LP is the recipient. SN is the recipient of a National Health and Medical Research Council (NHMRC) Investigator Grant (#2025894).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors report no conflicts of interest to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Rose Laing, Elisabeth Grist, Jana Dostal and Louisa Picco. The first draft of the manuscript was written by Rose Laing and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request with appropriate ethical approval.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e"},{"header":"REFERENCES","content":"\u003col\u003e\n\u003cli\u003eLam T, Hayman J, Berecki-Gisolf J, et al. 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Substance Abuse. 2018;39(3):331-41. https://doi.org/10.1080/08897077.2017.1391924.\u003c/li\u003e\n\u003cli\u003eAdeosun SO. Stigma by Association: To what Extent is the Attitude Toward Naloxone Affected by the Stigma of Opioid Use Disorder? Journal of Pharmacy Practice. 2023;36(4):941-52. https://doi.org/10.1177/08971900221097173.\u003c/li\u003e\n\u003cli\u003eMurphy J, Russell B. Stigma Reduction through Addiction and Naloxone Education. Journal of Criminal Justice Education. 2023;34(2):185-98. https://doi.org/10.1080/10511253.2022.2068632.\u003c/li\u003e\n\u003cli\u003eBascou NA, Haslund-Gourley B, Amber-Monta K, et al. Reducing the stigma surrounding opioid use disorder: evaluating an opioid overdose prevention training program applied to a diverse population. Harm Reduction Journal. 2022;19(1):5. https://doi.org/10.1186/s12954-022-00589-6.\u003c/li\u003e\n\u003cli\u003eThakur T, Frey M, Chewning B. Pharmacist roles, training, and perceived barriers in naloxone dispensing: A systematic review. Journal of the American Pharmacists Association. 2020;60(1):178-94. https://doi.org/https://doi.org/10.1016/j.japh.2019.06.016.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-clinical-pharmacy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijcp","sideBox":"Learn more about [International Journal of Clinical Pharmacy](https://www.springer.com/journal/11096)","snPcode":"11096","submissionUrl":"https://submission.nature.com/new-submission/11096/3","title":"International Journal of Clinical Pharmacy","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4127160/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4127160/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eProvision of take-home naloxone (THN) and overdose education reduces opioid-related mortality. In Australia, from July 2022, all Australian community pharmacies were eligible to supply naloxone for free through the national Take Home Naloxone Program. This study aims to identify naloxone stocking rates and correlates of stocking naloxone across Australian pharmacies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData was collected from a representative sample of Australian pharmacists in Victoria, New South Wales, Queensland and Western Australia via an online survey. Data collected included pharmacy and pharmacist characteristics and services offered within the pharmacy, including needle and syringe programs, opioid agonist treatment (OAT) and stocking naloxone. Binary probit regression analysis was used to identify correlates of stocking naloxone after controlling for key covariates.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData from 530 pharmacists were analysed. In total, 321 pharmacies (60.6%) reported stocking naloxone. Chain and banner pharmacies and pharmacies that provided OAT had a greater probability of stocking naloxone (B = 0.307, 95%CI: [0.057, 0.556], and B = 0.543, 95%CI: [0.308, 0.777] respectively). Most (61.7%) pharmacists felt comfortable discussing overdose prevention with patients who use prescription opioids, and this comfort was associated with a higher probability of stocking naloxone (B = 0.392, 95%CI: 0.128, 0.655). Comfort discussing overdose prevention with people who use illicit opioids was lower (49.4%) and was not associated with stocking naloxone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is scope to increase stocking of naloxone and comfort with overdose prevention, particularly through addressing comfort working with higher risk groups such as people who use illicit opioids.\u003c/p\u003e","manuscriptTitle":"Correlates of stocking naloxone: A cross sectional survey of community pharmacists","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-02 18:20:27","doi":"10.21203/rs.3.rs-4127160/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2024-03-28T12:50:52+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-03-28T12:41:09+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"International Journal of Clinical Pharmacy","date":"2024-03-20T08:19:56+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-03-20T02:30:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Journal of Clinical Pharmacy","date":"2024-03-19T00:23:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-clinical-pharmacy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijcp","sideBox":"Learn more about [International Journal of Clinical Pharmacy](https://www.springer.com/journal/11096)","snPcode":"11096","submissionUrl":"https://submission.nature.com/new-submission/11096/3","title":"International Journal of Clinical Pharmacy","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"03e8659e-b39c-497a-9f71-6e2ebcfcd14c","owner":[],"postedDate":"April 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-08-01T17:08:15+00:00","versionOfRecord":{"articleIdentity":"rs-4127160","link":"https://doi.org/10.1007/s11096-024-01773-3","journal":{"identity":"international-journal-of-clinical-pharmacy","isVorOnly":false,"title":"International Journal of Clinical Pharmacy"},"publishedOn":"2024-07-23 16:16:02","publishedOnDateReadable":"July 23rd, 2024"},"versionCreatedAt":"2024-04-02 18:20:27","video":"","vorDoi":"10.1007/s11096-024-01773-3","vorDoiUrl":"https://doi.org/10.1007/s11096-024-01773-3","workflowStages":[]},"version":"v1","identity":"rs-4127160","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4127160","identity":"rs-4127160","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}