Rurality and differences in pharmacy characteristics and community factors associated with provision of naloxone in the pharmacy.

BACKGROUND: Pharmacies are the most accessible healthcare settings across urban, suburban, and rural areas of the United States and, thus a key venue in the overdose risk environment. Pharmacy dispensing of naloxone is part of the public health response to the opioid overdose crisis, yet little is known about the pharmacy- and community-level characteristics with which naloxone provision is associated.

METHODS: We conducted a longitudinal analysis of pharmacy-level quarterly naloxone dispensed from one large US community pharmacy chain from the 1st quarter of 2013 to the 2nd quarter of 2017, examining associations between naloxone provision and pharmacy-level characteristics and community factors in two US states, Rhode Island and Massachusetts. Rurality was defined using the rural urban commuting area (RUCA) scale scores, calculated based on US 2010 Census variables. Pharmacy-level characteristics (e.g., 24 h store, average daily volumes of total prescriptions, nonprescription syringe sales, buprenorphine prescriptions) derived from the pharmacy chain; community factors (e.g., RUCA score, ZIP-code level age, race distributions, and median household income) were obtained from the decennial census files. The linear mixed effects methods modeled dispensing history and the number of naloxone doses dispensed through binomial and negative binomial distributions respectively, accounting for trend and covariates.

RESULTS: Adjusted analyses of dispensing data from 449 pharmacies in two states indicated that more rural pharmacies (i.e., stores in areas with higher RUCA scores), pharmacies with higher volumes of all prescriptions and of buprenorphine, that sell more nonprescription syringes, that have drive-throughs and longer weekend hours, and that are located in communities with younger age distributions were associated with increased likelihood of ever dispensing naloxone and a greater number of naloxone doses dispensed (all p<.05).

CONCLUSION: Pharmacies are a key evolving element in the overdose risk environment, striving to develop reputations as sources of wellness, prevention, and harm reduction supplies, like naloxone. Pharmacy naloxone dispensing may be an especially effective strategy to alter the overdose risk environment in rural communities.