Akers et al., 2017 [10] | | Communication strategy: General advertisement. Identification process: Technicians or clerks provide general information on program availability. Screening tool: not reported.
| Type of service/intervention: Take-home naloxone program (THN) + education (individual, group, community, providers). Intervention details: Dispensed naloxone; provided education on naloxone administration and how to manage opioid overdoses.
| Time: 20 min sessions. Setting: In-person. Materials: Patient intake form; video; standardized checklist. Model: Walk-in or appointment. Roles and processes: (Technician or clerk) Patient intake form completed. Patient roomed. (Pharmacist) Review pricing. Confirm preferred delivery method of naloxone for patient (IN or IM). (Technician or clerk) During video, prescription is processed by staff. (Pharmacist) Checklist reviewed with patient. (Technician or clerk) Naloxone dispensed and payment collected.
| Marketing: Marketing to bystanders (details not reported). Formalized policies and procedures: Figure developed to clarify staff roles. External collaborators: Partnered with Seattle-King County Public Health Department for CDTA and naloxone distribution. Pricing/reimbursement model: Out-of-pocket pricing. Prices in internal documents for staff awareness. Price included two doses of naloxone, a counseling fee, and other materials (nasal atomizer, breathing mask, etc.).
|
Cochran et al., 2019 [27] | | Communication strategy: Targeted offer. Identification process: Potential participants were approached in person by the pharmacist, technician, or researcher at the point-of-service if they were prescribed an opioid medication. Screening tool: Screened for prescription opioid misuse using the Prescription Opioid Misuse Index (POMI).
| Type of service/intervention: Brief Motivational Intervention–Medication Therapy Management (BMI-MTM). Intervention details: Participants assigned to standard medication counseling (SMC) or SMC + BMI-MTM. BMI-MTM consisted of one pharmacist-led medication counseling/brief motivational session and eight weekly patient navigation sessions.
| Time: 30–45 min. Setting: In-person (n = 1) and telephone (n = 8). Materials: Not reported. Model: Appointment. Roles and processes: (Pharmacist, technician, researcher) Screening. (Pharmacist) 30–45 min in-person BMI session. (Patient navigator who is a master’s level researcher) Eight patient navigation sessions via telephone; includes naloxone recommendation. (Pharmacist) Written summary of recommendations to patient and warm handoff to study navigator.
| |
Manzur et al., 2020 [28] | | Communication strategy: Targeted offer. Identification process: Rheumatology clinic patients prescribed opioids were identified by a community pharmacist or clinic provider as “high risk” and referred to the pilot program if they were prescribed (based on CDC guidelines): more than 1 short-acting opioid; more than 90 morphine milligram equivalents/day; more than 7 days’ supply of medications for acute pain; and high-risk medication combinations. Screening tool: Opioid Risk Tool (ORT).
| Type of service/intervention: Pain medication management. Intervention details: Pharmacists assessed pain management and associated concomitant disease states and provided medication recommendations to referring provider. They also performed opioid risk mitigation strategies including ORT, naloxone education, naloxone prescription, PDMP review, pain score assessment, pain medication counseling, and pain management education.
| | Marketing: Not reported. Formalized policies and procedures: Not reported. External collaborators: Nearby rheumatology clinic. Pricing/reimbursement model: Grant-funded program; visits free for patients.
|
Skoy et al., 2020a a [29] | | Communication strategy: Targeted offer. Identification process: Each patient receiving an opioid prescription was screened for risk of opioid misuse and risk of accidental overdose based on age, concurrent medication and alcohol use, and disease states. Screening tool: Opioid Risk Tool (ORT).
| Type of service/intervention: Opioid overdose education and naloxone distribution (OEND) + drug take-back + referral to community resources. Intervention details: The multicomponent statewide One Rx program included drug take-back, partial fills of opioid prescriptions, referral to community resources, naloxone education and dispensing, opioid use disorder (OUD) education, accidental overdose education, and contacting the primary healthcare provider as needed.
| Time: 5 min. Setting: In-person. Materials: Welcome packet with One Rx toolkit via hardcopy binder and website; screening tool via paper, QR code, or tablet; triage tool. Model: Walk-in. Roles and processes: (Pharmacist) Patient screening and PDMP review prior to prescription pick-up, followed by education and intervention guided by a triage tool and ORT score.
| Marketing: Pharmacist button advertising naloxone; window sticker; emails from Board of Pharmacy; television and newspaper interviews. Formalized policies and procedures: One Rx binder and website detailing screening, interventions, and workflow. External collaborators: North Dakota Board of Pharmacy. Pricing/reimbursement model: Funded by North Dakota Department of Human Services; USD 20 provided to pharmacies for each screening. Pharmacy awards for meeting screening benchmarks. Patient pricing model not reported.
|
Skoy et al., 2020b a [30] | | Communication strategy: Targeted offer. Identification process: Each patient receiving an opioid prescription was screened for the risk of opioid misuse and the risk of an accidental overdose based on age, concurrent medication and alcohol use, and disease states. Screening tool: Opioid Risk Tool (ORT).
| Type of service/intervention: Opioid overdose education and naloxone distribution (OEND) + drug take-back + referral to community resources. Intervention details: The multicomponent statewide One Rx program included drug take-back, partial fills of opioid prescriptions, referral to community resources, naloxone education and dispensing, OUD education, accidental overdose education, and contacting the primary healthcare provider as needed.
| | Marketing: Not reported. Formalized policies and procedures: Not reported. External collaborators: Not reported. Pricing/reimbursement model: Naloxone product reimbursed via patient insurance or grant funds; 72% of patients received naloxone at no cost. Further details not reported.
|
Strand et al., 2020 a [31] | | Communication strategy: Targeted offer. Identification process: Each patient receiving an opioid prescription was screened for risk of opioid misuse and risk of accidental overdose based on age, concurrent medication and alcohol use, and disease states. Screening tool: Opioid Risk Tool (ORT).
| Type of service/intervention: Opioid overdose education and naloxone distribution (OEND) + drug take-back + referral to community resources. Intervention details: The multicomponent statewide One Rx program included drug take-back, partial fills of opioid prescriptions, referral to community resources, naloxone education and dispensing, OUD education, accidental overdose education, and contacting the primary healthcare provider, as needed.
| Time: Not reported in this article; see Skoy et al. 2020a. Setting: Not reported. Materials: Welcome packet with One Rx toolkit via hardcopy binder and website; screening tool via paper, QR code, or tablet; triage tool. Model: Not reported. Roles and processes: Not reported.
| Marketing: Emails from Board of Pharmacy; press conference. Formalized policies and procedures: One Rx binder and website detailing screening, interventions, and workflow. External collaborators: North Dakota Board of Pharmacy. Pricing/reimbursement model: Funded by North Dakota Department of Human Services; USD 20 provided to pharmacies for each screening. Pharmacy awards for meeting screening benchmarks. Patient pricing model not reported.
|
Strand et al., 2019 a [34] | | Communication strategy: Targeted offer. Identification process: Each patient receiving an opioid prescription was screened for risk of opioid misuse and risk of accidental overdose based on age, concurrent medication and alcohol use, and disease states. Screening tool: Opioid Risk Tool (ORT).
| Type of service/intervention: Opioid overdose education and naloxone distribution (OEND) + drug take-back + referral to community resources. Intervention details: One Rx interventions were piloted prior to scaling up statewide, including drug take-back, partial fills of opioid prescriptions, referral to community resources, naloxone education and dispensing, OUD education, accidental overdose education, and contacting the primary healthcare provider, as needed.
| Time: Not reported. Setting: In-person. Materials: Opioid Misuse Risk Prevention Toolkit, including paper patient intake form, ORT, and triage tool, list of community resources, and naloxone and opioid misuse educational brochures. Model: Walk-in. Roles and processes: (Pharmacist) Patient screening, PDMP review, and “red flag” review prior to prescription pick-up, followed by education and intervention guided by a triage tool and ORT score.
| Marketing: Naloxone sign and brochures. Formalized policies and procedures: Triage tool for guiding decision making. External collaborators: North Dakota Board of Pharmacy. Pricing/reimbursement model: Not reported.
|
Wilkerson et al., 2020 [19] | | Communication strategy: Targeted off and general advertisement. Identification process: Patients at an increased risk of overdose identified by a pharmacist or intern at prescription drop-off based on criteria: high-dose opioids (> 80 MME) for chronic pain, history of OUD, and concomitant conditions (respiratory, renal, hepatic). Additionally, patient request. Screening tool: not reported.
| | Time: Not reported. Setting: In-person. Materials: Patient naloxone consent form (checklist); patient naloxone education brochure created by the state pharmacy board. Model: Walk-in. Roles and processes: (Pharmacist or intern) Identify at-risk patients at drop-off. (Pharmacist or intern) Patient fills out naloxone consent form. (Pharmacist or intern) Review consent form and naloxone dosage forms. (Technician) Naloxone prescription processed using a consent form as a prescription, prescriber on protocol, and name of individual requesting naloxone. (Technician) Naloxone prescription filled. (Pharmacist) Perform final check of naloxone prescription and add counseling note. (Pharmacist or intern) Review consent form and counsel on naloxone and opioid overdose at pick-up. Initial consent form, scan into dispensing system, and file with prescriptions.
| Marketing: Naloxone sign outside pharmacy. Formalized policies and procedures: Program designed at corporate/clinical team level and rolled out to pharmacies with a “best practices” document. External collaborators: Not reported. Pricing/reimbursement model: Not reported.
|
Hines et al., 2020 [9] | | Communication strategy: Universal offer. Identification process: All patients receiving a buprenorphine prescription. Screening tool: not reported.
| Type of service/intervention: OEND. Intervention details: Patients receiving buprenorphine recruited for OEND. OEND included naloxone dispensing, education on recognizing opioid overdose, identifying opioid medications, and where to obtain naloxone.
| Time: 5–20 min (10 min on average). Setting: In-person. Materials: Educational brochure from West Virginia naloxone protocol. Model: Walk-in. Roles and processes: (Pharmacy staff) Patients identified at prescription drop-off or pick-up and asked about interest in OEND. Interested patients moved to private counseling area. (Pharmacy resident) Opioid overdose education provided while waiting for buprenorphine prescription. Naloxone dispensed subsequent to obtaining a prescription from the patient’s provider; standing order not available for use during study period.
| Marketing: Not reported. Formalized policies and procedures: None during the study period; resident developed business plan post-program (details not reported). External collaborators: Not reported. Pricing/reimbursement model: Naloxone product reimbursement via patient insurance.
|
Sexton et al., 2019 [32] | | Communication strategy: Targeted offer. Identification process: Clinical flag placed in the dispensing system to alert the pharmacist to speak with the patient at pick-up if patients had (based on CDC guidelines): an opioid prescription in the past 30 days; opioid prescription lasting ≥ 5 days; greater than or equal to 50 morphine milligram equivalents per day; concurrent benzodiazepine and opioid use; fentanyl patch greater than or equal to 25 mg/hour; and documented or verbal history of overdose or substance use disorder. Screening tool: not reported.
| Type of service/intervention: OEND. Intervention details: One pharmacy implemented a standardized team-based approach (intervention); one pharmacy used the standard of practice (control). OEND included naloxone dispensing and education on opioid risks and naloxone benefits.
| Time: Not reported. Setting: In-person. Materials: List of opioids at drop-off station; one-page instruction sheet at each workstation using colored paper; MME conversion chart; naloxone eligibility checklist; educational handout for patients. Model: Walk-in. Roles and processes: (Pharmacist, student pharmacist, technician) Identify naloxone-eligible patients at drop-off. Perform profile search and MME calculations. (Pharmacist) Verify that the patient meets naloxone eligibility. (Pharmacist) Place “hard stop” in dispensing software to alert the pharmacist to recommend naloxone. (Pharmacist) Recommend naloxone and provide education on opioid risks and naloxone benefits. Provide educational handout.
| Marketing: Not reported. Formalized policies and procedures: Standardized one-page instruction sheet describing workflow steps posted at each station. External collaborators: Not reported. Pricing/reimbursement model: Not reported.
|
Teeter et al., 2021 [14] | | Communication strategy: Targeted offer (proactive) and general advertisement (passive). Identification process: (Proactive) Patients flagged in the pharmacy dispensing software if at a high risk of an overdose based on CDC guidelines (≥50 morphine milligram equivalents (MME) per day) or concurrent benzodiazepines, muscle relaxers, or sedative hypnotics. (Passive) Warning sticker on all opioid prescription vial caps dispensed; posters in the pharmacy rotated weekly. Screening tool: not reported.
| | | Marketing: Posters in the pharmacy rotated weekly. Formalized policies and procedures: Not reported. External collaborators: Not reported. Pricing/reimbursement model: Study funded by the UAMS Translational Research Institute and National Center of Advancing Translational Sciences. Naloxone product reimbursement via patient insurance.
|
Santa et al., 2021 [33] | | Communication strategy: Universal offer. Identification process: Pharmacy-specific protocols used for recommending naloxone to all patients prescribed opioids (details not reported). Screening tool: formal screening tool mentioned, but details not reported.
| Type of service/intervention: OEND. Intervention details: Screening, brief intervention, and referral to treatment (SBIRT). Brief intervention included counseling regarding opioid overdose and naloxone using motivational interviewing (MI) and naloxone dispensing.
| Time: Not reported. Setting: In-person. Materials: SBIRT proficiency checklist; workflow outline using the “A3” format. Model: Not reported. Roles and processes: (Pharmacist) At least one pharmacist per site served as a program champion. (Champion) Check other pharmacists’ SBIRT abilities using a checklist. (Champion) Monitor naloxone dispensing using a workflow outline each week.
| Marketing: Not reported. Formalized policies and procedures: Formal naloxone dispensing policies and procedures developed by a pharmacist site champion, specific to each pharmacy (details not reported). Workflow outline for ensuring protocol fidelity. External collaborators: Not reported. Pricing/reimbursement model: Study funded by the Pennsylvania Commission on Crime and Delinquency. Patient pricing model not reported.
|