Optimising take home naloxone intervention delivery in the community (retail) pharmacy setting.

Background: In the UK take home naloxone (THN) can be supplied without prescription by drug treatment providers, including pharmacy teams. Community pharmacies are well placed to supply THN because they already provide opioid substitution (OST) medications and needle and syringe programmes (NSP). However some commissioned pharmacies make few supplies. Barriers and facilitators have been reported, so next steps are to operationalise solutions to improve delivery.

Aims: (1)Define what makes a pharmacy THN service successful and what impedes success. (2)To optimise the pharmacy THN intervention model, using findings, with the goal of maximising supply activity.

Methods: Semi structured interviews were undertaken with pharmacists who participated in THN schemes and pharmacists who did not, both groups provided other addiction services. Data was transcribed verbatim and analysed using deductive and inductive thematic analysis. Secondary deductive theming used the COM-B framework. A focus group held with six people who use drugs (PWUD) not in contact with treatment services, informed priorities. Medical Research Council guidance on complex intervention optimisation was followed and a logic model produced to theorise intervention operation.

Results: The overarching theme ‘Components of success’, comprised sub-themes - Proactive supply (psychological capability and physical opportunity), Using a ‘hook’ to engage (reflective motivation), Quick supply, Staff attitudes and relationships with PWUD (automatic motivation, social opportunity and psychological capability). Barriers included perceived time required (physical opportunity), pharmacist work pressures and remuneration (physical opportunity) and fear of causing offence. The final intervention prioritised supply, designed to be akin to an over the counter transaction. It takes 2-3 minutes, hooked into NSP or OST provision and can be delivered by any trained pharmacy staff.

Conclusion: The THN intervention was optimised for the community pharmacy setting, taking into account needs of PWUD, and responding to time and workload pressures that community pharmacy teams face. This model can now be tested.